Hypertension, often described as a “silent killer,” remains one of the leading modifiable risk factors for cardiovascular disease, stroke, chronic kidney disease, and premature mortality worldwide. Its burden is rising most rapidly in low- and middle-income countries, where health systems are least equipped to respond. Nigeria, Africa’s most populous nation, faces a particularly severe challenge. Current estimates indicate that approximately 36% of Nigerian adults are living with hypertension, yet awareness, treatment, and control rates remain critically low. As Nigeria undergoes rapid demographic growth, urbanization, and epidemiologic transition, the absolute number of individuals affected is projected to increase substantially, amplifying pressure on the health system and national workforce. This narrative review synthesizes peer-reviewed literature, national surveys, and global health reports published between 2010 and 2025 to examine the burden of undiagnosed and poorly controlled hypertension in Nigeria. We reviewed the trends, sociocultural and structural drivers, health system barriers, and public health responses within the Nigerian context. Evidence highlights the role of dietary transitions, physical inactivity, low health literacy, cultural misconceptions, and limited access to affordable primary care in sustaining the epidemic. The review suggests that effective responses must extend beyond individual behavior change to include community-based screening, workplace health programs, culturally tailored education, sodium reduction strategies, and strengthened primary healthcare delivery, hence framing hypertension as a shared public health and development challenge, rather than solely an individual clinical condition, is essential for reducing preventable morbidity and mortality, protecting workforce productivity, and supporting Nigeria’s long-term health and socioeconomic development.