Conclusion
Hellblade Senua's Sacrifice comes with the most stunning facial animations I've ever seen on a computer game protagonist. The Ninja Theory team invested heavily in motion capture, which won them a Siggraph 2016 award. Thanks to Epic's Unreal Engine 4, the other visuals are also amazing even though we spotted some lower resolution textures in a few places, especially when you walk up closely to walls.
Gameplay consists of a mix of walking, solving puzzles, and sword combat and does feel slightly slow at times, but the rich Nordic mythology makes up for that. An interesting and I think unique puzzle feature are "portals" that work through a "don't trust your eyes" story element, which will change the level slightly to open up passages, letting you reach areas that seemed unreachable before. Also, the pains of Senua's voices in her head convey a rich, sometimes shocking picture of how people with mental illnesses think and feel - Ninja Theory worked with affected people and medical experts on that, too.
Performance at the highest "Very High" setting is highly demanding for even modern graphics cards. I'd recommend a GTX 1060 / RX 580 class card for 1080p gameplay, a GTX 1070 for 1440p, and a GTX 1080 Ti for 4K. While the other resolutions are fluid with their recommended cards, even the GTX 1080 Ti will not reach 60 FPS. A surprising performance result is that of the Radeon R9 Fury X, which manages to beat the GTX 1070 at 4K. This is probably due to the game's low VRAM requirements, which lets the Fury X make optimum use of its shading power and HBM memory.
The game doesn't have too many knobs and dials for graphics settings; also, some people report that starting with the "very low" quality preset and then manually switching the remaining options to "very high" will give additional performance because it disables AA and god rays. Post-processing effects are top notch, but slightly distracting at times; they can be disabled through manual .ini tweaks we mentioned on page 3 of this article. I talked to both AMD and NVIDIA regarding updated drivers and both companies don't have plans to release new drivers for Hellblade - their current latest releases are already properly optimized.
What I'd also like to highlight is that Hellblade Senua's Sacrifice comes DRM-free, at affordable pricing, and is available on GOG as well as Steam. With around eight hours, the overall length of the game seems shorter than with other titles, but pricing is lower as well, so why not give it a try.