Many cases of hypertension in England remain undetected, untreated or inadequately controlled, despite being one of the most important causes of stroke, heart disease and premature death, according to a study by Oxford Population Health, published in BMJ Public Health.
As per the World Health Organization, a person has hypertension if the systolic blood pressure is 140 mmHg or greater, and diastolic blood pressure is 90 mmHg or greater.
The researchers analysed clinic blood pressure measurements collected by Our Future Health from participants who enrolled between 2022 and 2025.
It was done in over 200 enrolment centres across England, and blood pressure measurements of 1.4 million adults aged 18 or above were taken.
They found that over one-third (37%) of participants had hypertension and covered every age group - ranging from one-sixth (15%) in those aged 18 to 39 years to three-quarters (71%) in those aged 80 years or older.
For almost two-thirds (59%) of people with hypertension, it had remained undetected. They were never diagnosed and not taking blood pressure-lowering medication.
Among those taking one or more blood pressure medications, half (50%) still had elevated levels of blood pressure.
The findings show that despite longstanding clinical guidance, the current estimates of hypertension awareness, treatment and control in England have not improved in recent decades.
The researchers argue that the current NICE guidelines, which require multiple confirmatory blood pressure readings before a diagnosis is confirmed and recommend lifestyle advice ahead of drug treatment, result in many cases of hypertension never being properly detected, treated or controlled.
Wenyu Liu, Medical Statistician at Oxford Population Health and lead author of the study, said: "While hypertension is largely a 'silent killer', the current approach to detecting and treating high blood pressure is not fit for purpose.
"This isn't a problem confined to a particular group; it's substantial across almost every demographic we examined.
"Even among younger adults, who currently aren't eligible for an NHS Health Check, over 15% already had high blood pressure. This underscores the need for population-wide prevention strategies alongside targeted treatment for people at high cardiovascular risk."
Iain Turnbull, Deputy Chief Medical Officer at Our Future Health, Clinical Research Fellow at Oxford Population Health, and GP said: "Our Future Health is a valuable resource for research on blood pressure and the findings reflect what we see day to day in general practice.
"Many patients with high blood pressure are undetected or are sub-optimally treated. There is a need for a more proactive approach to detection of high blood pressure and to consider initiation of treatment based on predicted risk of cardiovascular disease in addition to levels of blood pressure."
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: "This study paints a concerning picture of the scale of undetected high blood pressure in the UK, and the challenges of keeping blood pressure under control in those already receiving treatment.
"High blood pressure remains the leading modifiable risk factor for cardiovascular disease, linked to around half of heart attacks and strokes in the UK. The worrying reality is that millions of people are still living with the condition without knowing it and missing opportunities for early diagnosis and treatment."
