New research from Oxford University highlights ongoing challenges in the detection and management of high blood pressure in England, revealing that many individuals remain unaware of their condition while those receiving treatment often do not achieve adequate control. The study, which analyzed data from 1.4 million adults enrolled in the Our Future Health programme between 2022 and 2025, estimates that over one-third of adults in England have high blood pressure, with 59% unaware of their diagnosis.
High blood pressure was defined in the study as a reading of 140/90 mmHg or higher, or the use of blood pressure-lowering medication. The condition was found to be nearly 50% more prevalent in men than women—42% compared to 29% across all age groups—and more common among older individuals. Researchers expressed concern about the 15.3% prevalence of hypertension among adults under 40, a group currently ineligible for NHS Health Checks, which are a primary route for early detection.
The study attributes part of the issue to current guidelines from the National Institute for Health and Care Excellence (NICE), which recommend confirming high blood pressure through repeated measurements, including home monitoring, and emphasise lifestyle changes before medication is initiated. These protocols, combined with primary care workloads largely focused on managing established diseases, may contribute to a "leaky cascade of care," with many cases going undiagnosed or inadequately treated.
Additionally, evidence suggests that even when high blood pressure is identified during NHS Health Checks, some patients are not prescribed medication, which may limit effective management. The researchers noted that progress in detection and control of hypertension appears to have stalled since 2011, with signs of decline following disruptions caused by the Covid-19 pandemic. This has resulted in current hypertension prevalence rates similar to those observed two decades ago.
Wenyu Liu, a medical statistician and lead author of the study, described hypertension as a "silent killer" and criticised existing approaches to detection and treatment as insufficient. Iain Turnbull, deputy chief medical officer at Our Future Health and a practising GP, stressed the need for a more proactive strategy, suggesting that treatment decisions should incorporate predicted cardiovascular risk alongside blood pressure levels.
Commenting on the findings, Professor Bryan Williams, chief scientific and medical officer at the British Heart Foundation, called the situation “concerning,” highlighting high blood pressure as the leading modifiable risk factor for cardiovascular disease in the UK. He pointed out that millions remain undiagnosed or undertreated, missing opportunities to prevent heart attacks and strokes. Williams urged a rethink in how individuals at risk are identified and supported, emphasising that improved detection and effective treatment could significantly reduce preventable cardiovascular events.
According to analysis by the British Heart Foundation based on NHS data, more than 11 million people in the UK have been diagnosed with high blood pressure by their general practitioners. The findings underscore the ongoing need for enhanced public health approaches to tackle this widespread and potentially life-threatening condition.