Researchers from Oxford Population Health have found that high blood pressure remains widely undetected, untreated or inadequately controlled in England. The team analysed clinic blood pressure measurements collected by Our Future Health, the UK’s largest health research programme, from participants enrolled between 2022 and 2025.

Using World Health Organization criteria, hypertension was defined as systolic blood pressure of 140 mmHg or higher, diastolic blood pressure of 90 mmHg or higher, or the use of blood pressure-lowering medication. Researchers examined how common hypertension was and how many people had been diagnosed, treated and had their blood pressure successfully controlled.

More than one-third (37%) of participants had hypertension, with prevalence rising sharply with age. Around 15% of adults aged 18 to 39 had high blood pressure, compared with 71% of those aged 80 or older. After adjusting for age, hypertension was also almost 50% more common among men than women, at 42% compared with 29%.

Perhaps most concerning, 59% of people with hypertension were unaware of their condition, meaning they had never been diagnosed and were not taking blood pressure-lowering medication. Treatment did not always mean the condition was well controlled: among people taking one or more blood pressure medications, half still had readings of 140/90 mmHg or higher.

The researchers noted that estimates of hypertension awareness, treatment and control in England have shown little improvement in recent decades despite longstanding clinical guidance. They argue that current approaches requiring multiple confirmatory blood pressure readings before diagnosis, along with lifestyle advice before medication in some cases, may contribute to hypertension remaining undetected or inadequately controlled.

Wenyu Liu, Medical Statistician at Oxford Population Health and lead author of the study, described hypertension as largely a “silent killer” and said the current approach to detecting and treating it needs improvement. The problem was widespread across demographic groups, including younger adults. More than 15% of adults aged 18 to 39 had high blood pressure, even though younger adults are not currently eligible for an NHS Health Check.

Iain Turnbull, Deputy Chief Medical Officer at Our Future Health, Clinical Research Fellow at Oxford Population Health and a GP, said the findings reflect what is commonly seen in general practice. He called for a more proactive approach to detecting high blood pressure. He suggested that decisions about treatment should consider a person’s predicted cardiovascular disease risk as well as their blood pressure readings.

Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said the findings highlight both the scale of undetected hypertension and the difficulty of controlling blood pressure among people already receiving treatment. High blood pressure is a major modifiable risk factor for cardiovascular disease and is linked to around half of heart attacks and strokes in the UK. Improving detection, treatment and ongoing support could therefore help prevent many avoidable cardiovascular events.

More information: Wenyu Liu et al, Hypertension prevalence, detection, treatment and control among 1.4 million adults in England: a cross-sectional analysis from the Our Future Health study in 2022–2025, BMJ Public Health. DOI: 10.1136/bmjph-2025-004815

Journal information: BMJ Public Health Provided by University of Oxford