A significant new analysis suggests that England has lost much of the progress it made during the 2000s in preventing, detecting, and managing high blood pressure, raising concerns about growing cardiovascular risk across the population. Researchers found that gains achieved through improved screening, diagnosis, and treatment have stalled over the past decade and, in some cases, reversed, leaving millions of people with hypertension either undiagnosed or inadequately controlled.
The study analysed data from more than 67,000 adults who participated in the Health Survey for England between 2003 and 2021, allowing researchers to examine long-term trends rather than short-term fluctuations. Their findings show that rates of high blood pressure, undiagnosed hypertension, and inadequate treatment control improved steadily until around 2011. After that point, progress plateaued, and several key indicators worsened, particularly in the period following the COVID-19 pandemic.
Overall, the prevalence of high blood pressure fell from 37.8 per cent in 2003 to 33.2 per cent by 2018, reflecting sustained improvement over the years. However, this downward trend did not continue, with little evidence of further progress up to 2021. The authors describe this stagnation as a sign that earlier public health and clinical strategies have lost momentum amid growing pressures on the healthcare system and changing population health patterns.
Trends in undiagnosed hypertension show an even more apparent reversal. The proportion of people with high blood pressure who were unaware of their condition declined sharply from 32.6 per cent in 2003 to 23.7 per cent in 2011. Over the following decade, however, this figure rose steadily, reaching 32.4 per cent by 2021. As a result, levels of undiagnosed hypertension have effectively returned to where they were two decades ago, undoing years of improvement in early detection.
The study also found that blood pressure control among those receiving treatment has weakened. Although the share of people with hypertension achieving adequate control increased strongly until 2011, it showed no meaningful improvement thereafter and declined from 63.1 per cent in 2011 to 56.8 per cent in 2021. These patterns suggest that around five million adults in England may now be living with undiagnosed high blood pressure. At the same time, a similar number have been diagnosed but do not have their condition under control.
Senior author Dr Ajay Gupta warned that only 38.3 per cent of people with hypertension currently have adequately controlled blood pressure, far below the level that might have been achieved had earlier trends continued. He argued that this shortfall is likely contributing to the recent rise in cardiovascular deaths and called for urgent action from policymakers and healthcare providers.
High blood pressure remains the leading cause of cardiovascular mortality in England, and the researchers note that recent increases in premature cardiovascular deaths closely track the growing burden of poorly controlled and undiagnosed hypertension. They also point to wider influences, including rising obesity, high salt intake, widening socioeconomic inequalities, and the impact of the Covid-19 pandemic, which disrupted access to routine care and blood pressure monitoring. Reversing these trends, they conclude, will require coordinated national action to strengthen prevention, diagnosis, and long-term management of high blood pressure.
More information: Catherine Graham et al, Trends in hypertension prevalence, control, and antihypertensive use in England from 2003 to 2021: insights from annual, nationwide Health Surveys for England, BMJ Medicine. DOI: 10.1136/bmjmed-2025-001556
Journal information: BMJ Medicine Provided by Queen Mary University of London
