Study Finds Most High Blood Pressure Cases in England Are Undiagnosed

The research used data from the Our Future Health programme and examined people enrolled between 2022 and 2025 with high blood pressure, defined as 140/90 mmHg or higher. It calculated that more than a third of adults, 37%, had high blood pressure, and six in 10 of those were unaware of their condition. Most people with hypertension, 59%, were undiagnosed, increasing their risk of stroke, heart attack and early death, the study said.

Hypertension was almost 50% more common in men than women, at 42% compared with 29% across all ages, and was more common in older people. The researchers said that despite substantial improvements in detection and control during the 2000s, progress had plateaued since about 2011, with “indications of worsening trends following the Covid-19 pandemic, possibly because disruptions to healthcare delivery may have had lasting effects.”

Wenyu Liu, a 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.” Liu added that the study highlighted the prevalence of hypertension across demographics and underscored the need for population-wide prevention strategies alongside targeted treatment for people at high cardiovascular risk.

The researchers said “the most striking finding” was the high absolute number and high proportion of people with undiagnosed hypertension. They also found that only half of adults with high blood pressure treated by a GP were adequately controlled.

Dr Iain Turnbull, a GP, deputy chief medical officer at Our Future Health and a clinical research fellow at Oxford Population Health, said it was not clear why 50% of patients who said they were taking blood pressure-lowering drugs had uncontrolled hypertension. He said blood pressure varies considerably between people, and some people need changes in dose or two or more different medicines before it is brought under control. Other health conditions and medications can affect blood pressure too. He also cited practical and social factors including side effects, complicated treatment regimens and competing health or life pressures, as well as weight, diet, salt intake, alcohol and physical activity.

Turnbull said a high reading can have many explanations and should not be seen simply as a reflection of what an individual patient or healthcare professional has done. He noted important caveats: the study did not have prescribing records available to independently confirm medication use, and a blood pressure measurement on one day does not necessarily represent someone’s usual blood pressure. “Even with those caveats, I wouldn’t regard 50% as a satisfactory figure,” he said. “Persistently high blood pressure increases the risk of stroke and heart disease, and bringing it under control reduces that risk.”

Prof Bryan Williams, chief scientific and medical officer at the British Heart Foundation, said the 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.” He added: “Better detection and treatment could help tens of thousands of people to avoid a preventable heart attack and stroke. But to achieve this, we will need to rethink how we identify, treat and support those at risk so that blood pressure checks and effective treatment can benefit everyone.”