A comprehensive new analysis by researchers at Queen Mary University of London warns that England has lost the substantial gains made in high blood pressure prevention, diagnosis and management during the 2000s.
Drawing on data from more than 67,000 adults who participated in the annual Health Survey for England between 2003 and 2021, researchers report that the rates of high blood pressure, undiagnosed hypertension and inadequate treatment control have plateaued since 2011 and deteriorated sharply in the aftermath of the Covid-19 pandemic.
Findings of the study published in BMJ Medicine show that while high blood pressure prevalence fell steadily from 37.8 per cent in 2003 to 33.2 per cent in 2018, this improvement stalled thereafter, with little evidence of continued progress up to 2021. Rates of undiagnosed hypertension declined markedly from 32.6 per cent in 2003 to 23.7 per cent in 2011. Subsequently rose back to 32.4 per cent by 2021, effectively returning to levels last observed two decades ago.
The study also revealed that the proportion of people with undiagnosed high blood pressure who successfully achieved blood pressure control increased strongly until 2011 but showed no meaningful improvement over the following decade, dropping from 63.1 per cent in 2011 to 56.8 per cent in 2021. This indicates that an estimated five million adults in England may now be living with undiagnosed high blood pressure, and roughly another five million have diagnosed but uncontrolled high blood pressure.
Dr Ajay Gupta, senior author and Consultant in Cardiovascular Medicine and Clinical Pharmacology at Queen Mary said, "Despite early gains, only 38.3% of people with hypertension now have adequately controlled blood pressure—far below the envisioned 80% target if trends in the improvement continued in 2010's. This shortfall may be a key driver of recently seen rise in the cardiovascular deaths. Urgent action is needed from policymakers and healthcare providers."
High blood pressure remains the leading cause of cardiovascular deaths in England. The authors note that premature cardiovascular mortality in England has risen in recent years and closely tracks the increasing burden of poorly controlled and undiagnosed high blood pressure. The stagnation in blood pressure control, combined with growing levels of obesity, higher average salt intake, widening socioeconomic inequalities and increasing prevalence if mental health disorders, suggests that broader changes in health policy, lifestyle and social conditions have contributed to the erosion of earlier progress.
The study also evaluated the impact of the Covid-19 pandemic. It identified a pronounced deterioration of high blood pressure detection and management between 2019 and 2021, characterised by declining blood pressure control and reduced medication use. They attribute these changes partly to pandemic-related disruptions, including reduced access to routine primary care and curtailed opportunities for blood pressure measurement.
The authors emphasise that reversing these declines will require coordinated action, including a strengthened national salt-reduction programme, improved access to diagnostic services, robust strategies to remove barriers to medication adherence and a renewed emphasis on clinical education designed to reduce therapeutic inertia.
