Researchers from Oxford Population Health analysed clinic blood pressure measurements collected by Our Future Health, the UK's largest health research programme, from participants who enrolled between 2022 and 2025. The findings paint a stark picture of how many cases of hypertension in England remain undetected, untreated or inadequately controlled, despite hypertension being one of the most important causes of stroke, heart disease and premature death.
Hypertension was defined by World Health Organization criteria using systolic blood pressure of 140 mmHg or greater, diastolic blood pressure of 90 mmHg or greater, or use of blood pressure-lowering medication. Using this definition, the team assessed how many participants had high blood pressure, how many were diagnosed and were treated, and how many had their blood pressure controlled.
Key findings:
- Over one-third (37%) of participants had hypertension, ranging from one-sixth (15%) in those aged 18 to 39 years to three-quarters (71%) in those aged 80 years or older;
- Hypertension was almost 50% more common in men than women (42% vs 29% after age-standardisation);
- For almost two-thirds (59%) of people with hypertension it was undetected, meaning they had never been diagnosed and were not on blood pressure-lowering medication;
- Among those taking one or more blood pressure medications, half (50%) still had elevated levels of blood pressure (140/90 mmHg or higher).
Despite longstanding clinical guidance, current estimates of hypertension awareness, treatment and control in England have not improved in recent decades. The authors argue that the current NICE guidelines, which require multiple confirmatory blood pressure readings before a diagnosis is confirmed and recommend lifestyle advice ahead of drug treatment, result in many cases of hypertension never being properly detected, treated or controlled.
Wenyu Liu , 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.
'This isn't a problem confined to a particular group; it's substantial across almost every demographic we examined. Even among younger adults, who currently aren't eligible for an NHS Health Check, over 15% already had high blood pressure. This underscores the need for population-wide prevention strategies alongside targeted treatment for people at high cardiovascular risk.'
Iain Turnbull , Deputy Chief Medical Officer at Our Future Health, Clinical Research Fellow at Oxford Population Health, and GP said 'Our Future Health is a valuable resource for research on blood pressure and the findings reflect what we see day to day in general practice.
'Many patients with high blood pressure are undetected or are sub-optimally treated. There is a need for a more proactive approach to detection of high blood pressure and to consider initiation of treatment based on predicted risk of cardiovascular disease in addition to levels of blood pressure.'
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said 'This 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.
'High blood pressure remains the leading modifiable risk factor for cardiovascular disease, linked to around half of heart attacks and strokes in the UK. The worrying reality is that millions of people are still living with the condition without knowing it and missing opportunities for early diagnosis and treatment.
'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.'
