High blood pressure becomes more common after age 40years yet new research from The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin shows that many people in Ireland with hypertension are still not optimally diagnosed or treated based on European Gudelines. The study is published in the international journal Open Heart.
High blood pressure (hypertension) is a significant risk factor for cardiovascular disease, stroke, dementia, and chronic kidney disease, yet it often causes no symptoms and can go undetected for years. This 12-year longitudinal study, involving over 8,000 participants, provides a detailed national picture of how high blood pressure is being managed in Ireland and examines adherence to the latest European Society of Cardiology (ESC) guidelines, including the 2024 recommendations.
Drawing on more than a decade of TILDA data, the researchers show that unmet need in hypertension care is not a new problem, but one that has persisted over time. At the most recent data collection, 62% (approximately 445,000 people aged 50 and over) with high blood pressure were not appropriately managed: they had undiagnosed hypertension, were diagnosed but not receiving treatment, or were on treatment but had blood pressure above recommended targets.
When the lower blood pressure target of <130/80 mmHg, as advised by the 2024 ESC guidelines, is applied, this figure rises to 77% — meaning more than three out of every four older adults with hypertension in Ireland are not optimally managed.
Key findings from the study:
- Hypertension prevalence remained consistently high, increasing from 63% to 71% over 12 years.
- Only 56% of those with hypertension are aware they have it, highlighting substantial ongoing under-diagnosis.
- 71% of those with hypertension were taking a medication, treatment intensity was often suboptimal: only 14% were prescribed a guideline-recommended dual therapy and only 57% guideline-recommended monotherapy.
- Among those receiving treatment, just 33% achieved the guideline-recommended blood pressure target of <130/80 mmHg, while 54% were controlled to <140/90 mmHg.
- Overall, 62% (445,000 people) with hypertension in Ireland were not appropriately managed according to the 2018 ESC guidelines, consistent with previous TILDA evidence showing poor long-term control of modifiable cardiovascular risk factors.
- Forty per cent of the population had elevated blood pressure (SBP value of 120–139mmHg or a DBP value of 70-89mmHg) and 71% of this group had evidence of high cardiovascular risk.
- People aged 85 years and older and those with moderate to severe frailty were less likely to have undiagnosed hypertension and were more likely to be taking guideline-recommended medications similar rates of blood pressure control when compared to the wider population.
- People with chronic kidney disease (CKD) were more likely to receive guideline-recommended treatment and achieve blood pressure control to a target of <140/90mmHg, suggesting targeted care can be effective in high-risk groups.
Dr Caoimhe McGarvey, Research Fellow at TILDA and Specialist Registrar in Geriatric Medicine at St James's Hospital Dublin and lead author on the new study, commented:
"High blood pressure is a common and treatable condition. However, when left untreated it can cause heart disease, kidney disease, stroke and dementia. This study highlights a significant unmet need in the management of high blood pressure in Ireland. Systematically addressing this need has the potential to dramatically reduce avoidable complications and improve the health outcomes for older adults across the country."
Professor Donal Sexton, Consultant Nephrologist and Associate Professor at Trinity College Dublin, said:
"This study exemplifies the unique ability of the TILDA study to assess how well we are performing as a nation in the treatment of modifiable risk factors for cardiovascular disease, chronic kidney disease and premature death. It emphasises the unmet need in the management of high blood pressure in Ireland and the urgent requirement to improve its recognition and treatment."
Regius Professor Rose Anne Kenny, Principal Investigator of TILDA and Professor of Medical Gerontology at Trinity College Dublin, added:
"The message for the public is simple: if you are 40 years or over get your blood pressure checked. It's quick, painless, and can make a life-changing difference.
TILDA has been highlighting gaps in the detection and control of high blood pressure for over a decade. What makes this study particularly powerful is the maturity of the TILDA dataset, following the same people over more than 12 years gives Ireland a unique national asset for understanding how health changes as we age and how well our health system is responding."
This long-term evidence shows that, despite clear guidelines and effective treatments, too many older adults are still living with poorly controlled hypertension. High blood pressure is one of the most modifiable risk factors for stroke, heart disease and dementia, and improving its management represents one of the most effective opportunities we must support healthier ageing in Ireland.
This research aligns closely with current Health Service Executive (HSE) and Department of Health priorities, which emphasise the early detection and effective management of chronic conditions to support healthy ageing and reduce avoidable illness. High blood pressure is easy to check and can often be managed effectively once identified. Adults are encouraged to have their blood pressure checked regularly with their GP or local pharmacist, particularly as they get older or if they have other health conditions. Early detection and appropriate treatment can significantly reduce the risk of heart disease, stroke, kidney disease and dementia.
READ: You can read the published paper: 'Adherence to the European Society of Cardiology hypertension guidelines over 12 years of follow-up in the Irish' at the following link: https://openheart.bmj.com/content/12/2/e003744
