Researchers at Oxford Population Health have found that high blood pressure is going undetected or remains poorly controlled in a large share of adults in England.
The team examined blood pressure readings taken in clinics as part of Our Future Health, the UK’s largest health research program. Participants joined the program between 2022 and 2025. The results suggest that hypertension remains widely undiagnosed, untreated, or inadequately managed, even though it is a major contributor to stroke, heart disease, and premature death.
How Researchers Defined High Blood Pressure
The researchers used World Health Organization criteria to identify hypertension. A participant was considered to have high blood pressure if their systolic blood pressure was 140 mmHg or greater, their diastolic blood pressure was 90 mmHg or greater, or they were taking blood pressure lowering medication.
Using these criteria, the team examined how common hypertension was, how often people had already been diagnosed, how many were receiving treatment, and whether treatment was successfully bringing blood pressure under control.
More Than a Third Had Hypertension
More than one third (37%) of participants met the definition for hypertension.
Rates varied sharply with age. Hypertension affected one sixth (15%) of people aged 18 to 39 years, rising to three quarters (71%) among those aged 80 years or older.
High blood pressure was also almost 50% more common among men than women, with age standardized rates of 42% and 29%, respectively.
Perhaps most strikingly, almost two thirds (59%) of participants with hypertension did not know they had the condition. They had never received a diagnosis and were not taking blood pressure-lowering medication.
Treatment also did not guarantee adequate control. Among participants taking one or more medications for high blood pressure, half (50%) still had readings of 140/90 mmHg or higher.
Researchers Question the Current Approach
Despite years of clinical guidance, estimates of hypertension awareness, treatment, and control in England have shown little improvement in recent decades.
The researchers argue that current NICE guidelines may be contributing to the problem. These guidelines require several blood pressure measurements to confirm a diagnosis and recommend lifestyle changes before medication in some cases. According to the authors, this approach can result in hypertension remaining undetected, untreated, or insufficiently 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.”
A Call for More Proactive Detection
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.”
The findings suggest that identifying high blood pressure earlier could be important not only for people already considered at high risk, but across a much broader portion of the population.
Millions May Be Living With Undetected Hypertension
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.”
