ENGLAND — Researchers from Oxford Population Health are calling for a reevaluation of hypertension detection and treatment strategies in England after analyzing data that reveals widespread underdiagnosis and poor control. The study, published in the journal BMJ Public Health, indicates that current approaches are failing to identify and manage high blood pressure across large segments of the adult population.

The analysis drew on 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 study included 1.4 million adults, providing a substantial dataset for assessing the prevalence and management of hypertension in the region.

Hypertension was defined using World Health Organization criteria as a systolic blood pressure of 140 mmHg or greater, a diastolic blood pressure of 90 mmHg or greater, or the use of blood pressure-lowering medication. Based on these criteria, 37% of participants had hypertension. The prevalence varied by age, ranging from 15% in participants aged 18 to 39 years to 71% in participants aged 80 years or older. After age-standardization, hypertension was present in 42% of men and 29% of women.

The findings show gaps in diagnosis and treatment. Specifically, 59% of people with hypertension had not been diagnosed and were not taking blood pressure-lowering medication. Among participants taking one or more blood pressure medications, 50% had blood pressure levels of 140/90 mmHg or higher. Estimates of hypertension awareness, treatment, and control in England have not improved in recent decades, with progress in high blood pressure detection and control plateauing around 2011.

Wenyu Liu, a Medical Statistician at Oxford Population Health and the lead author of the study, criticized the existing framework. "While hypertension is largely a 'silent killer', the current approach to detecting and treating high blood pressure is not fit for purpose," Liu said. She noted that the issue spans various demographics. "This isn't a problem confined to a particular group; it's substantial across almost every demographic we examined," she said.

Liu pointed out specific shortcomings in current screening eligibility. "Even among younger adults, who currently aren't eligible for an NHS Health Check, over 15% already had high blood pressure," she said. The study authors stated that current NICE guidelines require multiple confirmatory blood pressure readings before a diagnosis is confirmed and recommend lifestyle advice ahead of drug treatment. "This underscores the need for population-wide prevention strategies alongside targeted treatment for people at high cardiovascular risk," Liu said.

Iain Turnbull, Deputy Chief Medical Officer at Our Future Health, supported the call for change. "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," Turnbull said. He observed that "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," he said.

Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, also weighed in on the implications. "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," Williams said. He emphasized the health risks involved. "High blood pressure remains the leading modifiable risk factor for cardiovascular disease, linked to around half of heart attacks and strokes in the UK," he said.

Williams argued that improvements could yield public health benefits. "Better detection and treatment could help tens of thousands of people to avoid a preventable heart attack and stroke," he said. However, he noted that achieving this requires systemic changes. "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," he said.

Why It Matters

The study shows a stagnation in public health progress, as estimates of hypertension awareness, treatment, and control in England have not improved in recent decades. With progress plateauing around 2011, the findings suggest that existing strategies are insufficient to meet the needs of the population. The World Health Organization has set a global target to reduce the prevalence of uncontrolled hypertension by 25% between 2010 and 2025 as part of its noncommunicable disease prevention strategy, a goal that appears distant given the current rates of undiagnosed and uncontrolled cases in England.

The scale of the Our Future Health programme provides a robust basis for these conclusions. Launched in 2021 with the goal of recruiting 5 million adults to gather long-term health data, the programme includes 1.98 million participants with geographical data. A subset of 1.69 million participants successfully linked to an NHS number, allowing for detailed analysis of health outcomes across different regions in England. This extensive data infrastructure enables researchers to identify patterns that smaller studies might miss, reinforcing the urgency of the call for revised detection and treatment protocols.

What's New

According to EurekAlert!, the study titled Hypertension prevalence, detection, treatment and control among 1.4 million adults in England: a cross-sectional analysis from the Our Future Health study in 2022–2025 states that 59% of people with hypertension in England were undetected, meaning they had never been diagnosed and were not on blood pressure-lowering medication. In 2021, the World Health Organization released updated guidelines for the pharmacological treatment of hypertension, recommending earlier initiation of treatment based on individual risk profiles rather than solely on blood pressure readings. Our Future Health, the UK's largest health research programme, was launched in 2021 with the goal of recruiting 5 million adults to gather long-term health data, including information on chronic conditions like hypertension.

The Our Future Health cohort includes 1.98 million participants with geographical data, and a subset of 1.69 million participants successfully linked to an NHS number, allowing for detailed analysis of health outcomes across different regions in England. Wenyu Liu, the lead author of the study, has previously published research on cardiovascular disease and public health policy, including work on the impact of hypertension on mortality rates in England. The World Health Organization (WHO) has set a global target to reduce the prevalence of uncontrolled hypertension by 25% between 2010 and 2025, as part of its noncommunicable disease prevention strategy. Bryan Williams, chief scientific and medical officer at the British Heart Foundation, has previously led national initiatives to improve hypertension management and has contributed to the development of clinical guidelines for blood pressure control in the UK. The study was published in the journal BMJ Public Health.

How Sources Differ

Sources differ on the characterization of the Our Future Health programme. EurekAlert.org describes the study as a cross-sectional analysis from the Our Future Health study in 2022–2025, stating that 59% of people with hypertension in England were undetected. The World Health Organization describes Our Future Health as the UK's largest health research programme, launched in 2021 with the goal of recruiting 5 million adults to gather long-term health data, including information on chronic conditions like hypertension.

Regarding hypertension details, EurekAlert.org focuses on the undetected rate of 59% among people with hypertension in England.