A study of 1.4 million adults in England found that more than one-third had high blood pressure, while nearly two-thirds were unaware they had it.
A person can have blood pressure high enough to meet the clinical definition of hypertension without ever being diagnosed or receiving medication.
That gap matters because hypertension is one of the most important causes of stroke, heart disease, and premature death, yet many cases in England remain undetected, untreated, or inadequately controlled.
Hypertension rises sharply with age
Researchers from Oxford Population Health examined clinic blood pressure measurements collected by Our Future Health, the UK’s largest health research program, from participants who enrolled between 2022 and 2025. They used World Health Organization criteria, defining hypertension as systolic blood pressure of 140 mmHg or higher, diastolic blood pressure of 90 mmHg or higher, or the use of blood pressure-lowering medication.
The results revealed how widely high blood pressure extends across the population and how often it escapes detection or remains uncontrolled:
- More than one-third, 37%, of participants had hypertension. The proportion ranged from 15% among adults ages 18 to 39 to 71% among people ages 80 and older.
- Hypertension was almost 50% more common in men than women, affecting 42% of men compared with 29% of women after age standardization.
- Among people with hypertension, 59% had never been diagnosed and were not taking blood pressure-lowering medication.
- Even among people taking one or more blood pressure medications, 50% still had readings of 140/90 mmHg or higher.
Diagnosis and treatment still fall short
Despite longstanding clinical guidance, estimates of hypertension awareness, treatment, and control in England have not improved in recent decades. The authors argue that current NICE guidelines may contribute to the problem because they require multiple blood pressure readings before confirming a diagnosis and recommend lifestyle advice before drug treatment. In their view, this approach means many cases are never 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 a 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.”
Better detection could reduce cardiovascular risk
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.”
Reference: “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” by Wenyu Liu, Jennifer Collister, Thomas Littlejohns, Iain James Turnbull, Robert Clarke and David John Hunter, 23 September 2026, BMJ Public Health.
DOI: 10.1136/bmjph-2025-004815
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