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More than one-third of adults in England have high blood pressure, and two-thirds of them are unaware of their diagnosis, according to a new study of 1.4 million adults published in BMJ Public Health. The study also reported that only half of adults with high blood pressure who are treated by a doctor have their condition adequately controlled.

Researchers from Oxford Population Health analyzed clinic blood pressure measurements collected by Our Future Health, the U.K.'s largest health research program, 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 had been diagnosed and treated, and how many had their blood pressure controlled.

Despite longstanding clinical guidance, current estimates of hypertension awareness, treatment and control in England have not improved in recent decades. The authors argue that current NICE guidelines, which require multiple confirmatory blood pressure readings before a diagnosis is confirmed and recommend lifestyle advice before drug treatment, result in many cases of hypertension never being properly detected, treated or controlled.

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