Two-thirds of adults in the UK with high blood pressure do not know they have it
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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.
Key findings from the study showed that:
- More than one-third (37%) of participants had hypertension, ranging from one-sixth (15%) among those ages 18 to 39 to three-quarters (71%) among those 80 or older.
- Hypertension was almost 50% more common in men than in women (42% vs. 29% after age standardization).
- Hypertension was undetected in almost two-thirds (59%) of people with the condition, meaning they had never been diagnosed and were not taking blood pressure-lowering medication.
- Among those taking one or more blood pressure medications, half (50%) still had elevated blood pressure (140/90 mmHg or higher).
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.
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. Our study highlights the prevalence of hypertension across demographics. 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 general practitioner, 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 suboptimally treated. There is a need for a more proactive approach to detecting high blood pressure and to consider initiating treatment based on predicted cardiovascular disease risk in addition to blood pressure levels."
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 U.K. 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 U.K. 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 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."
Publication details
Wenyu Liu et. al., 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, BMJ Public Health (2026). DOI: 10.1136/bmjph-2025-004815
Journal information: BMJ Public Health
Key medical concepts
High Blood PressureDiastolic blood pressureSystolic blood pressure
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