Nearly 6 in 10 people with high blood pressure don’t know they have it

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.

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 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.

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.