Millions Unaware of High Blood Pressure, Risking Fatal Health Events

More than half of individuals living with high blood pressure are unaware of their condition, placing them at an elevated risk for heart attack, stroke, and premature death, a study from the University of Oxford has revealed.

Further analysis indicates that even among patients receiving treatment for hypertension from their general practitioners, only about half have their condition adequately controlled.

The research examined the records of 1.4 million participants in the Our Future Health program, the UK's largest health research initiative. The findings suggest that over one-third of adults in England have high blood pressure, with 59% of these individuals being unaware of their diagnosis. High blood pressure, also known as hypertension, was defined as a reading of 140/90 mmHg or higher, or the use of blood pressure-lowering medication.

The study, published in the journal BMJ Public Health, observed that hypertension was nearly 50% more prevalent in men than in women across all age groups (42% compared to 29%) and was more common in older individuals.

Researchers noted that current guidelines from the National Institute for Health and Care Excellence (Nice) may contribute to a "leaky cascade of care," leading to numerous undiagnosed or inadequately treated cases. The authors pointed out that primary care's focus on managing existing diseases leaves limited opportunities for disease prevention. Additionally, evidence suggests that even when high blood pressure is identified during routine checks, patients are not always prescribed medication.

The prevalence of hypertension in individuals under 40, which stands at 15.3%, is a particular concern as this age group is ineligible for NHS Health Checks.

While high blood pressure detection and control saw improvements in the 2000s, progress has plateaued since approximately 2011. The study suggests that trends may have worsened following the COVID-19 pandemic due to disruptions in healthcare delivery, bringing current prevalence levels back to those seen two decades ago.

Wenyu Liu, lead author of the study and a medical statistician at Oxford Population Health, stated that the current approach to detecting and treating high blood pressure is "not fit for purpose." Iain Turnbull, deputy chief medical officer at Our Future Health and a GP, emphasized the need for a more proactive strategy, including 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, described the findings as painting a "concerning picture" of undetected high blood pressure and the challenges in controlling it for those being treated. He highlighted that high blood pressure is the leading modifiable risk factor for cardiovascular disease, contributing to roughly half of all heart attacks and strokes in the UK.

According to British Heart Foundation analysis of NHS data, over 11 million people in the UK have been diagnosed with high blood pressure by their GP. A Nice spokesperson clarified that their guideline supports lifestyle advice alongside necessary medication, rather than recommending delaying treatment for lifestyle changes alone.