More than a third of adults in England have high blood pressure, and nearly six in ten of those cases are going undetected, according to an analysis of 1.4 million volunteers published this week in BMJ Public Health. Among those already diagnosed and treated, only about half had their blood pressure under control, the researchers found.
The study, led by Oxford Population Health, drew on clinic blood pressure readings collected between 2022 and 2025 by Our Future Health, the UK's largest health research program. Applying World Health Organization thresholds — a systolic reading of 140 mmHg or higher, or a diastolic reading of 90 or higher — researchers found hypertension in 37% of participants overall, ranging from about 15% of adults in their 20s and 30s to 71% of those over 80. Men were affected far more often than women, at 42% versus 29%.
"The current approach to detecting and treating high blood pressure is not fit for purpose," said Wenyu Liu, a medical statistician at Oxford Population Health and the study's lead author.
Because Our Future Health recruits volunteers rather than drawing a random sample of the population, the cohort is not a perfect mirror of England as a whole — volunteer health studies often skew toward people who are more health-conscious or have more contact with medical services, which could mean the true scale of undiagnosed hypertension nationally is even larger, or could differ from this estimate in other ways. The findings are also cross-sectional, a single snapshot that can measure how common a condition is but cannot by itself show whether detection rates are improving or worsening over time.
A long-known gap
Undiagnosed hypertension is a longstanding problem in public health: because high blood pressure rarely produces symptoms until it causes a stroke, heart attack or kidney damage, it is often called a "silent killer." Bryan Williams, chief scientific officer at the British Heart Foundation, which was not involved in the study, said the findings paint "a concerning picture of the scale of undetected high blood pressure" in England.
The study's authors argued that current screening, which largely relies on opportunistic checks during unrelated doctor visits, is too passive to catch most cases early. They called for more proactive detection, such as targeted outreach to people with known risk factors, and said treatment decisions should weigh a patient's overall cardiovascular risk rather than blood pressure readings alone.
Our Future Health has said it plans further analyses of its growing volunteer dataset, which organizers hope will eventually include 5 million UK participants, to study other common but under-detected conditions, including high cholesterol.
