The research, published in BMJ Public Health, used data collected between 2022 and 2025 and defined hypertension as a reading of 140/90 mmHg or higher, or the use of blood‑pressure‑lowering medication. The investigators calculated that over 33 % of English adults meet this definition, equating to roughly 12 million people.
Among those with hypertension, 59 % do not know they have the condition, raising their risk of stroke, heart attack and premature death. The prevalence was almost 50 % higher in men than women – 42 % of men versus 29 % of women across all ages – and rose sharply with age.
The study highlights a “leaky cascade of care” in the NHS. Current NICE guidance recommends confirming elevated clinic readings with ambulatory or home monitoring and prioritising lifestyle advice before prescribing medication. Researchers say these steps, while well‑intentioned, can delay treatment and leave many patients undiagnosed or sub‑optimally managed.
Evidence cited by the authors shows that even when high blood pressure is identified during an NHS Health Check in a GP surgery, patients are often not started on medication. The problem is compounded for younger adults: 15.3 % of people under 40 have hypertension, yet they are ineligible for the NHS Health Check programme.
Lead author Wenyu Liu, a medical statistician at Oxford Population Health, called the current detection and treatment model “not fit for purpose”. Iain Turnbull, deputy chief medical officer of Our Future Health and a GP, urged a more proactive approach that considers cardiovascular risk alongside blood‑pressure levels. Bryan Williams of the British Heart Foundation warned that millions are missing early diagnosis and treatment opportunities, while Juliet Bouverie of the Stroke Association stressed that regular checks – now available in pharmacies and via inexpensive home monitors – are essential for prevention.
The authors note that improvements in hypertension detection and control seen in the 2000s have stalled since around 2011 and appear to have worsened after the Covid‑19 pandemic, suggesting that current prevalence levels mirror those of two decades ago. They call for renewed focus on early detection, streamlined prescribing pathways and greater public awareness to curb the silent killer that remains the leading modifiable risk factor for cardiovascular disease in the UK.