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
TL;DR
Over one-third of adults in England had hypertension, yet only half of affected individuals were detected and half of those treated achieved blood pressure control, highlighting the need for population-wide prevention strategies alongside targeted treatment of individuals at high cardiovascular risk.
Abstract
Abstract Objectives To assess the prevalence, detection, treatment and control of hypertension in England. Design Cross-sectional analysis of baseline blood pressure measurements from the Our Future Health study. Setting Over 200 enrolment centres across England, 2022–2025. Participants 1.4 million adults aged ≥18 years with available clinic blood pressure measurements. Main outcome measures Hypertension was defined according to WHO guidelines as systolic blood pressure (SBP) ≥140 mm Hg, diastolic blood pressure (DBP) ≥90 mm Hg or self-reported use of antihypertensive medication. Detection was defined as self-reported prior diagnosis by a health professional or reported use of antihypertensive medication. Controlled hypertension was defined as SBP <140 mm Hg and DBP <90 mm Hg among those receiving antihypertensive treatment. Results Overall, 37.2% of participants had hypertension, with higher age-standardised prevalence in men than women (41.9% vs 28.6%). Prevalence increased markedly with age, from 23% to 73% in men and from 10% to 69% in women at ages 18–39 and ≥80 years, respectively. Despite this high burden, 58.8% of individuals with hypertension were undetected. Hypertension was strongly associated with older age, male sex and higher body mass index, but the prevalence remained substantial across all population subgroups. Factors associated with hypertension detection largely mirrored those associated with hypertension, except in individuals with prior cardiovascular disease or diabetes, among whom detection was higher. Among detected participants, antihypertensive treatment was associated with lower odds of uncontrolled blood pressure; however, 50.2% of treated individuals did not achieve blood pressure control. Conclusions Over one-third of adults in England had hypertension, yet only half of affected individuals were detected and half of those treated achieved blood pressure control. The high prevalence across nearly all population subgroups underscores the need for population-wide prevention strategies alongside targeted treatment of individuals at high cardiovascular risk.