Advancements in hypertension prevalence and control seen in the 2000s have plateaued since 2011, with signs of reversal since 2019, according to an analysis of annual nationwide surveys in England.

Published in BMJ Medicine, the study aimed to determine whether improvements in blood pressure management observed in the early 2000s have been sustained in more recent years.

Led by the William Harvey Research Institute at Queen Mary University of London, with collaborators from Barts Health NHS Trust and Imperial College London, the study reflected long-term trends in hypertension prevalence, diagnosis, control and antihypertensive prescribing in England over nearly two decades.

The data, drawn from 14 nationally representative Health Surveys for England conducted between 2003 and 2021, included 67,242 adults aged 16 years or older living in private households, all of whom had valid nurse-measured blood pressure readings.

Hypertension was defined using national guidelines and categorised as diagnosed, undiagnosed, controlled or uncontrolled.

Hypertension prevalence

The results showed that measured hypertension prevalence declined from 37.8% in 2003 to 33.2% in 2018 (average annual percentage change (AAPC) −0.9).

The mean population systolic and diastolic blood pressure also decreased significantly between 2003 to 2019. Systolic blood pressure fell from 128.7 to 124.0 mm Hg (AAPC −0.15%) and diastolic blood pressure from 73.7 to 71.8 mm Hg (AAPC −0.12%).

However, the results showed that progress regarding diagnosis and control stalled after 2011. By 2021, the proportion of people with undiagnosed hypertension had risen sharply to 32.4% (AAPC −1.04%), returning to levels seen two decades earlier.

Among individuals with diagnosed hypertension, blood pressure control improved substantially between 2003 and 2009 but then plateaued. There was no further significant progress until a decline was observed in 2021.

Changes in treatment patterns were also identified. While most patients with diagnosed hypertension continued to receive combination therapy, the mean number of antihypertensive drugs used by those with uncontrolled blood pressure fell slightly over time.

Urgent action required

Several limitations were acknowledged by the authors, including the fact that blood pressure classification was based on measurements taken during a single home visit. This potentially overestimates hypertension prevalence due to the so-called white coat effect.

In addition, data collection in 2021 differed from previous years due to pandemic-related restrictions, limiting comparability. The absence of data beyond 2021 also prevents firm conclusions about longer-term post-pandemic trends, the authors added.

Senior author Dr Ajay Gupta, consultant in cardiovascular medicine and clinical pharmacology at Queen Mary, said: ‘Despite early gains, only 38.3% of people with hypertension now have adequately controlled blood pressure – far below the envisioned 80% target if trends in the improvement continued in 2010s.

‘This shortfall may be a key driver of recently seen rise in the cardiovascular deaths. Urgent action is needed from policymakers and healthcare providers.’

The authors have advocated for renewed, coordinated action to strengthen hypertension screening, optimise treatment and address population-level risk factors associated with blood pressure management.

Earlier in 2025, research suggested that people in their thirties with ‘normal’ blood pressure which rises throughout their life may face an increased risk of heart disease, stroke or heart failure in later life.

Another study found that ethnicity may significantly affect how patients respond to hypertension medication, highlighting the critical importance of personalised medicine in blood pressure management.

Reference
Graham C et al. Trends in hypertension prevalence, control, and antihypertensive use in England from 2003 to 2021: insights from annual, nationwide Health Surveys for England. BMJ Med 2025 Nov 27;4(1):e001556.