Analysis of Blood Pressure Prevalence and Management Trends via the Health Survey for England

Article Impact Level: HIGH
Data Quality: STRONG
Summary of BMJ Medicine https://doi.org/10.1136/bmjmed-2025-001556 
Dr. Catherine Graham  et al.

Points

Researchers analyzed health data from over sixty-seven thousand adults to evaluate long-term trends in blood pressure prevalence and management across England between 2003 and 2021.
The study found that the prevalence of undiagnosed hypertension initially fell to nearly twenty-four percent in 2011 but rebounded to over thirty-two percent by 2021.
Data indicates that improvements in controlling blood pressure among diagnosed patients stalled significantly after 2011 with no meaningful progress observed in the subsequent decade.
The average number of antihypertensive medications prescribed to patients with uncontrolled blood pressure decreased slightly during the study period despite the need for intensified treatment.
Authors attribute the erosion of cardiovascular health gains to therapeutic inertia and pandemic-related disruptions to primary care access and diagnostic services.

Summary

This study analyzed data from over 67,000 adults participating in the Health Survey for England to evaluate trends in hypertension prevalence and management between 2003 and 2021. Results indicated that the prevalence of measured hypertension decreased significantly from 37.8% in 2003 to 33.2% in 2018, with an average annual percentage change (AAPC) of -0.9% (95% CI -1.6% to -0.6%). Concurrently, mean population systolic blood pressure dropped from 128.7 to 124.0 mm Hg (AAPC -0.15%), and diastolic pressure fell from 73.7 to 71.8 mm Hg (AAPC -0.12%) between 2003 and 2019. However, this positive trajectory stalled after 2011, with minimal improvement observed in the subsequent decade.

Analyses of diagnostic efficacy revealed a regression in detection rates following early gains. The prevalence of undiagnosed hypertension in the community declined from 32.6% in 2003 to a nadir of 23.7% in 2011, only to rebound to 32.4% by 2021. Among patients with a known diagnosis, the proportion achieving target blood pressure increased from 47.3% in 2003 to 56.5% in 2009 (AAPC 3.62%; 95% CI 1.52% to 5.74%). However, a significant plateau occurred from 2011 onwards, with no further statistical improvement in control rates among the diagnosed population. Consequently, an estimated five million adults currently live with undiagnosed hypertension.

Regarding pharmacotherapy, patients with diagnosed but uncontrolled hypertension exhibited a slight but significant decrease in the mean number of antihypertensive drugs utilized, dropping from 2.17 (SD 0.86) in 2003 to 2.14 (SD 0.96) in 2021 (AAPC -0.18%; 95% CI -0.68% to -0.03%). The study identified a sharp deterioration in management metrics following the onset of the COVID-19 pandemic, attributed to reduced primary care access and therapeutic inertia. The authors conclude that the substantial progress made in the 2000s has been largely eroded, necessitating renewed public health strategies to address the rising burden of cardiovascular mortality.

Link to the article: https://bmjmedicine.bmj.com/content/4/1/e001556

References

Graham, C., Steckelmacher, J., Prashar, J., Ahmed, A., Capel, M., Poulter, N. R., Sever, P. S., & Gupta, A. K. (2025). Trends in hypertension prevalence, control, and antihypertensive use in England from 2003 to 2021: Insights from annual, nationwide Health Surveys for England. BMJ Medicine, 4(1), e001556. https://doi.org/10.1136/bmjmed-2025-001556