High blood pressure is easy to detect – it takes only a few minutes and doesn’t require needles or laboratory tests. Relatively cheap, easy-to-use machines let people check their own blood pressure at home, and many high street pharmacies offer free checks. Yet new research suggests many adults in England are still walking around unaware they have it.
The problem may no longer be whether we can measure blood pressure, but whether we are looking for it in the right people and often enough.
A new study involving around 1.4 million adults in England, found that 37% had hypertension (high blood pressure). Of those, 59% had not previously been diagnosed and were not taking blood-pressure-lowering drugs. The research used blood pressure measurements collected from adults recruited between 2022 and 2025 to Our Future Health, the UK’s largest health research programme.
Hypertension became increasingly common with age, rising from 15% among 18- to 39- year-olds to 71% among people aged 80 years and over. After adjusting for age, it was also considerably more common in men than in women: 42% compared with 29%, respectively.
Finding hypertension is only part of the problem. Among participants already taking blood-pressure-lowering medication, half still had high blood pressure.
It is worth noting that these figures apply to the study population in England, not the whole of the UK. Our Future Health is also a huge volunteer research group, rather than a randomly selected, nationally representative sample. The exact percentages should therefore be interpreted with some caution. Still, the sheer scale of the study makes the central finding difficult to ignore: large numbers of adults are living with potentially important dangerous high blood pressure without knowing it.
Silent killer
Hypertension is often called a silent killer, and for a good reason. Most people with it experience no symptoms and feel perfectly well. That is precisely what makes finding it difficult.
Persistently raised pressure gradually damages blood vessels and places strain on the heart and other organs. Left untreated, it increases the risk of heart disease, heart attack, stroke, heart failure, kidney disease and vascular dementia. This creates an unusual healthcare problem. We have a common condition that is straightforward to detect, for which effective lifestyle changes and medication already exist, but which gives most people little immediate reason to seek medical attention.
Since 2021, NHS England has operated a Community Pharmacy Hypertension Case-Finding Service. Participating pharmacies can offer free blood pressure measurements to people aged 40 years and over who have not previously been diagnosed with hypertension. This makes enormous sense. Pharmacies are embedded within communities, and people visit them for prescriptions and everyday healthcare advice without needing a GP appointment.
Given this, why are we still missing so many people? Part of the answer may be surprisingly simple: people still have to take up the offer.
An NHS England survey of adults aged over 40 found that 44% were unaware they could get a free pharmacy blood pressure check. Even more (59%) didn’t realise they could have one without an appointment. And 17% of people who had not recently had their blood pressure measured said they had avoided doing so because they did not feel unhealthy or stressed.
There is another potential reason for the gap. Routine pharmacy blood pressure testing primarily targets adults aged 40 years and over. Yet the new study found hypertension in more than 15% of adults aged 18 to 39 years. Previous research has also suggested that younger men with hypertension may be particularly likely to remain undiagnosed.
Also, with the use and ease of the NHS app, and online pharmacy dispensing and direct-to-door delivery, many patients do not attend a pharmacy to collect their medicines.
Don’t wait for people to ask
Perhaps the solution is to stop treating blood pressure measurement as something people have to actively request. Instead, it could become a routine part of everyday encounters with healthcare.
Collecting a repeat prescription? Ask to have your blood pressure checked. Having a vaccination or health review? Check it.
Further testing could involve dentists, optometrists, physiotherapy, osteopathy or chiropractic clinics, workplaces and community settings. NHS England’s pharmacy service already allows referrals from GPs and other healthcare professionals, including dentists and optometrists.
Taking blood pressure testing to people rather than waiting for people to come looking for it should become the new norm.
Home monitoring has an important role too. However, people should be aware that one raised measurement does not automatically mean someone has hypertension. Blood pressure fluctuates significantly throughout the day and can be influenced by activity, stress and the circumstances in which it is measured.
The National Institute for Health and Care Excellence recommends confirming suspected hypertension using a portable device that measures blood pressure repeatedly over 24 hours (so-called “ambulatory monitoring”) or multiple morning and evening home measurements over seven days when ambulatory monitoring is unsuitable.
Know your numbers
We already have the technology to tackle undiagnosed hypertension. Much of the healthcare infrastructure is also in place. What appears to be missing is a culture in which knowing your blood pressure is considered routine, particularly when you feel completely healthy.
Perhaps we should know our blood pressure in much the same way that we know our height or weight. We routinely (and are legally required) arrange an MOT for our cars even when they appear to be running perfectly well. Our cardiovascular system deserves at least the same attention. Because when it comes to hypertension, feeling healthy is no guarantee that everything under the bonnet is working as well as it seems.