High blood pressure, known medically as hypertension, has become a growing concern in the United Kingdom as the National Health Service (NHS) faces significant challenges in managing this condition. Once regarded as a notable success for the NHS, hypertension treatment has stalled and may even be reversing, according to recent findings.
Hypertension is frequently referred to as a “silent killer.” It often presents no symptoms while contributing significantly to heart attacks and strokes. For years, the NHS made substantial progress in identifying patients with high blood pressure and providing treatments to lower their readings to safer levels. However, a study published in BMJ Medicine indicates that progress on this front has stagnated over the past decade and worsened during the COVID-19 pandemic.
The decline in hypertension management has been attributed to a combination of factors, including unhealthy lifestyle choices and difficulties in accessing general practitioner (GP) services. Professor Ian Wilkinson, president of the British and Irish Hypertension Society, emphasized the severity of the issue, stating, “Hypertension will kill more people in the UK than anything else. But we’ve stalled [on treating it], and we’re going backwards.”
According to health experts, blood pressure represents the force exerted by circulating blood on the walls of blood vessels. Elevated blood pressure can lead to severe health complications, including damage to vital organs, heart attacks, strokes, and even dementia. It is considered the most significant modifiable risk factor for poor health.
The NHS had previously encouraged GPs to diagnose and treat as many patients with high blood pressure as possible. Strategies included promoting weight loss, smoking cessation, and reducing salt intake, as excessive salt raises blood volume and, consequently, blood pressure. Data from the Health Surveys for England indicated promising trends until approximately 2010, when improvements began to plateau.
Between 2003 and 2011, the proportion of individuals identified with high blood pressure but not diagnosed by their GP decreased from 33 percent to 24 percent. Additionally, the average systolic blood pressure across the surveyed population dropped from 129 to 124 millimeters of mercury (mm Hg). However, from 2017 to 2019, these positive trends halted.
Dr. Ajay Gupta, a consultant in cardiovascular medicine at Queen Mary University of London and lead author of the recent study, suggested that the lack of progress stems partly from long-term trends of unhealthy eating and rising obesity rates. He noted an increase in salt consumption, which had initially declined due to public health campaigns. Daily salt intake fell from 9.4 grams to 7.6 grams between 2004 and 2014 but rebounded to 8.4 grams by 2018, surpassing the recommended maximum of 6 grams.
The COVID-19 pandemic further exacerbated the situation. During the height of the crisis, the public was often discouraged from seeking GP appointments for non-urgent health concerns. This disruption led to missed health checks and routine appointments that could have identified high blood pressure and adjusted medications accordingly. Dr. Gupta remarked, “Access to medications, access to evaluations got disrupted. Waiting lists worsened, and the time to see your GP in person worsened. All those things will have a small incremental effect.”
By 2021, the percentage of individuals with undiagnosed high blood pressure had risen to 32 percent, and the average systolic blood pressure increased to 126 mm Hg. Preliminary data for 2022 suggest minimal improvement in hypertension management since the previous year.
Experts believe that the challenges faced by the NHS in controlling hypertension are compounded by a growing population and rising obesity rates. Professor Wilkinson pointed out that the increasing prevalence of pre-packaged foods, often high in salt, is a significant concern. “The population is getting heavier, and that is one of the strongest risk factors for hypertension,” he stated.
Additionally, the shift to remote consultations during the pandemic has affected patient willingness to start blood pressure treatments. “Part of the issue with hypertension is that, because most people don’t feel unwell, there is a degree of reluctance from some people to start treatment,” Professor Wilkinson noted. He emphasized the importance of thorough conversations between patients and healthcare professionals, highlighting that early treatment could lead to a healthier life.
As the NHS grapples with these challenges, it remains essential for public health initiatives to focus on lifestyle changes and improve access to healthcare services. The future of hypertension management will depend on addressing these multifaceted issues to ensure better health outcomes for the population. NHS England has been contacted for comments regarding these findings and the ongoing efforts to address hypertension.
