Hypertension Management in England: A Serial Cross-Sectional Study From 1994 to 2011

Study Questions:

What were the changes in blood pressure management between 1994 and 2011 in England?


The investigators did a serial cross-sectional study of five Health Survey for England surveys based on nationally representative samples of noninstitutionalized adults (ages ≥16 years). Mean blood pressure levels and rates of awareness, treatment, and control of hypertension were assessed. Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or receiving treatment for high blood pressure.


The mean blood pressure levels of men and women in the general population and among patients with treated hypertension progressively improved between 1994 and 2011. In patients with treated hypertension, blood pressure improved from 150.0 (standard error [SE], 0.59)/80.2 (0.27) mm Hg to 135.4 (0.58)/73.5 (0.41) mm Hg. Awareness, treatment, and control rates among men and women combined also improved significantly across each stage of this 17-year period, with the prevalence of control among treated patients almost doubling, from 33% (SE 1.4) in 1994 to 63% (1.7) in 2011. Nevertheless, of all adults with survey-defined hypertension in 2011, hypertension was controlled in only 37%.


The authors concluded that if the same systematic improvement in all aspects of hypertension management continues until 2022, 80% of patients with treated hypertension will have controlled blood pressure levels, with a potential annual saving of approximately 50,000 major cardiovascular events.


These data from a large representative sample of the English adult population show that all aspects of hypertension management have improved systematically across the five national surveys that focused on cardiovascular disease since 1994. The so-called rule of halves (i.e., that half of patients with high blood pressure in a population have been diagnosed, half of those detected have been treated, and half of those treated have been controlled), is now the rule of two-thirds. However, despite these systemic improvements, the rates of diagnosis, treatment, and control of raised blood pressure remain suboptimal, and every effort needs to be made to target a 100% goal of diagnosis, treatment, and control of hypertension. While several hundreds of thousands of cardiovascular events might possibly have already been prevented as a result of improvements in practice, many more will be prevented with additional improvements.

Clinical Topics: Prevention, Hypertension

Keywords: Prevalence, Cross-Sectional Studies, Blood Pressure Determination, Hypertension, England, Health Surveys

< Back to Listings