Trends in hypertension prevalence, control, and antihypertensive use in England from 2003 to 2021: insights from annual, nationwide Health Surveys for England.

Objective: To determine the annual trends over two decades in hypertension diagnosis, true hypertension prevalence, and control and use of antihypertensive drugs in England. Design: Annual, representative, nationwide Health Surveys for England from 2003 to 2021. Setting: Nationally representative sample consisting of participants from private households, identified through stratified, national, multistage sampling. Participants: 67 242 people older than 16 years surveyed between 2003 and 2021. Results: Between 2003 and 2021, the prevalence of measured hypertension decreased significantly from 37.8% in 2003 to 33.2% in 2018 (average annual percentage change (AAPC) -0.9%, 95% confidence interval -1.6% to -0.6%). Mean population systolic and diastolic blood pressure decreased significantly between 2003 to 2019 (systolic blood pressure from 128.7 to 124.0 mm Hg, AAPC -0.15%, -0.21% to -0.11%; diastolic blood pressure from 73.7 to 71.8 mm Hg, AAPC -0.12%, -0.20% to -0.04%). The prevalence of those with undiagnosed hypertension in the community decreased from 32.6% in 2003 to 23.7% in 2011, gradually worsening thereafter, with a steep increase in 2021 when 32.4% of those with hypertension were undiagnosed (AAPC -1.04%, -1.92% to -0.22%). Among people diagnosed (known) with hypertension, the proportion of those with blood pressure controlled to target increased across the study period (AAPC 1.66%, 0.04% to 2.27%), but this was mainly driven by the significant increase from 47.3% in 2003 to 56.5% in 2009 (AAPC 3.62%, 1.52% to 5.74%). A plateau was observed from 2011 onwards when there was no further significant improvement in the proportion of people with diagnosed (known) hypertension and blood pressure controlled to target. People with diagnosed (known) but uncontrolled hypertension showed a small but significant decrease in the mean number (standard deviation) of antihypertensive drugs used during the study period from 2.17 (0.86) in 2003 to 2.14 (0.96) in 2021 (AAPC -0.18%, -0.68% to -0.03%). Those with diagnosed (known) and controlled hypertension had no significant change in the mean number of drugs used. Conclusions: These findings indicate that there was a significant improvement in hypertension prevalence and control in the 2000s, with a plateau after 2011. The prevalence of undiagnosed hypertension in the community reduced in the early 2000s and 2010s, but has since returned to the same level as two decades ago.