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High Blood Pressure: Tackling the Silent Killer

We need to work across the health system and with our partners to raise awareness and motivate people - at every age and across all our communities - to take control of their blood pressure and invest in their health, for now and for the future.

High blood pressure is often dubbed the silent killer because so many people don't know they have it and yet it can lead to a number of fatal conditions. If it's left untreated, high blood pressure increases the risks of having a stroke or heart disease. It affects our lives in other ways as well, increasing the risks of chronic kidney disease and cognitive decline. This is because chronically raised blood pressure can impair the blood supply to our vital organs, such as our brains, hearts and kidneys.

High blood pressure (blood pressure of 140/90mmHg or higher) can often be avoided and effectively treated. So the fact that over 12 million people in the UK have the condition - and that over 5 million of these people remain undiagnosed - is a terrible, and unacceptable, waste of health and life on a huge scale. It also contributes to lower life expectancy for the worst-off, because high blood pressure is more common among the most deprived communities.

High blood pressure is, in fact, one of the most important preventable causes of premature ill-health and death in the country, second only to tobacco, and is often linked with other risks to health, such as diabetes and obesity.

It's time for renewed action to tackle this problem. That means better prevention, so that fewer people develop high blood pressure in the first place. It means doing a much better job of diagnosing high blood pressure and making sure that people are effectively treated so that their blood pressure is under control - something that's not the case for almost 40% of people on treatment.

It's an ambitious agenda, and one that Public Health England, together with partners, is committed to championing.

So what do we have to do, to improve this country's record on prevention, early detection and treatment? We've seen encouraging progress on all of these areas in recent years, but we know that great lessons can be learned by looking at what other countries have achieved. For instance, surveys show that in Canada and the US, there's higher awareness of the problem amongst members of the general population compared with England, as well as higher levels of treatment, better control of high blood pressure and lower death rates from heart disease and stroke.

Prevention starts with the evidence of what drives high blood pressure and focusing on those risks that can be modified. Diet is key here - too much salt in the diet increases the risk of high blood pressure, as does obesity. Other risks include harmful levels of alcohol, physical inactivity and poor stress management.

So some key actions include trying to keep salt intake below 6g per day, following the eat well plate, and getting 150 minutes or more exercise per week. This isn't as daunting as it may sound: cycling, gardening or walking that bit further as part of a daily commute are examples of how we can all become more physically active.

As a population, we tend to consume too much salt and alcohol, and have high levels of obesity and low levels of physical activity, so there's potential for many of us to lower our blood pressure by making lifestyle changes. The reason this matters is that most of us could reduce our risk of cardiovascular disease by reducing our blood pressure; some research suggests there may be health benefits from a population reduction in blood pressure, even for individuals whose blood pressures are in the currently 'normal' range.

We've seen some success already - perhaps most notably the 15% reduction in population salt intake as a result of a national salt reduction programme, which experts say is likely to have contributed to falls in blood pressure in England. The World Health Organization describes systematic salt reduction, targeting the whole population, as among the most cost-effective interventions to reduce the negative consequences of high blood pressure.

We also need to link our efforts to prevent high blood pressure in people affected by the cluster of conditions, such as diabetes and high cholesterol, which combined, greatly increase the risks of cardiovascular disease (stroke and heart disease). You can read more about this approach in England's cardiovascular disease outcomes strategy.

But prevention isn't enough. We also have to become much better at detecting high blood pressure earlier. Over 5 million people have high blood pressure that isn't diagnosed. Closing this gap is one of the benefits of the NHS Health Check programme, which systematically targets the top seven causes of premature death in people between the ages of 40 and 74. Public Health England has also been trialling supplementary approaches to detection through a recent pilot project in Wakefield. Individuals also have a role to play in continuing to monitor their own blood pressure (recommended home monitors are now available at very low cost).

Even after diagnosis, however, there's the final challenge of making sure that people are treated effectively. That's not the case for far too many people. Even though we have strong evidence for the effectiveness of drugs and lifestyle changes, there is a lot of variation in how well people's blood pressure is controlled. An important area of focus for us is to understand where and why the quality of treatment varies and what we can do about it.

Getting prevention, detection and treatment right can't be done by one institution or one service alone. We need to work across the health system and with our partners to raise awareness and motivate people - at every age and across all our communities - to take control of their blood pressure and invest in their health, for now and for the future.


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