09 · Chapter

High Blood Pressure

Hypertension is the single largest modifiable risk factor for cardiovascular disease in the UK — and around half of those affected are not adequately controlled.

Key facts and figures

30%
of adults in England had hypertension (high blood pressure).
Source: NHS Digital, Health Survey for England 2021
≥ 140/90
mm Hg clinic threshold for stage 1 hypertension (NICE NG136).
Source: NICE, 2023
Up to 4.2m
people in England could be living with undiagnosed high blood pressure.
Source: DHSC / NHS, 2024

Diagnosis

The NICE thresholds

NICE NG136 defines stage 1 hypertension as a clinic reading ≥ 140/90 mm Hg confirmed by ambulatory (ABPM) or home (HBPM) monitoring averaging ≥ 135/85 mm Hg. Stage 2 is ≥ 160/100 mm Hg clinic / ≥ 150/95 mm Hg ABPM.^{[2]NICE NG136}

Lifestyle

What moves the dial first

NICE recommends a DASH-style diet, reduced salt (< 6 g/day), reduced alcohol, regular physical activity, smoking cessation and weight loss as first-line for everyone, alongside drug therapy where indicated.^[2]NICE^[1]NHS

Treatment

Step-wise pharmacotherapy

For adults under 55 (non–Black African or African-Caribbean): ACE inhibitor or ARB first. For those 55+ or of Black African / African-Caribbean family origin: a calcium-channel blocker first. Thiazide-like diuretics and spironolactone step in at later stages.^{[2]NICE NG136}

References

[1] NHS. High blood pressure (hypertension) · 2024
[2] NICE. Hypertension in adults: diagnosis and management — NG136 · 2023
[3] NHS Digital. Health Survey for England, 2021 part 2 — Adults' health: Hypertension · 2023
[5] Department of Health and Social Care / NHS. Get your blood pressure checked · 2024