DiagnosticPrevention Understanding inequalities and gaps in care for people with high blood pressure in North West London

High blood pressure affects about one in three adults in England and is the biggest single risk factor for heart attacks and strokes. Many people remain undiagnosed, untreated, or inadequately treated. In North West London, one of the most culturally and ethnically diverse regions of the country, fewer people are diagnosed than expected, but there was limited evidence to understand where inequalities exist and how to target action.

Working with the North West London ARC, we assessed GP records from 2 million North West London residents. We found significant inequalities, including that people of Black ethnicities were less likely to be treated or have well-controlled blood pressure. We also identified over 120,000 adults with high blood pressure who had not had further investigations or formal diagnosis, and we recommended targeted approaches to proactively identify and review these patients.

So far, our findings and recommendations were shared via the North West London ICB’s Health Equity symposium in June 2025. North West London’s integrated primary care contract for cardio-renal-metabolic conditions starting in April 2026 now incentivises GP practices to proactively call in patients with raised blood pressure for investigation and diagnosis.

Based on our findings, we expect this to reduce under-diagnosis, improve blood pressure treatment and control, and help address ethnic disparities in care. Across the population, earlier diagnosis and treatment could prevent heart attacks and stroke, improve quality of life, and deliver cost savings to the NHS through reduced hospital admissions and long-term complications.