However, the number of people started on treatment immediately may be reduced because of undertaking investigations first. The population with severe hypertension is very small, and the proportion with severe hypertension and additional symptoms that suggest accelerated hypertension is even smaller; therefore, resource impact is unlikely to be substantial. Return to recommendations Context High blood pressure (hypertension) is one of the most important, treatable causes of premature morbidity and mortality in the world. It is a major risk factor for stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. In 2015, it was reported that high blood pressure affected more than 1 in 4 adults in England (31% of men; 26% of women) around 13.5 million people and contributed to 75,000 deaths. The clinical management of hypertension accounts for 12% of visits to primary care and up to 2.1 billion of healthcare expenditure. Managing the cardiovascular events caused by hypertension also consumes considerable resources. The guideline covers adults (over 18 years) with suspected or diagnosed hypertension, including those with type 2 diabetes. Between 2010 and 2020, progress has been made to improve the diagnosis and management of hypertension: the population average blood pressure in England has fallen by about 3 mmHg systolic and the proportion of adults with untreated high blood pressure has decreased. However, the Public Health England Blood Pressure Action Plan called for further action to reduce the population average blood pressure by 5 mmHg through improved prevention, detection and management (Public Health England's Tackling high blood pressure: from evidence into action, 2015 and Tackling high blood pressure: an update, 2018). 