High blood pressure, a condition that becomes increasingly common after the age of 40, is under-diagnosed and inadequately treated among Irish adults over 50, according to a new study by The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin. Published in the international journal Open Heart, the research reveals significant gaps in the management of hypertension, despite European guidelines aimed at improving diagnosis and treatment.
Hypertension is a major risk factor for cardiovascular disease, stroke, dementia, and chronic kidney disease, yet it often remains undetected due to its asymptomatic nature. The 12-year longitudinal study, involving over 8,000 participants, offers a comprehensive view of how high blood pressure is managed in Ireland, scrutinizing adherence to the latest European Society of Cardiology (ESC) guidelines, including the 2024 recommendations.
Persistent Challenges in Hypertension Management
The study highlights that the unmet need in hypertension care is not a new issue but one that has persisted over time. The most recent data collection indicates that 62% of individuals aged 50 and over with high blood pressure are not appropriately managed. This includes those with undiagnosed hypertension, those diagnosed but not receiving treatment, and those on treatment but not meeting recommended blood pressure targets.
When applying the 2024 ESC guidelines, which recommend a lower blood pressure target of <130/80 mmHg, the figure rises to 77%, indicating that more than three out of every four older adults with hypertension in Ireland are not optimally managed.
Key Findings from TILDA
- Hypertension prevalence remained consistently high, increasing from 63% to 71% over 12 years.
- Only 56% of those with hypertension are aware of their condition, underscoring substantial under-diagnosis.
- 71% of those with hypertension were on medication, but treatment intensity was often suboptimal: only 14% received guideline-recommended dual therapy, while 57% were on guideline-recommended monotherapy.
- Among those receiving treatment, just 33% achieved the guideline-recommended blood pressure target of <130/80 mmHg, while 54% were controlled to <140/90 mmHg.
Overall, 62% (445,000 people) with hypertension in Ireland were not appropriately managed according to the 2018 ESC guidelines, consistent with previous TILDA evidence showing poor long-term control of modifiable cardiovascular risk factors.
Implications for Public Health
The findings reveal that 40% of the population had elevated blood pressure (SBP value of 120–139mmHg or a DBP value of 70-89mmHg), and 71% of this group showed evidence of high cardiovascular risk. Interestingly, people aged 85 years and older and those with moderate to severe frailty were less likely to have undiagnosed hypertension and were more likely to be taking guideline-recommended medications, achieving similar rates of blood pressure control compared to the wider population.
Dr. Caoimhe McGarvey, Research Fellow at TILDA and Specialist Registrar in Geriatric Medicine at St James’s Hospital Dublin, emphasized the significance of the study:
“High blood pressure is a common and treatable condition. However, when left untreated, it can cause heart disease, kidney disease, stroke, and dementia. This study highlights a significant unmet need in the management of high blood pressure in Ireland. Systematically addressing this need has the potential to dramatically reduce avoidable complications and improve health outcomes for older adults across the country.”
Expert Opinions and Future Directions
Professor Donal Sexton, Consultant Nephrologist and Associate Professor at Trinity College Dublin, added:
“This study exemplifies the unique ability of the TILDA study to assess how well we are performing as a nation in the treatment of modifiable risk factors for cardiovascular disease, chronic kidney disease, and premature death. It emphasizes the unmet need in the management of high blood pressure in Ireland and the urgent requirement to improve its recognition and treatment.”
Regius Professor Rose Anne Kenny, Principal Investigator of TILDA and Professor of Medical Gerontology at Trinity College Dublin, stressed the importance of regular blood pressure checks:
“The message for the public is simple: if you are 40 years or over, get your blood pressure checked. It’s quick, painless, and can make a life-changing difference.”
This research aligns closely with current Health Service Executive (HSE) and Department of Health priorities, which emphasize the early detection and effective management of chronic conditions to support healthy ageing and reduce avoidable illness. Regular blood pressure checks, particularly for older adults or those with other health conditions, are encouraged to significantly reduce the risk of heart disease, stroke, kidney disease, and dementia.
