UKKW news: Lecture stresses need for streamlined approach to hypertension management

Professor Ian Wilkinson, President of the British and Irish Hypertension Society, used his State-of-the-Art Plenary Lecture at UK Kidney Week 2026 to warn of the scale of the global burden of hypertension and propose a simplified framework to improve blood pressure management.

Setting the scale of the problem, Professor Wilkinson drew on a report from the World Health Organization indicating that 1.4 billion people worldwide live with hypertension, contributing to 11 million deaths annually and a 2% loss of global GDP. Compared with other modifiable risk factors, including smoking, hypertension is the leading driver of premature mortality and disability. Evidence shows that a modest lowering in blood pressure of 10 mmHg is associated with a 17% reduced risk of coronary heart disease and a 27% lowering of the risk of stroke. 

Despite this, a recent study showed that blood pressure control in England has worsened since 2010 – a situation that Professor Wilkinson described as “a national disgrace”. He argued that a contributing factor is the number of guidelines, which often conflict with each other, and their length, which can run to hundreds of pages.

To address this complexity, Professor Wilkinson and colleagues have proposed “the ‘4 Ss’ for successful blood pressure control”, as outlined in The Journal of Hypertension.  

• Salt and satiety. Educate people about how to reduce their salt intake and to achieve and maintain a healthy weight.
• Sensible drugs, sensible doses. 
  • Follow the NICE algorithm but prescribe the specific drugs with the strongest supporting evidence:
    • A (ACE inhibitors): lisinopril or perindopril
    • C (CCBs): amlodipine or lercanidipine
    • D (thiazides): chlorthalidone or indapamide
  • Simplify blood pressure target to 130/80 mmHg for (almost) all renal patients, irrespective of whether readings are taken in the clinic or at home.
  • Aim to achieve this target within 6 months.
• pSeudo-resistant hypertension. Be wary of white-coat hypertension (always take three readings and ignore the first). Confirm medical adherence, as an estimated 25% of patients are not taking some, or all, of their prescribed medications for hypertension.
• Secondary hypertension. Be alert to secondary hypertension which is rare in the general hypertensive population, except for renal disease, hypertension in pregnancy and hyperaldosteronism. Consider medications the person may be taking – and less obvious causes, such as dietary intake of liquorice, which can mimic the effects of Conn’s syndrome.  

Professor Wilkinson also highlighted the exciting work being carried out by the AIM HY study. It is investigating whether an individual’s genetic ancestry markers and information about the chemical make-up of their blood can be used to predict the most effective blood pressure medications for that person. The aim is to deliver personalised treatment for hypertension from a single blood test.