Nicky Bray: The silent killer we’re still ignoring

Zurich’s chief underwriter Nicky Bray urges advisers to put blood pressure on the customer agenda – and make the case for prevention and protection.

The case for action is stark: more than six million people in the UK are living with high blood pressure without knowing it.

Hypertension – persistently high blood pressure – is one of the biggest public health challenges worldwide. The World Health Organization describes it as the leading modifiable risk factor for stroke and a major cause of heart attacks, heart failure and kidney disease.

It is also one of the most preventable and treatable causes of premature death. Every day in the UK, 350 people suffer a stroke or heart attack that could have been avoided.

And while it’s often associated with ageing, younger adults are far from immune. The latest Health Survey for England shows 11% of adults have undiagnosed hypertension (blood pressure above 140/90) – around 6.3 million people.

Prevalence is highest among men. Nearly one in five (19%) men aged 55-64 have undiagnosed high blood pressure, alongside 14% of those aged 45-54 and 13% of those aged 35-44. Even in the youngest group, 16-34-year-olds, 3% are living with high blood pressure without realising it.

Covid’s lasting impact

Despite advances in medicines and clinical practice, the picture has barely changed in 20 years. Back in 2003, 31% of adults were living with hypertension. Two decades later, it still hovers around 30%.

Even where it is recognised and treated, control is often poor: 40% of men and 36% of women on treatment still recorded high readings in the 2022 survey.

The pandemic has added another layer. Routine health checks were missed and emerging evidence suggests the Covid-19 infection itself can raise long-term blood pressure.

A review of 30 studies found most showed a heightened risk of developing hypertension post-Covid, with some pointing to lasting arterial stiffness that effectively ages blood vessels by several years.

Taken together, these trends suggest hypertension prevalence could rise further, with delayed diagnoses and Covid-related changes feeding through into the data in the coming years.

For advisers, this reinforces the importance of reviewing customer health, risk profiles and the adequacy of cover.

The silent killer

High blood pressure is called the ‘silent killer’ for good reason: in most cases you simply don’t feel it. Stress or exertion can cause temporary spikes, but persistent high readings usually develop unnoticed. In extreme cases, symptoms may include headaches, blurred vision or nosebleeds, but by then serious damage may already be done.

The consequences are wide-ranging. Hypertension is the single biggest risk factor for stroke, responsible for around half of all cases. It plays a major role in heart attacks, heart failure and other cardiovascular disease, which already accounts for a quarter of all deaths in the UK. It is also linked to vascular dementia, where reduced blood flow leads to cognitive decline.

Crucially, high blood pressure is also a leading condition behind early exits from the labour market, alongside cancer and mental health issues – underlining the importance of income protection for those affected.

Last year, the NHS Confederation report Paving a new pathway to prevention highlighted cardiovascular disease as a leading cause of illness and inequality, costing the NHS £7.4 billion annually and the wider economy £15.8 billion.

Lifestyle risk factors

Blood pressure isn’t only about genetics or ageing – lifestyle choices make a big difference. Excessive salt or sugar consumption, being overweight, smoking or using certain drugs such as cocaine can all drive it up.

Alcohol can also affect blood pressure even in moderate amounts. “Many people assume that only large quantities of alcohol are harmful, but research shows the risk of high blood pressure starts to rise at around 1.5 units per day. That’s equivalent to just a small glass of wine or half a pint of beer,” says Bray.

Conversely, positive changes can help reduce risk. Even modest improvements make a difference: a 10 mmHg drop in systolic pressure (the top number in a blood pressure reading, relating to when the heart contracts) is linked to a 17% lower risk of coronary heart disease, 27% lower risk of stroke, 28% lower risk of heart failure and a 13% reduction in all-cause mortality.

The good news is that lowering blood pressure doesn’t always mean medical intervention. Exercise, weight management and better diet all help.

Exposure to sunshine has also been shown to lower blood pressure via nitric oxide release in the skin, while research suggests drinking beetroot juice can reduce systolic readings by around 4%.

Know your numbers

Because high blood pressure develops silently, the only way to know is to measure it. Blood pressure can be checked at pharmacies, NHS health checks or as part of an insurance medical exam. These screenings can catch problems early, before damage is done – and that’s exactly why insurers ask for them when customers apply for higher levels of cover.

Getting a reliable reading is important. A poor technique can give false reassurance or exaggerate the risk.

Following some simple steps can help:

• Sit comfortably with back supported and feet flat on the floor;
• Rest quietly for 3-5 minutes before the test;
• Keep your arm supported at heart level;
• Use the right cuff size, placed directly on the skin;
• Avoid talking during the test and don’t smoke or consume alcohol or caffeine for 30 minutes beforehand;
• Make sure your bladder is empty and the room is at a comfortable temperature.

Adviser action points

For advisers, the message is clear: encourage customers to check their blood pressure regularly and ensure the readings are accurate. Early detection opens the door to lifestyle change, medical treatment and better long-term health.

But there’s also a financial dimension. Because high blood pressure strikes without warning and often triggers serious conditions, it highlights the value of robust protection policies – cover that pays out when it’s needed, based on full disclosure. These policies safeguard customers’ financial security just as effectively as health checks safeguard their wellbeing.

In our experience, when customers report a history of high blood pressure, there are often additional health factors that may not come to light initially. GPs frequently reveal information that wasn’t disclosed, such as higher or less well-controlled blood pressure than reported, past or current alcohol use, high blood sugar, pre-diabetes or diabetes, previous heart conditions or abnormal test results and incomplete smoking histories.

Full and accurate disclosure is essential, both for effective underwriting and for advisers to provide the best possible guidance. Advisers should use this as an opportunity to ask targeted follow-up questions, helping to capture a complete picture of the customer’s health.

The silent killer is still with us, but it doesn’t have to be. By raising awareness, encouraging regular checks and ensuring the right protection is in place, advisers can make a difference – protecting both lives and livelihoods.