This study evaluate whether blood pressure management has improved in England between 2003 and 2006, using cross-sectional, nationally representative, random samples of 8834 (in 2003) and 7478 (in 2006) noninstitutionalized adults (aged > or =16 years) of mean age 46 (in 2003) and 47 (in 2006) years. Overall mean blood pressure levels in 2006 were 130.8/74.2 mm Hg in men and 124.0/72.4 mm Hg in women. Awareness of hypertension increased significantly in the overall population (from 62% in 2003% to 66% in 2006; P<0.001), the increase being significant in women (from 64% in 2003% to 71% in 2006; P<0.001) but not in men (from 60% to 62%; P=0.26). Similarly, the proportion treated had risen significantly overall (from 48% to 54%; P<0.001) and in women (from 52% to 62%; P<0.001) but not in men (from 43% to 47%; P=0.05). Control rates (<140/90 mm Hg) were higher in 2006 than in 2003 (from 22% to 28%; P<0.001) and had increased more among women than men: from 23% to 32% in women (P<0.001) and from 21% to 24% in men (P=0.02). Among those on treatment, control rates increased from 46% to 52% (P<0.001; from 44% to 53% in women, P<0.001; and from 48% to 52% in men, P=0.18). The most common agents used for monotherapy have changed since 2003 and were angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Where > or =2 drugs were used, the most common antihypertensive class used varied by age and ethnicity. Awareness, treatment, and control of hypertension increased between 2003 and 2006, particularly in women, but opportunities for further improvement remain.