Prevalence and control rates of hypertension in the USA: 2017–2018

Background

Recent review of hypertension guidelines requires fresh updates of prevalence and control rates. Though retrospective analysis provided burden estimates, control rates were grossly misleading. We set out to update the prevalence and control rates of hypertension in the USA using contemporary NHANES data.

Methods

Persons with mean systolic blood pressure (mSBP) ≥130 mmHg or mean diastolic blood pressure (mDBP) ≥80 mmHg or self-reported current use of antihypertensive medications were classified as hypertensives. Hypertensives on medications with mSBP <130 mmHg and mDBP <80 mmHg were classified as having well-controlled hypertension. Subgroup comparisons of hypertension prevalence were computed using Chi-square test. Predictors of hypertension and well-controlled BP were assessed using multivariable logistic regressions. Two tailed p-values <0.05 were considered statistically significant.

Results

The prevalence of hypertension in the USA in 2017–2018 was 49.64% (95% CI 46.67–52.61) corresponding to 115(95% CI 104–128) million persons. NH Blacks: 58.53% (95% CI 55.39–61.60); Men: 54.46% (95% CI 51.01–57.87); older persons and obese individuals: 61.03% (95% CI 57.31–64.63) as well as persons with diabetes and CKD, comparatively. The overall rate of well-controlled hypertension was 39.64% (95% CI 36.20–42.81). Persons with at least a college degree: OR 2.20(95% CI 1.02–5.04, p=0.049) and persons with incomes ≥3 times the poverty threshold; OR 1.88(95% CI 1.1.8–2.99, p=0.011) had higher rates of well-controlled hypertension when compared to lowest categories.

Conclusion

One in every two persons ≥20 years in the USA has hypertension with only 39.64% on medications having well-controlled hypertension. Significant discrepancies exist in the burden and control rates in different subpopulation categories. Targeted interventions could help improve the prevalence and hypertension control rates in the USA.