Context Prior analyses of National Health and Nutrition Examination Survey (NHANES)
data through 1991 have suggested that hypertension prevalence is declining,
but more recent self-reported rates of hypertension suggest that the rate
Objective To describe trends in the prevalence, awareness, treatment, and control
of hypertension in the United States using NHANES data.
Design, Setting, and Participants Survey using a stratified multistage probability sample of the civilian
noninstitutionalized population. The most recent NHANES survey, conducted
in 1999-2000 (n = 5448), was compared with the 2 phases of NHANES III conducted
in 1988-1991 (n = 9901) and 1991-1994 (n = 9717). Individuals aged 18 years
or older were included in this analysis.
Main Outcome Measures Hypertension, defined as a measured blood pressure of 140/90 mm Hg or
greater or reported use of antihypertensive medications. Hypertension awareness
and treatment were assessed with standardized questions. Hypertension control
was defined as treatment with antihypertensive medication and a measured blood
pressure of less than 140/90 mm Hg.
Results In 1999-2000, 28.7% of NHANES participants had hypertension, an increase
of 3.7% (95% confidence interval [CI], 0%-8.3%) from 1988-1991. Hypertension
prevalence was highest in non-Hispanic blacks (33.5%), increased with age
(65.4% among those aged ≥60 years), and tended to be higher in women (30.1%).
In a multiple regression analysis, increasing age, increasing body mass index,
and non-Hispanic black race/ethnicity were independently associated with increased
rates of hypertension. Overall, in 1999-2000, 68.9% were aware of their hypertension
(nonsignificant decline of −0.3%; 95% CI, −4.2% to 3.6%), 58.4%
were treated (increase of 6.0%; 95% CI, 1.2%-10.8%), and hypertension was
controlled in 31.0% (increase of 6.4%; 95% CI, 1.6%-11.2%). Women, Mexican
Americans, and those aged 60 years or older had significantly lower rates
of control compared with men, younger individuals, and non-Hispanic whites.
Conclusions Contrary to earlier reports, hypertension prevalence is increasing in
the United States. Hypertension control rates, although improving, continue
to be low. Programs targeting hypertension prevention and treatment are of