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(Hypertension. 1995;26:60-69.)
© 1995 American Heart Association, Inc.

Articles

Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population

Data From the Health Examination Surveys, 1960 to 1991

Vicki L. Burt; Jeffrey A. Cutler; Millicent Higgins; Michael J. Horan; Darwin Labarthe; Paul Whelton; Clarice Brown; Edward J. Roccella

From the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (V.L.B.); Johns Hopkins Medical Institutions, Baltimore, Md (P.W.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (E.J.R., C.B., J.A.C., M.H., M.J.H.); and University of Texas, Houston Health Science Center, School of Public Health (D.L.).

Correspondence to Vicki L. Burt, ScM, RN, Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Rd, Room 1070, Hyattsville, MD 20782. E-mail vlb2@nch09a.em.cdc.gov.

Abstract The objective of this study was to describe secular trends in the distribution of blood pressure and prevalence of hypertension in US adults and changes in rates of awareness, treatment, and control of hypertension. The study design comprised nationally representative cross-sectional surveys with both an in-person interview and a medical examination that included blood pressure measurement. Between 6530 and 13 645 adults, aged 18 through 74 years, were examined in each of four separate national surveys during 1960-1962, 1971-1974, 1976-1980, and 1988-1991. Protocols for blood pressure measurement varied significantly across the surveys and are presented in detail. Between the first (1971-1974) and second (1976-1980) National Health and Nutrition Examination Surveys (NHANES I and NHANES II, respectively), age-adjusted prevalence of hypertension at 160/95 mm Hg remained stable at approximately 20%. In NHANES III (1988-1991), it was 14.2%. Age-adjusted prevalence at 140/90 mm Hg peaked at 36.3% in NHANES I and declined to 20.4% in NHANES III. Age-specific prevalence rates have decreased for every age-sex-race subgroup except for black men aged 50 and older. Age-adjusted mean systolic pressures declined progressively from 131 mm Hg at the NHANES I examination to 119 mm Hg at the NHANES III examination. The mean systolic and diastolic pressures of every sex-race subgroup declined between NHANES II and III (3 to 6 mm Hg systolic, 6 to 9 mm Hg diastolic). During the interval between NHANES II and III, the threshold for defining hypertension was changed from 160/95 to 140/90 mm Hg. Hypertension awareness has increased substantially at both thresholds, to 89% and 73% for 160/1995 and 140/90 mm Hg, respectively. Compared with only 16% of all people with hypertension being <160/95 mm Hg in 1960-1962 and 1971-1974, 64% of all people with hypertension now have it controlled to below the 160/95 mm Hg threshold but only 29% to below 140/90 mm Hg. For people with treated hypertension, the rate of control (<140/90 mm Hg) ranges from 47% of black men to 60% of white women. Hypertension prevalence in the United States has declined progressively since 1971, and the distributions of systolic and diastolic pressures have shifted downward during the approximately 30-year period between 1960-1962 and 1988-1991. Variation in blood pressure measurement techniques may explain some of the decline in prevalence and the downward shift in distribution. Hypertension awareness, treatment, and control also have improved tremendously during the same period, accounting for much of the shift at the upper end of the distribution. Despite these favorable trends, many people with hypertension are unaware of their condition, and many more are untreated or inadequately treated.

Key Words: hypertension, essential • blood pressure • prevalence • cross-sectional studies • NHANES

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				J. A. Staessen, T. Kuznetsova, and K. Stolarz Hypertension Prevalence and Stroke Mortality Across Populations JAMA, May 14, 2003; 289(18): 2420 - 2422. [Full Text] [PDF]

				E. S. Ford, A. H. Mokdad, W. H. Giles, and G. A. Mensah Serum Total Cholesterol Concentrations and Awareness, Treatment, and Control of Hypercholesterolemia Among US Adults: Findings From the National Health and Nutrition Examination Survey, 1999 to 2000 Circulation, May 6, 2003; 107(17): 2185 - 2189. [Abstract] [Full Text] [PDF]

				T. Y. Goraya, S. J. Jacobsen, T. E. Kottke, R. L. Frye, S. A. Weston, and V. L. Roger Coronary Heart Disease Death and Sudden Cardiac Death: A 20-Year Population-based Study Am. J. Epidemiol., May 1, 2003; 157(9): 763 - 770. [Abstract] [Full Text] [PDF]

				B. M. Psaty and D. Rennie Stopping Medical Research to Save Money: A Broken Pact With Researchers and Patients JAMA, April 23, 2003; 289(16): 2128 - 2131. [Full Text] [PDF]

				M. Moser No Surprises in Blood Pressure Awareness Study Findings: We Can Do a Better Job Arch Intern Med, March 24, 2003; 163(6): 654 - 656. [Full Text] [PDF]

				S. J. C. Davies, P. R. Jackson, L. E. Ramsay, and P. Ghahramani Drug Intolerance Due to Nonspecific Adverse Effects Related to Psychiatric Morbidity in Hypertensive Patients Arch Intern Med, March 10, 2003; 163(5): 592 - 600. [Abstract] [Full Text] [PDF]

				P. August Initial Treatment of Hypertension N. Engl. J. Med., February 13, 2003; 348(7): 610 - 617. [Full Text] [PDF]

				S. Ruland, R. Raman, S. Chaturvedi, S. Leurgans, and P. B. Gorelick Awareness, treatment, and control of vascular risk factors in African Americans with stroke Neurology, January 14, 2003; 60(1): 64 - 68. [Abstract] [Full Text] [PDF]

				K. D. Graves and P. M. Miller Behavioral Medicine in the Prevention and Treatment of Cardiovascular Disease Behav Modif, January 1, 2003; 27(1): 3 - 25. [Abstract] [PDF]

				M. Tamminen, J. Westerbacka, S. Vehkavaara, and H. Yki-Jarvinen Insulin-Induced Decreases in Aortic Wave Reflection and Central Systolic Pressure Are Impaired in Type 2 Diabetes Diabetes Care, December 1, 2002; 25(12): 2314 - 2319. [Abstract] [Full Text] [PDF]

				D. K. Arnett, P. G. McGovern, D. R. Jacobs Jr., E. Shahar, S. Duval, H. Blackburn, and R. V. Luepker Fifteen-Year Trends in Cardiovascular Risk Factors (1980-1982 through 1995-1997): The Minnesota Heart Survey Am. J. Epidemiol., November 15, 2002; 156(10): 929 - 935. [Abstract] [Full Text] [PDF]

				B. M. Psaty, T. A. Manolio, N. L. Smith, S. R. Heckbert, J. S. Gottdiener, G. L. Burke, J. Weissfeld, P. Enright, T. Lumley, N. Powe, et al. Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults: The Cardiovascular Health Study Arch Intern Med, November 11, 2002; 162(20): 2325 - 2332. [Abstract] [Full Text] [PDF]

				E. R. Miller 3rd, T. P. Erlinger, D. R. Young, M. Jehn, J. Charleston, D. Rhodes, S. K. Wasan, and L. J. Appel Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT) Hypertension, November 1, 2002; 40(5): 612 - 618. [Abstract] [Full Text] [PDF]

				D. Levy, S. Kenchaiah, M. G. Larson, E. J. Benjamin, M. J. Kupka, K. K.L. Ho, J. M. Murabito, and R. S. Vasan Long-Term Trends in the Incidence of and Survival with Heart Failure N. Engl. J. Med., October 31, 2002; 347(18): 1397 - 1402. [Abstract] [Full Text] [PDF]

				M. M. Redfield Heart Failure -- An Epidemic of Uncertain Proportions N. Engl. J. Med., October 31, 2002; 347(18): 1442 - 1444. [Full Text] [PDF]

				G. D. Murthy Barriers to Blood Pressure Control Arch Intern Med, October 28, 2002; 162(19): 2245 - 2245. [Full Text] [PDF]

				K. Gupta, S. Gupta, and J. D. Cohen Undertreatment of Hypertension: A Dozen Reasons Arch Intern Med, October 28, 2002; 162(19): 2246 - 2248. [Full Text] [PDF]

				K. M. Flegal, M. D. Carroll, C. L. Ogden, and C. L. Johnson Prevalence and Trends in Obesity Among US Adults, 1999-2000 JAMA, October 9, 2002; 288(14): 1723 - 1727. [Abstract] [Full Text] [PDF]

				M. Koc, A. Toprak, H. Tezcan, A. Bihorac, E. Akoglu, and I. C. Ozener Uncontrolled hypertension due to volume overload contributes to higher left ventricular mass index in CAPD patients Nephrol. Dial. Transplant., September 1, 2002; 17(9): 1661 - 1666. [Abstract] [Full Text] [PDF]

				E. J. Benjamin, S. C. Smith Jr, R. S. Cooper, M. N. Hill, and R. V. Luepker Task Force #1--magnitude of the prevention problem: opportunities and challenges J. Am. Coll. Cardiol., August 21, 2002; 40(4): 588 - 603. [Full Text] [PDF]

				H. A. Llewellyn-Thomas, J. M. Paterson, J. A. Carter, A. Basinski, M. G. Myers, G. D. Hardacre, E. V. Dunn, R. B. D'Agostino, P. A. Wolf, and C. D. Naylor Primary Prevention Drug Therapy: Can It Meet Patients' Requirements for Reduced Risk? Med Decis Making, August 1, 2002; 22(4): 326 - 339. [Abstract] [PDF]