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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
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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