Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


The prevalence and control of hypertension

PREVALENCE

The National Health and Nutrition Examination Survey (NHANES) data have provided important epidemiologic information on the prevalence and control of hypertension in the United States between 1960 and 2008 [1-4]. Overall, the prevalence is higher in older individuals, non-Hispanic blacks, and women (figure 1). The prevalence of hypertension in children is discussed separately. (See "Definition and diagnosis of hypertension in children and adolescents".)

It remains unclear why non-Hispanic blacks are more likely to become hypertensive. Both genetic and environmental factors are probably important, one of which may be a greater likelihood of low birth weight, which appears to predict higher pressures in adulthood. (See "Possible role of low birth weight in the pathogenesis of primary (essential) hypertension".)

NHANES data from 2007 to 2008 and United States Census bureau information demonstrated a 28 to 30 percent prevalence of hypertension in the 18-years-and-older population of the United States [2,3,5-7]. This translates into approximately 65 million hypertensives in the adult population in the United States, which is substantially higher than the 43.2 million estimate derived from the 1988-1991 NHANES-III survey [1,3,6].

One possible explanation for the increased prevalence of hypertension reported in the latest survey data is that, over the last decade, there has been a marked increase in obesity and average body mass index [2]. It is estimated, for example, that one-half of the relative increased prevalence of hypertension may be due to an increased weight of the average individual.

A higher prevalence of hypertension has also been found in other industrialized societies. In surveys similar to the United States NHANES performed in Canada and Europe, the age- and sex-adjusted prevalence of hypertension (defined as 140/90 mmHg or higher) ranged from 20 to 55 percent (figure 1) [5,8].

   

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: Aug 12, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995; 25:305.
  2. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 2003; 290:199.
  3. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303:2043.
  4. Centers for Disease Control and Prevention (CDC). Vital signs: prevalence, treatment, and control of hypertension--United States, 1999-2002 and 2005-2008. MMWR Morb Mortal Wkly Rep 2011; 60:103.
  5. Joffres M, Falaschetti E, Gillespie C, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open 2013; 3:e003423.
  6. Fields LE, Burt VL, Cutler JA, et al. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 2004; 44:398.
  7. Navar-Boggan AM, Pencina MJ, Williams K, et al. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA 2014; 311:1424.
  8. Wolf-Maier K, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289:2363.
  9. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217.
  10. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens 2009; 27:963.
  11. Wang YR, Alexander GC, Stafford RS. Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med 2007; 167:141.
  12. Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310:959.
  13. Banegas JR, Segura J, Ruilope LM, et al. Blood pressure control and physician management of hypertension in hospital hypertension units in Spain. Hypertension 2004; 43:1338.
  14. Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation 2005; 112:1651.
  15. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345:479.
  16. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560.
  17. Fletcher RD, Amdur RL, Kolodner R, et al. Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration health data repository. Circulation 2012; 125:2462.
  18. Jaffe MG, Lee GA, Young JD, et al. Improved blood pressure control associated with a large-scale hypertension program. JAMA 2013; 310:699.
  19. Dolor RJ, Schulman KA. Financial incentives in primary care practice: the struggle to achieve population health goals. JAMA 2013; 310:1031.
  20. Bardach NS, Wang JJ, De Leon SF, et al. Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial. JAMA 2013; 310:1051.
  21. Petersen LA, Simpson K, Pietz K, et al. Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA 2013; 310:1042.
  22. Mosterd A, D'Agostino RB, Silbershatz H, et al. Trends in the prevalence of hypertension, antihypertensive therapy, and left ventricular hypertrophy from 1950 to 1989. N Engl J Med 1999; 340:1221.