Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

The prevalence and control of hypertension in adults

Brent M Egan, MD
Section Editor
George L Bakris, MD
Deputy Editors
Daniel J Sullivan, MD, MPH
John P Forman, MD, MSc


The National Health and Nutrition Examination Surveys (NHANES) have provided important epidemiologic information on the prevalence and control of hypertension in the United States between 1960 and 2014 [1-7]. Overall, the prevalence is higher in individuals who are 60 years and older as compared with younger adults and is higher in non-Hispanic blacks compared with non-Hispanic whites and Hispanics. 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" and "Treatment of hypertension in blacks".)

NHANES data from 2011 to 2014 demonstrated that 46 percent of adults 18 years and older in the United States had hypertension (defined as a systolic pressure ≥130 mmHg and/or a diastolic pressure ≥80 mmHg) [1]. Based upon the size of the adult population, this translates into 103 million adults with hypertension. Prior to the redefinition of hypertension by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, the prevalence of hypertension (defined as a systolic pressure ≥140 mmHg and/or a diastolic pressure ≥90 mmHg) was 32 percent [8] and had remained relatively constant since 1999 [6,7]. (See "Overview of hypertension in adults", section on 'Definitions'.)

Using the prior definition of hypertension, prevalence estimates among adults from 90 countries worldwide (approximately 31 percent in 2010) were similar to those in the United States [9]. In surveys similar to NHANES that were 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) [10,11].

The estimated global prevalence of hypertension is high. In a review, pooled data suggested that 26 percent of the world's adult population (972 million) had hypertension, using the prior definition, in the year 2000 [12]. In 2010, this estimate increased to 31 percent of the global population, or 1.39 billion people [13]. Rates were higher in low- and middle-income (31.5 percent) than in high-income (28.5 percent) countries. Long-term projections suggest that, by 2025, 29 percent of adults worldwide would have hypertension (ie, 1.56 billion people globally) [12].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
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 ©2017 UpToDate, Inc.
  1. Muntner P, Carey RM, Gidding S, et al. Potential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Circulation 2017.
  2. 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.
  3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 2003; 290:199.
  4. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303:2043.
  5. 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.
  6. Yoon SS, Carroll MD, Fryar CD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS Data Brief 2015; :1.
  7. Egan BM, Li J, Hutchison FN, Ferdinand KC. Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals. Circulation 2014; 130:1692.
  8. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.
  9. Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension 1995; 26:60.
  10. 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.
  11. 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.
  12. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217.
  13. Mills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation 2016; 134:441.
  14. 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.
  15. 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.
  16. 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.
  17. Navar-Boggan AM, Pencina MJ, Williams K, et al. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA 2014; 311:1424.
  18. 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.
  19. 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.
  20. Jaffe MG, Lee GA, Young JD, et al. Improved blood pressure control associated with a large-scale hypertension program. JAMA 2013; 310:699.
  21. He J, Irazola V, Mills KT, et al. Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial. JAMA 2017; 318:1016.
  22. Dolor RJ, Schulman KA. Financial incentives in primary care practice: the struggle to achieve population health goals. JAMA 2013; 310:1031.
  23. 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.
  24. 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.
  25. 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.