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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 [1-6]. 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 (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" and "Treatment of hypertension in blacks".)

NHANES data from 2011 to 2014 demonstrated that 29 percent of adults 18 years and older in the United States had hypertension [2,3,5,7-9], and, based upon the size of the adult population, this translates into 72 million adults with hypertension. The prevalence of hypertension among adults in the United States has remained relatively constant since 1999 [5,6] and is higher than the nadir of 24 percent between 1988 and 1994 [1,3,5,6,8,10].

One possible explanation for the increased prevalence of hypertension from 1988 through 1994 to more recent surveys may be the 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.

Estimates of hypertension prevalence among adults from 90 countries worldwide (approximately 31 percent in 2010) are similar to those in the United States [10]. 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) [7,11].

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Literature review current through: Sep 2017. | This topic last updated: Jun 12, 2017.
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  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. Yoon SS, Carroll MD, Fryar CD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS Data Brief 2015; :1.
  6. 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.
  7. 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.
  8. 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.
  9. Navar-Boggan AM, Pencina MJ, Williams K, et al. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA 2014; 311:1424.
  10. 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.
  11. 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.
  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. Egan BM, Li J, Small J, et al. The growing gap in hypertension control between insured and uninsured adults: National Health and Nutrition Examination Survey 1988 to 2010. Hypertension 2014; 64:997.
  18. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345:479.
  19. 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.
  20. 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.
  21. Jaffe MG, Lee GA, Young JD, et al. Improved blood pressure control associated with a large-scale hypertension program. JAMA 2013; 310:699.
  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.