U.S. Hypertension Rates Going Up

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U.S. Hypertension Rates Going Up

The National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics, provides periodic information on the general health of the U.S. adult population. Previous analyses of the NHANES have shown that between 1960 and 1991, the incidence of hypertension in the general population declined.

These findings have been contradicted by the Behavioral Risk Factor Surveillance System, which found that self-reported cases of hypertension increased, from 22.9 percent in 1991 to 24.9 percent in 1999; the primary problem with this system, however, is that blood pressure is not actually measured. Other studies have shown that at best, less than 25 percent of U.S. adults with hypertension have their blood pressure under control - far below the objectives outlined by the Department of Health and Human Services.

To determine trends in the prevalence, awareness, treatment and control of hypertension in the United States, researchers re-examined data compiled by the NHANES between 1998 and 2000. Participants were considered "hypertensive" if their average systolic blood pressure was 140 or higher, their average diastolic blood pressure was 90 or higher, or they were currently taking antihypertensive medications. In addition to blood pressure measurements, the researchers accounted for age, sex, ethnicity, body mass index (BMI), and history of diabetes.

Analysis of the NHANES data found that hypertension awareness rates remained virtually unchanged (69.2% in 1988-1991 vs. 68.9% in 1999-2000). However, treatment and control rates improved significantly between 1988 and 2000 (6.0% and 6.2%, respectively). The overall number of Americans with hypertension appeared to increase significantly. In 1999-2000, the average prevalence of hypertension was 28.7 percent - a 3.6 percent increase compared with data taken from 1988-1991. Non-Hispanic black women had the highest increase in hypertension (7.2%).

Weight increase appeared to be the single biggest contributor to an increase in hypertension. According to the researchers, "Our analysis indicates that BMI was associated with higher hypertension prevalence after adjusting for age, sex, and race/ethnicity, and contributed to more than half of the 3.6% increase in hypertension prevalence. Therefore, the increased prevalence of hypertension ... appears to be partially related to, but not solely secondary to, the increase in BMI."

"This analysis indicates that almost 29% of the adult U.S. population, an estimated 58.4 million individuals, had hypertension in 1999-2000," the researchers also note: "This is an overall increase from 1988-1991 and demonstrates a reversal of the previously reported trend of an overall decline in hypertension prevalence between 1960 and 1991 using the NHANES survey. ... The increase in hypertension prevalence in women, non-Hispanic blacks, and older individuals highlights the need for interventions that would target prevention in those groups."

Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. Journal of the American Medical Association, July 9, 2003:290(2), pp199-206.
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