Has blood pressure control changed among adults with hypertension over the past 20
years in the US? In this serial cross-sectional study that included 18 262 US adults
aged 18 years or older with hypertension, with data weighted to be representative
of the US population, the age-adjusted estimated proportion with controlled blood
pressure increased from 31.8% in 1999-2000 to 48.5% in 2007-2008, remained stable
through 2013-2014 (53.8%), and then declined to 43.7% in 2017-2018. The prevalence
of controlled blood pressure in the US may have decreased from 2013-2014 to 2017-2018.
Controlling blood pressure (BP) reduces the risk for cardiovascular disease. To determine
whether BP control among US adults with hypertension changed from 1999-2000 through
2017-2018. Serial cross-sectional analysis of National Health and Nutrition Examination
Survey data, weighted to be representative of US adults, between 1999-2000 and 2017-2018
(10 cycles), including 18 262 US adults aged 18 years or older with hypertension defined
as systolic BP level of 140 mm Hg or higher, diastolic BP level of 90 mm Hg or higher,
or use of antihypertensive medication. The date of final data collection was 2018.
Calendar year. Mean BP was computed using 3 measurements. The primary outcome of BP
control was defined as systolic BP level lower than 140 mm Hg and diastolic BP level
lower than 90 mm Hg. Among the 51 761 participants included in this analysis, the
mean (SD) age was 48 (19) years and 25 939 (50.1%) were women; 43.2% were non-Hispanic
White adults; 21.6%, non-Hispanic Black adults; 5.3%, non-Hispanic Asian adults; and
26.1%, Hispanic adults. Among the 18 262 adults with hypertension, the age-adjusted
estimated proportion with controlled BP increased from 31.8% (95% CI, 26.9%-36.7%)
in 1999-2000 to 48.5% (95% CI, 45.5%-51.5%) in 2007-2008 ( P < .001 for trend), remained
stable and was 53.8% (95% CI, 48.7%-59.0%) in 2013-2014 ( P = .14 for trend), and
then declined to 43.7% (95% CI, 40.2%-47.2%) in 2017-2018 ( P = .003 for trend).
Compared with adults who were aged 18 years to 44 years, it was estimated that controlled
BP was more likely among those aged 45 years to 64 years (49.7% vs 36.7%; multivariable-adjusted
prevalence ratio, 1.18 [95% CI, 1.02-1.37]) and less likely among those aged 75 years
or older (37.3% vs 36.7%; multivariable-adjusted prevalence ratio, 0.81 [95% CI, 0.65-0.97]).
It was estimated that controlled BP was less likely among non-Hispanic Black adults
vs non-Hispanic White adults (41.5% vs 48.2%, respectively; multivariable-adjusted
prevalence ratio, 0.88; 95% CI, 0.81-0.96). Controlled BP was more likely among those
with private insurance (48.2%), Medicare (53.4%), or government health insurance other
than Medicare or Medicaid (43.2%) vs among those without health insurance (24.2%)
(multivariable-adjusted prevalence ratio, 1.40 [95% CI, 1.08-1.80], 1.47 [95% CI,
1.15-1.89], and 1.36 [95% CI, 1.04-1.76], respectively). Controlled BP was more likely
among those with vs those without a usual health care facility (48.4% vs 26.5%, respectively;
multivariable-adjusted prevalence ratio, 1.48 [95% CI, 1.13-1.94]) and among those
who had vs those who had not had a health care visit in the past year (49.1% vs 8.0%;
multivariable-adjusted prevalence ratio, 5.23 [95% CI, 2.88-9.49]). In a series of
cross-sectional surveys weighted to be representative of the adult US population,
the prevalence of controlled BP increased between 1999-2000 and 2007-2008, did not
significantly change from 2007-2008 through 2013-2014, and then decreased after 2013-2014.
This study uses US National Health and Nutrition Examination Survey data to characterize
changes in blood pressure control among adults with hypertension between 1999-2000
and 2017-2018 overall and by age, race, insurance type, and health care access.