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Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018

Educational Objective
To understand recent US trends in blood pressure control.
1 Credit CME
Key Points

Question  Has blood pressure control changed among adults with hypertension over the past 20 years in the US?

Findings  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.

Meaning  The prevalence of controlled blood pressure in the US may have decreased from 2013-2014 to 2017-2018.


Importance  Controlling blood pressure (BP) reduces the risk for cardiovascular disease.

Objective  To determine whether BP control among US adults with hypertension changed from 1999-2000 through 2017-2018.

Design, Setting, and Participants  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.

Exposures  Calendar year.

Main Outcomes and Measures  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.

Results  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]).

Conclusions and Relevance  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.

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Article Information

Corresponding Author: Paul Muntner, PhD, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Ste 140J, Birmingham, AL 35294 (pmuntner@uab.edu).

Accepted for Publication: July 21, 2020.

Published Online: September 9, 2020. doi:10.1001/jama.2020.14545

Author Contributions: Drs Muntner and Jaeger had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Muntner, Fine.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Muntner, Wozniak.

Critical revision of the manuscript for important intellectual content: Hardy, Fine, Jaeger, Wozniak, Levitan, Colantonio.

Statistical analysis: Muntner, Jaeger, Wozniak, Levitan.

Administrative, technical, or material support: Muntner.

Supervision: Muntner, Colantonio.

Conflict of Interest Disclosures: Dr Muntner reported receiving grant funding and consulting fees from Amgen Inc. Dr Levitan reported receiving grant funding from and serving on advisory boards for Amgen Inc; and serving as a consultant to Novartis. Dr Colantonio reported receiving grant funding from Amgen Inc. No other disclosures were reported.

Funding/Support: Drs Muntner and Jaeger receive support through grant R01HL144773 from the National Heart, Lung, and Blood Institute and grant 15SFRN2390002 from the American Heart Association. Drs Muntner and Hardy receive support through grant R01HL117323 from the National Heart, Lung, and Blood Institute. Dr Muntner receives support through grant R01HL139716 from the National Heart, Lung, and Blood Institute.

Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, the US government, or the American Medical Association.

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