This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (772)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Ihab Hajjar, MD, MS; Theodore A. Kotchen, MD

JAMA. 2003;290:199-206.

Context  Prior analyses of National Health and Nutrition Examination Survey (NHANES) data through 1991 have suggested that hypertension prevalence is declining, but more recent self-reported rates of hypertension suggest that the rate is increasing.

Objective  To describe trends in the prevalence, awareness, treatment, and control of hypertension in the United States using NHANES data.

Design, Setting, and Participants  Survey using a stratified multistage probability sample of the civilian noninstitutionalized population. The most recent NHANES survey, conducted in 1999-2000 (n = 5448), was compared with the 2 phases of NHANES III conducted in 1988-1991 (n = 9901) and 1991-1994 (n = 9717). Individuals aged 18 years or older were included in this analysis.

Main Outcome Measures  Hypertension, defined as a measured blood pressure of 140/90 mm Hg or greater or reported use of antihypertensive medications. Hypertension awareness and treatment were assessed with standardized questions. Hypertension control was defined as treatment with antihypertensive medication and a measured blood pressure of less than 140/90 mm Hg.

Results  In 1999-2000, 28.7% of NHANES participants had hypertension, an increase of 3.7% (95% confidence interval [CI], 0%-8.3%) from 1988-1991. Hypertension prevalence was highest in non-Hispanic blacks (33.5%), increased with age (65.4% among those aged 60 years), and tended to be higher in women (30.1%). In a multiple regression analysis, increasing age, increasing body mass index, and non-Hispanic black race/ethnicity were independently associated with increased rates of hypertension. Overall, in 1999-2000, 68.9% were aware of their hypertension (nonsignificant decline of -0.3%; 95% CI, -4.2% to 3.6%), 58.4% were treated (increase of 6.0%; 95% CI, 1.2%-10.8%), and hypertension was controlled in 31.0% (increase of 6.4%; 95% CI, 1.6%-11.2%). Women, Mexican Americans, and those aged 60 years or older had significantly lower rates of control compared with men, younger individuals, and non-Hispanic whites.

Conclusions  Contrary to earlier reports, hypertension prevalence is increasing in the United States. Hypertension control rates, although improving, continue to be low. Programs targeting hypertension prevention and treatment are of utmost importance.

Author Affiliations: Division of Geriatrics, Department of Medicine, Palmetto Health Richland, University of South Carolina, Columbia (Dr Hajjar); Departments of Medicine and Epidemiology, Medical College of Wisconsin, Milwaukee (Dr Kotchen).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Factors in the Increasing Prevalence of Hypertension
Joseph A. Hyder
JAMA. 2003;290(22):2940.
EXTRACT | FULL TEXT  

Sex, Not Just Race
Kresimir Oremus and Zrinka Safaric Oremus
Arch Intern Med. 2005;165(20):2432-2433.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

LUCHAR: Using Computer Technology to Battle Heart Disease Among Latinos
Leeman-Castillo et al.
AJPH 2010;100:272-275.
ABSTRACT | FULL TEXT  

The Relation of Hypertension to Changes in ADL/IADL Limitations of Mexican American Older Adults
Caskie et al.
J Gerontol B Psychol Sci Soc Sci 2010;:gbq001v1-gbq001.
ABSTRACT | FULL TEXT  

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease
Bibbins-Domingo et al.
NEJM 2010;0:NEJMoa0907355v1-1.
ABSTRACT | FULL TEXT  

Designing a Cardiovascular Disease Prevention Web Site for Latinos: Qualitative Community Feedback
Padilla et al.
Health Promot Pract 2010;11:140-147.
ABSTRACT  

High prevalence of abnormal nocturnal oximetry in patients with hypertrophic cardiomyopathy.
Eleid et al.
J Am Coll Cardiol 2009;54:1805-1809.
ABSTRACT | FULL TEXT  

Community-Based Interventions to Promote Blood Pressure Control in a Developing Country: A Cluster Randomized Trial
Jafar et al.
ANN INTERN MED 2009;151:593-601.
ABSTRACT | FULL TEXT  

Blood Cadmium and Lead and Chronic Kidney Disease in US Adults: A Joint Analysis
Navas-Acien et al.
Am J Epidemiol 2009;170:1156-1164.
ABSTRACT | FULL TEXT  

Hypertension, Diabetes, And Elevated Cholesterol Among Insured And Uninsured U.S. Adults
Wilper et al.
Health Aff (Millwood) 2009;28:w1151-w1159.
ABSTRACT | FULL TEXT  

Sex-Specific Trends in Midlife Coronary Heart Disease Risk and Prevalence
Towfighi et al.
Arch Intern Med 2009;169:1762-1766.
ABSTRACT | FULL TEXT  

Impact of Nonadherence to Antihypertensive Therapy
Chobanian
Circulation 2009;120:1558-1560.
FULL TEXT  

Metoprolol Succinate Combination in the Treatment of Hypertension
Papadopoulos and Papademetriou
ANGIOLOGY 2009;60:608-613.
ABSTRACT  

ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease) developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association Endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research.
Redberg et al.
J Am Coll Cardiol 2009;54:1364-1405.
FULL TEXT  

ACCF/AHA 2009 Performance Measures for Primary Prevention of Cardiovascular Disease in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for Primary Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: Endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:1296-1336.
FULL TEXT  

Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial
Cohen et al.
Evid Based Complement Alternat Med 2009;0:nep130v1-nep130.
ABSTRACT | FULL TEXT  

Whole grains and incident hypertension in men
Flint et al.
Am. J. Clin. Nutr. 2009;90:493-498.
ABSTRACT | FULL TEXT  

Trends in 10-Year Predicted Risk of Cardiovascular Disease in the United States, 1976 to 2004
Lopez-Jimenez et al.
Circ Cardiovasc Qual Outcomes 2009;2:443-450.
ABSTRACT | FULL TEXT  

The Hypertension Paradox -- More Uncontrolled Disease despite Improved Therapy
Chobanian
NEJM 2009;361:878-887.
FULL TEXT  

The relationship between circulating endothelial microparticles and arterial stiffness and atherosclerosis in children with chronic kidney disease
Dursun et al.
Nephrol Dial Transplant 2009;24:2511-2518.
ABSTRACT | FULL TEXT  

Trends in Cardiovascular Disease Risk Factors in Individuals With and Without Diabetes Mellitus in the Framingham Heart Study
Preis et al.
Circulation 2009;120:212-220.
ABSTRACT | FULL TEXT  

Hypertension management by family physicians: Is it time to pat ourselves on the back?
Tu
cfp 2009;55:684-685.
FULL TEXT  

Prise en charge de l'hypertension par les medecins de famille: Est-ce le temps de nous feliciter?
Tu
cfp 2009;55:686-687.
FULL TEXT  

Hypertension treatment and control rates: Chart review in an academic family medicine clinic
Houlihan et al.
cfp 2009;55:735-741.
ABSTRACT | FULL TEXT  

Quality Improvement Initiatives Improve Hypertension Care Among Veterans
Choma et al.
Circ Cardiovasc Qual Outcomes 2009;2:392-398.
ABSTRACT | FULL TEXT  

Triple Antihypertensive Therapy With Amlodipine, Valsartan, and Hydrochlorothiazide: A Randomized Clinical Trial
Calhoun et al.
Hypertension 2009;54:32-39.
ABSTRACT | FULL TEXT  

Community-Based Participatory Research From the Margin to the Mainstream: Are Researchers Prepared?
Horowitz et al.
Circulation 2009;119:2633-2642.
ABSTRACT | FULL TEXT  

Consistency of Care and Blood Pressure Control among Elderly African Americans and Whites with Hypertension
Howard et al.
J Am Board Fam Med 2009;22:307-315.
ABSTRACT | FULL TEXT  

Does Reducing Physician Uncertainty Improve Hypertension Control?: Rationale and Methods
Pavlik et al.
Circ Cardiovasc Qual Outcomes 2009;2:257-263.
ABSTRACT | FULL TEXT  

Health and Functioning Among Baby Boomers Approaching 60
Martin et al.
J Gerontol B Psychol Sci Soc Sci 2009;64B:369-377.
ABSTRACT | FULL TEXT  

Cystatin C Levels in U.S. Adults, 1988-1994 Versus 1999-2002: NHANES
Foley et al.
CJASN 2009;4:965-972.
ABSTRACT | FULL TEXT  

Stroke Rates: 1980-2000: The Minnesota Stroke Survey
Lakshminarayan et al.
Am J Epidemiol 2009;169:1070-1078.
ABSTRACT | FULL TEXT  

Effectiveness of Valsartan for Treatment of Hypertension: Patient Profiling and Hierarchical Modeling of Determinants and Outcomes (the PREVIEW Study)
Van der Niepen et al.
The Annals of Pharmacotherapy 2009;43:849-861.
ABSTRACT | FULL TEXT  

Cost Sharing and the Initiation of Drug Therapy for the Chronically Ill
Solomon et al.
Arch Intern Med 2009;169:740-748.
ABSTRACT | FULL TEXT  

Incarceration, Incident Hypertension, and Access to Health Care: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Wang et al.
Arch Intern Med 2009;169:687-693.
ABSTRACT | FULL TEXT  

A 41-Year-Old African American Man With Poorly Controlled Hypertension: Review of Patient and Physician Factors Related to Hypertension Treatment Adherence
Cooper
JAMA 2009;301:1260-1272.
ABSTRACT | FULL TEXT  

Treatment Choices and Patterns in Migraine Patients With and Without a Cardiovascular Risk Profile
Wames-van der Heijden et al.
Cephalalgia 2009;29:322-330.
ABSTRACT | FULL TEXT  

Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon Hypertension Study
Erem et al.
J Public Health (Oxf) 2009;31:47-58.
ABSTRACT | FULL TEXT  

Association of the Calcium-Sensing Receptor Gene with Blood Pressure and Urinary Calcium in African-Americans
Jung et al.
J. Clin. Endocrinol. Metab. 2009;94:1042-1048.
ABSTRACT | FULL TEXT  

Can Self-Reported Strokes Be Used to Study Stroke Incidence and Risk Factors?: Evidence From the Health and Retirement Study
Glymour and Avendano
Stroke 2009;40:873-879.
ABSTRACT | FULL TEXT  

Impact of Obtaining Medications from Pharmaceutical Company Assistance Programs on Therapeutic Goals
Trompeter and Havrda
The Annals of Pharmacotherapy 2009;43:469-477.
ABSTRACT | FULL TEXT  

Isolated Systolic Hypertension and Incident Heart Failure in Older Adults: A Propensity-Matched Study
Ekundayo et al.
Hypertension 2009;53:458-465.
ABSTRACT | FULL TEXT  

Diabetes in African American Youth: Prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study
Mayer-Davis et al.
Diabetes Care 2009;32:S112-S122.
ABSTRACT | FULL TEXT  

Sociodemographic Groups at Risk: Race/Ethnicity
Kleindorfer
Stroke 2009;40:S75-S78.
FULL TEXT  

The aorta and resistant hypertension.
Williams
J Am Coll Cardiol 2009;53:452-454.
FULL TEXT  

Prevalence, Awareness, and Management of Hypertension, Dyslipidemia, and Diabetes Among United States Adults Aged 65 and Older
McDonald et al.
J Gerontol A Biol Sci Med Sci 2009;64A:256-263.
ABSTRACT | FULL TEXT  

Erectile Dysfunction and Cardiovascular Disease: Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors in Men With Both Conditions
Nehra
Mayo Clin Proc. 2009;84:139-148.
ABSTRACT | FULL TEXT  

Racial/Ethnic Disparities in Medication Use Among Veterans with Hypertension and Dementia: A National Cohort Study
Poon et al.
The Annals of Pharmacotherapy 2009;43:185-193.
ABSTRACT | FULL TEXT  

Acute Kidney Injury: New Concepts in Definition, Diagnosis, Pathophysiology, and Treatment
Lattanzio and Kopyt
JAOA: Journal of the American Osteopathic Association 2009;109:13-19.
ABSTRACT | FULL TEXT  

Contributions of a Local Health Examination Survey to the Surveillance of Chronic and Infectious Diseases in New York City
Gwynn et al.
AJPH 2009;99:152-159.
ABSTRACT | FULL TEXT  

Association Between the Dietary Approaches to Hypertension Diet and Hypertension in Youth With Diabetes Mellitus
Gunther et al.
Hypertension 2009;53:6-12.
ABSTRACT | FULL TEXT  

Obesity-induced glomerular hyperfiltration: its involvement in the pathogenesis of tubular sodium reabsorption
Chagnac et al.
Nephrol Dial Transplant 2008;23:3946-3952.
ABSTRACT | FULL TEXT  

Identifying metabolic syndrome without blood tests in young adults--The Terneuzen Birth Cohort
de Kroon et al.
Eur J Public Health 2008;18:656-660.
ABSTRACT | FULL TEXT  

Racial differences in central blood pressure and vascular function in young men
Heffernan et al.
Am. J. Physiol. Heart Circ. Physiol. 2008;295:H2380-H2387.
ABSTRACT | FULL TEXT  

Sex Differences in Blood Pressure Response to Antihypertensive Therapy in Chinese Patients with Hypertension
Fan et al.
The Annals of Pharmacotherapy 2008;42:1772-1781.
ABSTRACT | FULL TEXT  

Hypertension in a Population of Active Duty Service Members
Smoley et al.
J Am Board Fam Med 2008;21:504-511.
ABSTRACT | FULL TEXT  

The Cardiovascular Research Network: A New Paradigm for Cardiovascular Quality and Outcomes Research
Go et al.
Circ Cardiovasc Qual Outcomes 2008;1:138-147.
ABSTRACT | FULL TEXT  

The Darkening Cloud of Diabetes: Do trends in cardiovascular risk management provide a silver lining?
Eurich et al.
Diabetes Care 2008;31:2136-2142.
ABSTRACT | FULL TEXT  

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in United States Adults Between 1988-1994 and 1999-2004
Cutler et al.
Hypertension 2008;52:818-827.
ABSTRACT | FULL TEXT  

Association Between Blood Pressure Responses to the Cold Pressor Test and Dietary Sodium Intervention in a Chinese Population
Chen et al.
Arch Intern Med 2008;168:1740-1746.
ABSTRACT | FULL TEXT  

Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City
Angell et al.
Circ Cardiovasc Qual Outcomes 2008;1:46-53.
ABSTRACT | FULL TEXT  

Hypertension in rheumatoid arthritis
Panoulas et al.
Rheumatology (Oxford) 2008;47:1286-1298.
ABSTRACT | FULL TEXT  

Role of Endothelin-1 in Clinical Hypertension: 20 Years On
Dhaun et al.
Hypertension 2008;52:452-459.
FULL TEXT  

Corin Variant Associated With Hypertension and Cardiac Hypertrophy Exhibits Impaired Zymogen Activation and Natriuretic Peptide Processing Activity
Wang et al.
Circ. Res. 2008;103:502-508.
ABSTRACT | FULL TEXT  

Hypertension in children and adolescents
Bocelli and Ballo
CMAJ 2008;179:343-344.
FULL TEXT  

Ethnic Differences in Renal Responses to Furosemide
Chun et al.
Hypertension 2008;52:241-248.
ABSTRACT | FULL TEXT  

Altered Blood Pressure Progression in the Community and Its Relation to Clinical Events
Ingelsson et al.
Arch Intern Med 2008;168:1450-1457.
ABSTRACT | FULL TEXT  

Burden and Rates of Treatment and Control of Cardiovascular Disease Risk Factors in Obesity: The Framingham Heart Study
Molenaar et al.
Diabetes Care 2008;31:1367-1372.
ABSTRACT | FULL TEXT  

Trends in Diabetes, High Cholesterol, and Hypertension in Chronic Kidney Disease Among U.S. Adults: 1988-1994 to 1999-2004
Fox and Muntner
Diabetes Care 2008;31:1337-1342.
ABSTRACT | FULL TEXT  

Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial
Green et al.
JAMA 2008;299:2857-2867.
ABSTRACT | FULL TEXT  

Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research
Calhoun et al.
Circulation 2008;117:e510-e526.
ABSTRACT | FULL TEXT  

Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease
Mozaffarian et al.
Circulation 2008;117:3031-3038.
FULL TEXT  

Characterization of Resistant Hypertension: Association Between Resistant Hypertension, Aldosterone, and Persistent Intravascular Volume Expansion
Gaddam et al.
Arch Intern Med 2008;168:1159-1164.
ABSTRACT | FULL TEXT  

G Protein-Coupled Receptor Kinase 4: Role in Blood Pressure Regulation
Zeng et al.
Hypertension 2008;51:1449-1455.
FULL TEXT  

Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research
Calhoun et al.
Hypertension 2008;51:1403-1419.
ABSTRACT | FULL TEXT  

Mortality among patients with hypertension from 1995 to 2005: a population-based study
Tu et al.
CMAJ 2008;178:1436-1440.
ABSTRACT | FULL TEXT  

Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Schocken et al.
Circulation 2008;117:2544-2565.
ABSTRACT | FULL TEXT  

Stroke Health and Risk Education (SHARE) Pilot Project: Feasibility and Need for Church-Based Stroke Health Promotion in a Bi-Ethnic Community
Zahuranec et al.
Stroke 2008;39:1583-1585.
ABSTRACT | FULL TEXT  

Screening, Treatment, and Control of Hypertension in US Private Physician Offices, 2003-2004
Ma and Stafford
Hypertension 2008;51:1275-1281.
ABSTRACT | FULL TEXT  

Fact or fiction of the epidemic of chronic kidney disease--let us not squabble about estimated GFR only, but also focus on albuminuria
de Jong and Gansevoort
Nephrol Dial Transplant 2008;23:1092-1095.
FULL TEXT  

Impact of blood pressure on the Doppler echocardiographic assessment of severity of aortic stenosis
Linhartova
Heart 2008;94:508-508.
FULL TEXT  

Gender Difference in Blood Pressure Control and Cardiovascular Risk Factors in Americans With Diagnosed Hypertension
Ong et al.
Hypertension 2008;51:1142-1148.
ABSTRACT | FULL TEXT  

Primary prevention of coronary heart disease in women
Rees et al.
Menopause Int 2008;14:40-45.
ABSTRACT | FULL TEXT  

Neuroanatomical Correlates of Fluid Intelligence in Healthy Adults and Persons with Vascular Risk Factors
Raz et al.
Cereb Cortex 2008;18:718-726.
ABSTRACT | FULL TEXT  

Screening for Chronic Kidney Disease: Where Does Europe Go?
de Jong et al.
CJASN 2008;3:616-623.
ABSTRACT | FULL TEXT  

Cross-Sectional Association between Perceived Discrimination and Hypertension in African-American Men and Women: The Pitt County Study
Roberts et al.
Am J Epidemiol 2008;167:624-632.
ABSTRACT | FULL TEXT  

Prevalence, Awareness, Treatment, and Control of Hypertension in the Jackson Heart Study
Wyatt et al.
Hypertension 2008;51:650-656.
ABSTRACT | FULL TEXT  

Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003
Curtis et al.
Arch Intern Med 2008;168:418-424.
ABSTRACT | FULL TEXT  

Trends and Cardiovascular Mortality Effects of State-Level Blood Pressure and Uncontrolled Hypertension in the United States
Ezzati et al.
Circulation 2008;117:905-914.
ABSTRACT | FULL TEXT  

Genetic Variation Within Adrenergic Pathways Determines In Vivo Effects of Presynaptic Stimulation in Humans
Fung et al.
Circulation 2008;117:517-525.
ABSTRACT | FULL TEXT  

Racial Differences in Nitric Oxide--Dependent Vasorelaxation
Mata-Greenwood and Chen
Reproductive Sciences 2008;15:9-25.
ABSTRACT