Prevalence of hypertension and controlled hypertension among United States adults : Evidence from NHANES 2017-18 survey

Background
This study aims to compare the prevalence of hypertension (HTN) and controlled hypertension (CHTN) in US adults and determine the absolute difference in the prevalence of HTN and CHTN between the JNC7 and ACC/AHA 2017 guidelines.

Methods
Data for this study were derived from the most recent cycle of the National Health and Nutrition Examination Survey (NHANES) 2017–2018. After excluding participants with missing systolic blood pressure (BP) or diastolic BP and aged <18 years, 4730 participants were included in the final analyses. BP was defined as the average of the first three measurements. The prevalence of HTN and CHTN, including absolute differences of these prevalences, were estimated using both JNC7 and ACC/AHA 2017 guidelines.

Results
The overall weighted prevalence of HTN was 31.7% (95% CI: 28.7–34.8) based on JNC7, while the corresponding prevalence was 45.6% (95% CI: 43.0–48.3) when new guideline of ACC/AHA was used. Of the people who had HTN according to the JNC7 and ACC/AHA 2017 guidelines, 48.2% (95% CI: 44.4–52.0) and 21.0% (95% CI: 18.1–24.2) had a controlled blood pressure level, respectively. When blood pressure was assessed using both guidelines, the greatest absolute increase in rates of HTN and CHTN was 17.4% and 30.0% in people aged 40–59 years, respectively.

Conclusion
Given the high burden of disease due to complications arising from untreated HTN, as well as the higher costs of untreated disease, new guidelines have important public health implications to early detection of patients at risk and prevent complications across different populations.