Diagnosis, Treatment, and Control of Hypertension Among US Adults: The National Health and Nutrition Examination Survey, 2009 to 2020

OBJECTIVES: The 2020 US Surgeon General’s Call-to-Action recommends focus areas to promote health equity in hypertension management. Recent literature suggests a declining trend in BP control among US adults. We sort to determine causes of such decline and potential changes in treatment patterns.

METHODS: Non-pregnant adults (≥ 18 years) with hypertension from National Health and Nutrition Examination Survey (NHANES) 2009 to 2012, 2013 to 2016, and 2017 to 2020 were identified for the study. Hypertension was defined as systolic BP ≥ 90 mmHg or antihypertensive medication use. Undiagnosed hypertension was defined as having high BP and never having been told that they had hypertension. BP control among those with hypertension was defined as systolic BP < 140 mmHg and diastolic BP < 90 mmHg.

RESULTS: The prevalence of undiagnosed hypertension increased from 17.9% in 2009 to 2012 to 20.7% in 2017 to 2020 (P trend=0.028). The increasing trend was particularly pronounced among African Americans, women and 40-59 age group. Among those with diagnosed hypertension, the proportion of antihypertensive medication use remained unchanged (90.0% to 89.9%, P trend=0.716). However, rates of combination therapy were 55.2%, 54.4% and 51.3% in 2009 to 2012, 2013 to 2016 and 2017 to 2020, respectively (P trend= 0.031). Compared to African Americans and whites, Hispanic Americans were significantly less likely to receive combination therapy. Decreased rates of combination therapy were also observed among younger age groups (30.5% to 16.9%, P trend < 0.01 for 18-39 age group; 49.8% to 41.9%, P trend = 0.017 for 40-59 age group) as compared to the 60+ age group (62.0% to 61.2%, P trend = 0.329). BP control rates declined from 64.2% to 61.4% (P trend = 0.040) among individuals with diagnosed hypertension.

CONCLUSIONS: Decreased rates of antihypertensive combination therapy likely contributed to the declined BP control in recent years.