Trends in Hypertension Prevalence and Control in the United States Over 25 Years

Abstract

Despite sustained public health efforts, hypertension remains highly prevalent in the United States, with persistent disparities across demographic and socioeconomic groups. We examined 25-year trends in hypertension prevalence, undiagnosed hypertension, and on-treatment uncontrolled hypertension in the United States using nationally representative National Health and Nutrition Examination Survey (NHANES) data from adults aged ≥18 years. Hypertension was defined as systolic BP ≥130 mmHg, diastolic BP ≥80 mmHg, or current antihypertensive use. Undiagnosed hypertension was defined as elevated BP without prior diagnosis or treatment, while on-treatment uncontrolled hypertension was defined as diagnosed hypertension with BP ≥130/80 mmHg despite treatment. Survey-weighted generalized linear models were used to estimate adjusted prevalence ratios (PRs), accounting for age, sex, race and ethnicity, family income-to-poverty threshold ratio, and study period, with interaction terms to assess differential temporal trends. Among 61,847 participants (51.7% women; 21.0% Black; 25.1% Hispanic; 23.2% aged >65 years), adjusted hypertension prevalence was 44.3% (95% CI: 43.6–44.9) and remained stable over time (p for trend = 0.50). Relative to >65 years adults, hypertension prevalence increased significantly over time among the younger groups. Compared to White adults, Black adults had higher hypertension prevalence (52.7% vs 44.7%; p < 0.001), and Hispanic adults experienced a greater increase in prevalence over time. Among individuals with hypertension, undiagnosed hypertension declined from 46.4% to 41.5%, and on-treatment uncontrolled hypertension declined from 74.7% to 63.9% (both p < 0.001). Despite improvements in diagnosis and treatment control, hypertension prevalence remains high, with persistent sociodemographic disparities highlighting the need for targeted and equity-focused interventions.