Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Age-stratified prevalence, treatment status, and associated factors of hypertension among US adults following application of the 2017 ACC/AHA guideline

Abstract

The 2017 American College of Cardiology/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults reduced the systolic/diastolic blood pressure thresholds to define hypertension, including recommendations about treatment initiations and goals. We estimated the age-stratified prevalence, treatment status, and factors associated with hypertension among US adults aged ≥ 20 years based on this guideline. This cross-sectional study used the 2011–2016 National Health and Nutrition Examination Survey data. The primary outcomes were the presence and treatment status of hypertension. Among 16,103 participants, the proportions (95% confidence interval) of hypertensive, treatment-indicated, untreated individuals among treatment-indicated, and treatment goals not met among treated for hypertension by age groups were, respectively, 17.4% (15.8–19.1), 6.9% (6.1–7.8), 67.6% (61.0–73.5), and 58.6% (46.1–70.2) among 20–34 years; 39.2% (37.0–41.5), 24.4% (22.4–26.5), 41.8% (37.7–46.0), and 50.4% (44.7–56.1) among 35–49 years; 62.3% (60.1–64.6), 51.4% (49.0–53.8), 31.0% (28.2–34.0), and 51.9% (47.6–56.1) among 50–64 years; 77.7% (75.3–79.8), 77.0% (74.7–79.2), 27.0% (24.3–29.8), and 63.1% (59.4–66.5) among ≥ 65 years; and 46.8% (45.4–48.3), 36.9% (35.4–38.5), 33.2% (30.9–35.5), and 56.7% (54.1–59.3) among overall population. Despite some dissimilarities, the prevalence, treatment eligibility, and odds of hypertension were higher among non-Hispanic blacks and among people with high cholesterol, low high-density lipoprotein, chronic kidney disease, diabetes, increased body weight, and low leisure-time physical activity in all age strata. The prevalence and treatment eligibility were high among adults from all age groups; however, a significant proportion of participants, especially those who were younger, had blood pressure levels above the treatment goals or were untreated. Addressing the associated characteristics from a younger age may help prevent the complications of hypertension.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1

Data availability

The datasets are publicly available at the Centers for Disease Control and Prevention’s website. Dr. Kibria has full access to the data and takes responsibility for theintegrity of the data analysis.

References

  1. Heron M. National Vital Statistics Reports National Center for Health Statistics. Annual. Hyattsville, MD. 2018. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_06.pdf. Accessed 5 Dec 2018.

  2. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.

    Article  Google Scholar 

  3. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1603–58.

    Article  Google Scholar 

  4. GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1260–344.

    Article  Google Scholar 

  5. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT, et al. Potential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Circulation. 2017;109–18. https://doi.org/10.1161/CIRCULATIONAHA.117.032582.

    Article  Google Scholar 

  6. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017; HYP.0000000000000065.

  7. Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24:471–6.

    CAS  Article  Google Scholar 

  8. Dorans KS, Mills KT, Liu Y, He J. Trends in Prevalence and Control of Hypertension According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline. J Am Heart Assoc. 2018;7:e008888.

    Article  Google Scholar 

  9. Ostchega Y, Zhang G, Hughes JP, Nwankwo T. Factors associated with hypertension control in US adults using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999–2016. Am J Hypertens. 2018;31:886–94.

    Article  Google Scholar 

  10. Yano Y, Reis JP, Colangelo LA, Shimbo D, Viera AJ, Allen NB, et al. Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline with cardiovascular events later in life. JAMA. 2018;320:1774.

    Article  Google Scholar 

  11. Bundy JD, Mills KT, Chen J, Li C, Greenland P, He J. Estimating the association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: an analysis of national data. JAMA Cardiol. 2018;3:572.

    Article  Google Scholar 

  12. Park S, Gillespie C, Baumgardner J, Yang Q, Valderrama AL, Fang J, et al. Modeled state-level estimates of hypertension prevalence and undiagnosed hypertension among US adults during 2013–2015. J Clin Hypertens. 2018;20:1395–410.

    Article  Google Scholar 

  13. Borrud L, Chiappa MM, Burt Vi.L., Gahche J, Zipf G, Dohrmann SM, et al. National Health and Nutrition Examination Survey: National Youth Fitness Survey Plan, operations, and analysis, 2012. 2012. https://www.cdc.gov/nchs/data/series/sr_02/sr02_163.pdf. Accessed 27 Aug 2018.

  14. Curtin LR, Mohadjer LK, Dohrmann SM, Kruszon-Moran D, Mirel LB, Carroll MD, et al. National Health and Nutrition Examination Survey: sample design, 2007–2010. 2013. https://www.cdc.gov/nchs/data/series/sr_02/sr02_160.pdf.

  15. Johnson C, Burt ViL, Mohadjer LK. National Health and Nutrition Examination Survey: sample design, 2011–2014. 2014. https://www.cdc.gov/nchs/data/series/sr_02/sr02_162.pdf.

  16. Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J. National health and nutrition examination survey: plan and operations, 1999–2010. Vital- Health Stat. 2013;1:1–37.

    Google Scholar 

  17. National Center for Health Statistics. NCHS Research Ethics Review Board (ERB) approval. 2017. https://www.cdc.gov/nchs/nhanes/irba98.htm. Accessed 11 Sep 2018.

  18. National Health and Nutrition Examination Survey Data Documentation. https://wwwn.cdc.gov/Nchs/Nhanes/2013-2014/BPX_H.htm#Eligible_Sample.

  19. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    Article  Google Scholar 

  20. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.

    Article  Google Scholar 

  21. U.S. Department of Health & Human Services. Poverty Guidelines [WWW Document]. 2019. https://aspe.hhs.gov/poverty-guidelines. Accessed 16 Feb 2019.

  22. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138:923–36.

    CAS  Article  Google Scholar 

  23. Stata Corporation, College Station, Texas, USA. Stata 14.0. 2015.

  24. Al Kibria GM. Racial/ethnic disparities in prevalence, treatment and control of hypertension among US adults following application of the 2017 American College of Cardiology/American Heart Association guideline. Preventive Medicine Reports. 2019;100850.

  25. Al Kibria GM, Swasey K, Sharmeen A, Day B. Estimated change in prevalence and trends of childhood blood pressure levels in the United States after application of the 2017 AAP guideline. Prev Chronic Dis. 2019;16:180528.

    Article  Google Scholar 

  26. Gudmundsdottir H, Høieggen A, Stenehjem A, Waldum B, Os I. Hypertension in women: latest findings and clinical implications. Ther Adv Chronic Dis. 2012;3:137–46.

    CAS  Article  Google Scholar 

  27. Papadakis MA. Current medical diagnosis and treatment. McGraw-Hill Education/Medical; 2016.

  28. Davidson’s principles and practice of medicine. s.l.: Elsevier; 2018.

  29. Riaz H, Khan MS, Siddiqi TJ, Usman MS, Shah N, Goyal A, et al. Association between obesity and cardiovascular outcomes: a systematic review and meta-analysis of mendelian randomization studies. JAMA Netw Open. 2018;1:e183788.

    Article  Google Scholar 

  30. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–209.

    Article  Google Scholar 

  31. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    CAS  Article  Google Scholar 

  32. Sorof JM, Portman RJ. White coat hypertension in children with elevated casual blood pressure. J Pedia. 2000;137:493–7.

    CAS  Article  Google Scholar 

  33. Sharma AK, Metzger DL, Rodd CJ. Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics Guidelines. JAMA Pediatr. 2018;172:557.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are thankful to the survey participants and staff for their relentless efforts to obtain the NHANES data.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: Gulam Kibria; formal analysis: Gulam Kibria; writing—original draft preparation: Gulam Kibria, Brendan Day, and Atia Sharmeen; writing—review and editing: Amy Nemirovsky and Brendan Day.

Corresponding author

Correspondence to Gulam Muhammed Al Kibria.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Al Kibria, G.M., Nemirovsky, A., Sharmeen, A. et al. Age-stratified prevalence, treatment status, and associated factors of hypertension among US adults following application of the 2017 ACC/AHA guideline. Hypertens Res 42, 1631–1643 (2019). https://doi.org/10.1038/s41440-019-0275-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-019-0275-x

Further reading

Search

Quick links