Trends and influence factors in the prevalence, awareness, treatment, and control of hypertension among US adults from 1999 to 2018

Abstract

Objective We aimed to describe the trends and influence factors in the prevalence, awareness, treatment, and control of hypertension among US Adults from 1999 to 2018. Methods We utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning ten survey cycles (n = 53,496). Prevalence, awareness, treatment, and control of hypertension were calculated using survey weights. Joinpoint regression and survey-weighted generalized linear models were used to analyze trends and influence factors, respectively. Results The estimated prevalence of hypertension increased significantly from 33.53% to 40.58% (AAPC = 0.896, P = 0.002) during 1999–2018 with dropping rate of newly diagnosed hypertension from 8.62% to 4.82% before 2014 (APC = -4.075, P = 0.001), and then rose to 7.51% in 2018 (APC = 12.302, P = 0.126). Despite modest improvements or stability in the awareness, treatment, and control since 1999, the latter two remained inadequate in 2018 at 59.52% and 51.71%. There was an uptrend in the use of angiotensin-converting enzyme inhibitors (from 24.02% to 45.71%) and angiotensin receptor blockers (from 20.22% to 38.38%), and downtrend in β-blocker (from 12.71% to 4.21%). Men were at higher risk of incidence, un-awareness, un-treatment, and un-control for hypertension. Lower income and education were associated with susceptibility to hypertension, while being married was favorable for treatment and control. Optimal health reduced the incidence of hypertension, and increased the awareness and treatment. Conclusion Although the rate of newly diagnosed hypertension has declined slightly since 2010 in the US, the prevalence of hypertension is increasing, and treatment and control rates remain inadequate. To manage hypertension effectively, we need to focus on screening and prevention for high-risk populations, while advocating for optimal health to improve the burden of hypertension.

Trends in hypertension and hypertension treatment in primary care in general practices in Germany between 2013 and 2022

“…The present study adds to the literature by showing that decreasing trends in the diagnosis of hypertension persisted in the last years despite the human crisis related to the COVID-19 pandemic. Finally, it should also be noted that other studies have found either stable ( 10 , 11 , 14 ) or increasing trends in the prevalence of hypertension ( 9 , 15 , 16 , 18 ). This discrepancy in the findings in the literature may be related to several factors, such as differences in the settings in which the studies of interest were conducted, differences in the years during which the data were collected, and differences in the definition of hypertension.…”

“…It should be noted that this study apart, little research has analyzed trends in the prescription of antihypertensive drugs. A survey of 53,496 adults living in the USA found that, among those with hypertension, there was an uptrend in the use of ACEis and ARBs and a downtrend in the use of BBs between 1999 and 2018 ( 18 ). Regarding CCBs, there was an increase in the use of these molecules until 2005 and a subsequent decrease after 2005.…”

“…In the last decade, several studies have focused on the trends of the prevalence of hypertension ( 9 – 18 ). There is some discrepancy in the findings of this literature, and trends have been found to increase ( 9 , 15 , 16 , 18 ), stagnate ( 10 , 11 , 14 ), or decrease ( 12 , 13 , 17 ). Although this body of research has advanced the field, there are several limitations that should be acknowledged.…”

“…Although this body of research has advanced the field, there are several limitations that should be acknowledged. First, a substantial proportion of these studies were conducted in China ( 15 , 16 ) and the United States of America (USA) ( 11 , 12 , 18 ), and their results may not be extrapolated to other countries. Second, in these studies, trends in the prevalence of hypertension were analyzed prior to 2019, and there is no data on how the coronavirus disease 2019 (COVID-19) pandemic has impacted these trends.…”

“…This lack of data is of concern, as some evidence suggests that COVID-19 may favor the onset of hypertension ( 19 , 20 ) and that the related health crisis may have had deleterious effects on the management of hypertension ( 21 ). Third, to the best of the authors' knowledge, only one research has studied trends in the prescription of different antihypertensive drugs (e.g., angiotensin-converting enzyme inhibitors [ACEis], beta-blockers [BBs], and diuretics) ( 18 ). Taking these limitations into consideration, more data are warranted on how the diagnosis and treatment of hypertension have evolved in recent years.…”