Modeled state-level estimates of hypertension prevalence and undiagnosed hypertension among US adults during 2013-2015

Abstract

Hypertension affects about one in three US adults, from recent surveillance, or four in nine based on the 2017 ACC/AHA Hypertension Guideline; about half of them have their blood pressure controlled, and nearly one in six are unaware of their hypertension status. National estimates of hypertension awareness, treatment, and control in the United States are traditionally based on measured BP from National Health and Nutrition Examination Survey (NHANES); however, at the state level, only self-reported hypertension awareness and treatment are available from BRFSS. We used national- and state-level representative samples of adults (≥20 years) from NHANES 2011-2014 and BRFSS 2013 and 2015, respectively. The authors generated multivariable logistic regression models using NHANES to predict the probability of hypertension and undiagnosed hypertension and then applied the fitted model parameters to BRFSS to generate state-level estimates. The predicted prevalence of hypertension was highest in Mississippi among adults (42.4%; 95% CI: 41.8-43.0) and among women (42.6%; 41.8-43.4) and highest in West Virginia among men (43.4%; 42.2-44.6). The predicted prevalence was lowest in Utah 23.7% (22.8-24.6), 26.4% (25.0-27.7), and 21.0% (20.0-22.1) for adults, men, and women, respectively. Hypertension predicted prevalence was higher in most Southern states and higher among men than women in all states except Mississippi and DC. The predicted prevalence of undiagnosed hypertension ranged from 4.1% (3.4-4.8; Kentucky) to 6.5% (5.5-7.5; Hawaii) among adults, from 5.0% (4.0-5.9; Kentucky) to 8.3% (6.9-9.7; Hawaii) among men, and from 3.3% (2.5-4.1; Kentucky) to 4.8% (3.4-6.1; Vermont) among women. Undiagnosed hypertension was more prevalent among men than women in all states and DC.

Keywords: blood pressure; hypertension; prevalence; state-level; undiagnosed hypertension; variance.

Figure 1

Model‐predicted prevalence of hypertension among adults (≥20 y) by state and sex—BRFSS 2013/2015. Diamonds represent the first quartile (Q1). Squares indicate the second quartile (Q2). Circles indicate the 3rd quartile (Q3). Triangles indicate the 4th quartile (Q4). Black square indicates the median prevalence of all states. Solid (blue)‐filled shapes are significantly different from the median of all states, while white shapes are not significantly (P‐value <0.05). Panel A, All adults (≥20; Q1 range: 23.7‐30.8; Q2 range: 31.0‐32.6; Q3 range: 32.7‐36.2; Q4 range: 36.5‐42.4). Panel B, Men (Q1 range: 26.4‐32.4; Q2 range: 32.8‐34.5; Q3 range: 34.6‐37.5; Q4 range: 37.9‐43.4). Panel C, Women (Q1 range: 21.0‐28.7; Q2 range: 29.2‐31.0; Q3 range: 31.4‐34.3; Q4 range: 35.5‐42.6). BRFSS, Behavioral Risk Factor Surveillance System

Figure 2

Map of model‐predicted prevalence of hypertension among adults (≥20 y) by sex —BRFSS 2013/2015. BRFSS, Behavioral Risk Factor Surveillance System. AK, Alaska; AL, Alabama; AR, Arkansas; AZ, Arizona; CA, California; CO, Colorado; CT,,Connecticut; DC, District of Columbia; DE, Delaware; FL, Florida; GA, Georgia; HI, Hawaii; IA, Iowa; ID, Idaho; IL, Illinois; IN, Indiana; KS, Kansas; KY, Kentucky; LA, Louisiana; MA, Massachusetts; MD, Maryland; ME, Maine; MI, Michigan; MN, Minnesota; MO, Missouri; MS, Mississippi; MT, Montana; NC, North Carolina; ND, North Dakota; NE, Nebraska; NH, New Hampshire; NJ, New Jersey; NM, New Mexico; NV, Nevada; NY, New York; OH, Ohio; OK, Oklahoma; OR, Oregon; PA, Pennsylvania; RI, Rhode Island; SC, South Carolina; SD, South Dakota; TN, Tennessee; TX, Texas; UT, Utah; VA, Virginia; VT, Vermont; WA, Washington; WI, Wisconsin; WV, West Virginia; WY, Wyoming. Panel A, All adults (≥20). Panel B, Men. Panel C, Women

Figure 3

Model‐predicted prevalence of undiagnosed hypertension among adults (≥20 y) by state and sex—BRFSS 2013/2015. Diamonds represent the first quartile (Q1). Squares indicate the second quartile (Q2). Circles indicate the 3rd quartile (Q3). Triangles indicate the 4th quartile (Q4). Black square indicates the median prevalence of all states. Solid (blue)‐filled shapes are significantly different from the median of all states, while white shapes are not significantly (P‐value <0.05). Panel A, All adults (≥20; Q1 range: 4.1‐4.7; Q2 range: 4.7‐5.0; Q3 range: 5.1‐5.2; Q4 range: 5.2‐6.5). Panel B, Men (Q1 range: 5.0‐5.8; Q2 range: 5.8‐6.0;Q3 range: 6.1‐6.2; Q4 range: 6.3‐8.3). Panel C, Women (Q1 range: 3.3‐3.7; Q2 range: 3.7‐4.0; Q3 range: 4.1‐4.2; Q4 range: 4.2‐4.8). BRFSS, Behavioral Risk Factor Surveillance System

Figure 4

Map of model‐predicted prevalence of undiagnosed hypertension among adults (≥20 y) by sex—BRFSS 2013/2015. BRFSS, Behavioral Risk Factor Surveillance System. AK, Alaska; AL, Alabama; AR, Arkansas; AZ, Arizona; CA, California; CO, Colorado; CT,,Connecticut; DC, District of Columbia; DE, Delaware; FL, Florida; GA, Georgia; HI, Hawaii; IA, Iowa; ID, Idaho; IL, Illinois; IN, Indiana; KS, Kansas; KY, Kentucky; LA, Louisiana; MA, Massachusetts; MD, Maryland; ME, Maine; MI, Michigan; MN, Minnesota; MO, Missouri; MS, Mississippi; MT, Montana; NC, North Carolina; ND, North Dakota; NE, Nebraska; NH, New Hampshire; NJ, New Jersey; NM, New Mexico; NV, Nevada; NY, New York; OH, Ohio; OK, Oklahoma; OR, Oregon; PA, Pennsylvania; RI, Rhode Island; SC, South Carolina; SD, South Dakota; TN, Tennessee; TX, Texas; UT, Utah; VA, Virginia; VT, Vermont; WA, Washington; WI, Wisconsin; WV, West Virginia; WY, Wyoming. Panel A, All adults (≥20). Panel B, Men. Panel C, Women