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.