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. 2023 Jun;80(6):1311-1320.
doi: 10.1161/HYPERTENSIONAHA.123.20900. Epub 2023 Apr 21.

Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data

Byron C Jaeger  1 , Ligong Chen  2 , Kathryn Foti  2 , Shakia T Hardy  2 , Adam P Bress  3   4 , Sean P Kane  5 , Lei Huang  2 , Jennifer S Herrick  3   6 , Catherine G Derington  4 , Bharat Poudel  2 , Ashley Christenson  2 , Lisandro D Colantonio  2 , Paul Muntner  2
Affiliations

Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data

Byron C Jaeger et al. Hypertension. 2023 Jun.

Abstract

Background: Data from the US National Health and Nutrition Examination Survey are freely available and can be analyzed to produce hypertension statistics for the noninstitutionalized US population. The analysis of these data requires statistical programming expertise and knowledge of National Health and Nutrition Examination Survey methodology.

Methods: We developed a web-based application that provides hypertension statistics for US adults using 10 cycles of National Health and Nutrition Examination Survey data, 1999 to 2000 through 2017 to 2020. We validated the application by reproducing results from prior publications. The application's interface allows users to estimate crude and age-adjusted means, quantiles, and proportions. Population counts can also be estimated. To demonstrate the application's capabilities, we estimated hypertension statistics for noninstitutionalized US adults.

Results: The estimated mean systolic blood pressure (BP) declined from 123 mm Hg in 1999 to 2000 to 120 mm Hg in 2009 to 2010 and increased to 123 mm Hg in 2017 to 2020. The age-adjusted prevalence of hypertension (ie, systolic BP≥130 mm Hg, diastolic BP≥80 mm Hg or self-reported antihypertensive medication use) was 47.9% in 1999 to 2000, 43.0% in 2009 to 2010, and 44.7% in 2017 to 2020. In 2017 to 2020, an estimated 115.3 million US adults had hypertension. The age-adjusted prevalence of controlled BP, defined by the 2017 American College of Cardiology/American Heart Association BP guideline, among nonpregnant US adults with hypertension was 9.7% in 1999 to 2000, 25.0% in 2013 to 2014, and 21.9% in 2017 to 2020. After age adjustment and among nonpregnant US adults who self-reported taking antihypertensive medication, 27.5%, 48.5%, and 43.0% had controlled BP in 1999 to 2000, 2013 to 2014, and 2017 to 2020, respectively.

Conclusions: The application developed in the current study is publicly available at https://bcjaeger.shinyapps.io/nhanesShinyBP/ and produced valid, transparent and reproducible results.

Keywords: blood pressure; data visualization; hypertension; statistics.

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Conflict of interest statement

Disclosures P. Muntner reported receiving grant funding and consulting fees from Amgen Inc. unrelated to the current study. L.D. Colantonio reported receiving grant funding from Amgen Inc. unrelated to the current study. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.. Mean systolic blood pressure for US adults by calendar year.
Dots represent mean systolic blood pressure. Vertical lines represent the 95% confidence interval. The graph is identical to the web application’s output. The estimated prevalence and the upper and lower limits of the 95% confidence interval can be displayed in the application by hovering the cursor over the dot. The inputs used to generate this graph are available online
Figure 2.
Figure 2.. Age-adjusted prevalence of hypertension for US adults by calendar year.
Age adjustment was performed through direct standardization, using the estimated age distribution of US adults from 1999 to 2020 as the standard (49.3%, 33.6%, 10.1% and 7.0% being 18 to 44, 45 to 64, 65 to 74 and ≥75 years of age, respectively). The graph is identical to the web application’s output. The estimated prevalence and the upper and lower limits of the 95% confidence interval can be displayed in the application by hovering the cursor over the bar. The inputs used to generate this graph are available online
Figure 3.
Figure 3.. Number of US adults with hypertension by calendar year.
The graph is identical to the web application’s output. The estimated prevalence and the upper and lower limits of the 95% confidence interval can be displayed in the application by hovering the cursor over the bar. The inputs used to generate this graph are available online
Figure 4.
Figure 4.. Age-adjusted prevalence of blood pressure control by calendar year.
A. Among non-pregnant US adults with hypertension Age adjustment was performed through direct standardization, using the estimated age distribution of US adults with hypertension from 1999 to 2020 as the standard (26.4%, 43.4%, 17.0% and 13.2% being 18 to 44, 45 to 64, 65 to 74, and ≥75 years of age, respectively). The graph is identical to the web application’s output. The estimated prevalence and the upper and lower limits of the 95% confidence interval can be displayed in the application by hovering the cursor over the bar. Participants with missing values for pregnancy status were assumed to be non-pregnant in this analysis. The inputs used to generate this graph are available online B. Among non-pregnant US adults who self-reported taking antihypertensive medication. Age adjustment was performed through direct standardization, using the estimated age distribution of US adults with hypertension from 1999 to 2020 as the standard (26.4%, 43.4%, 17.0% and 13.2% being 18 to 44, 45 to 64, 65 to 74, and ≥ 75 years of age, respectively). The graph is identical to the web application’s output. The estimated prevalence and the upper and lower limits of the 95% confidence interval can be displayed in the application by hovering the cursor over the bar. Participants with missing values for pregnancy status were assumed to be non-pregnant in this analysis. The inputs used to generate this graph are available online
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References

    1. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). About the national health and nutrition examination survey. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed October 26, 2022.
    1. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT, Jr., Whelton PK. Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline. J Am Coll Cardiol. 2018;71:109–118. doi: 10.1016/j.jacc.2017.10.073 - DOI - PMC - PubMed
    1. U.S. Department of Health and Human Services. The Surgeon General’s call to action to control hypertension. In: Washington, D.C.: Department of Health and Human Services, Office of the Surgeon General; 2020.
    1. NHANES. National health and nutrition examination survey homepage, available at https://www.cdc.gov/nchs/nhanes/index.htm. Accessed October 3, 2022.
    1. Perens B The open source definition. In: Open sources: voices from the open source revolution. O’Reilly Media; 1999:171–188.

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