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Hypertension
In Health, United States, hypertension is identified from the questionnaire and examination portions of the National Health and Nutrition Examination Survey (NHANES). A participant is considered to have hypertension if they have measured high blood pressure (systolic blood pressure of at least 130 mm Hg or diastolic blood pressure of at least 80 mm Hg), report currently taking a prescription medicine for high blood pressure, or both. For current antihypertensive medication use, respondents are asked, “Are you now taking prescribed medicine for your high blood pressure?”
Blood pressure is measured by averaging multiple blood pressure readings taken for a participant. Blood pressure readings of 0 mm Hg are not included in the estimates. The methods used to measure the blood pressure of participants have changed over the different NHANES survey years. Changes have included:
- Number of blood pressure measurements
- Blood pressure instrument change, from mercury sphygmomanometer to an oscillometric device
- Training of people taking readings (usually a physician or health technician)
- Published diastolic definition
Starting in 1999, blood pressure is measured for participants age 8 years and older. Three consecutive blood pressure readings are obtained from the same arm. From 1999 to 2018, blood pressure was measured to the nearest even number by a physician using a mercury sphygmomanometer, with a 30-second wait time between measurements. If a blood pressure measurement was interrupted or incomplete, a fourth attempt was made. Starting in 2017, blood pressure is measured by a health technician using an oscillometric device, without rounding to the nearest even number and with a 60-second wait time between measurements. An analysis determined that this change had a minor impact on blood pressure measurements and little impact on the estimates of the prevalence of high blood pressure. For more information, see “Comparing Blood Pressure Values Obtained by Two Different Protocols: National Health and Nutrition Examination Survey, 2017–2018.” Participants with any of the following on both arms are excluded from the examination: rashes, gauze dressings, casts, edema, paralysis, tubes, open sores or wounds, withered arms, arteriovenous shunt, or radical mastectomy. Participants are also excluded if the blood pressure cuff does not fit on their arm.
In 2017, the American College of Cardiology and the American Heart Association Task Force recommended adopting lower thresholds of high blood pressure. For systolic blood pressure, the threshold was lowered from 140 mm Hg to 130 mm Hg. For diastolic blood pressure, the threshold was lowered from 90 mm Hg to 80 mm Hg. The impact of the lower blood pressure cutoffs on the percentage of the population that is classified as having hypertension is shown in Htn-Table. In 2017–2018, the age-adjusted percentage of hypertension in adults age 20 and older was 31.0% under the 2007 standards and 46.6% under the 2017 standards. Substantial changes in the percentage with hypertension were observed in men and women, across racial and ethnic groups, and by age group (Htn-Table).
For more information on the revised standards, see “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 among adults age 20 and older, based on two definitions: United States, 2017–2018
| Age (years), sex, and race and Hispanic origin | Hypertension based on the 2007 standards (systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg or taking antihypertensive medication)1 | Hypertension based on the 2017 standards (systolic pressure of at least 130 mm Hg or diastolic pressure of at least 80 mm Hg or taking antihypertensive medication)2 |
| 20 and older, age adjusted3 | Percent (weighted) | |
| Both sexes | 31.0 | 46.6 |
| Male | 33.3 | 52.6 |
| Female | 28.6 | 40.3 |
| Not Hispanic or Latino: | ||
| White only | 28.7 | 44.4 |
| Black only | 44.0 | 59.0 |
| Asian only | 33.1 | 49.3 |
| Hispanic or Latino | 30.3 | 45.4 |
| 20 and older, crude | ||
| Both sexes | 34.9 | 49.6 |
| Male | 35.8 | 54.1 |
| Female | 33.9 | 45.2 |
| Not Hispanic or Latino: | ||
| White only | 35.6 | 49.9 |
| Black only | 44.1 | 58.9 |
| Asian only | 33.0 | 49.1 |
| Hispanic or Latino | 26.1 | 41.6 |
| 20–44 | 10.5 | 27.5 |
| 45–64 | 45.0 | 60.3 |
| 65 and older | 68.4 | 77.3 |
1Based on the National Heart, Lung, and Blood Institute. See: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH publication no. 04–5230. 2004.
2Based on guidelines released in October 2017 by the American College of Cardiology and the American Heart Association. These guidelines have lower standards for defining high blood pressure. See: Whelton PK, Carey RM, Aronow WS, Casey DE Jr, 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 71(6):1269–324. 2018. Available from: .
3Estimates are age adjusted to the year 2000 standard population using five age groups: 20–34, 35–44, 45–54, 55–64, and 65 and older.