Most adults unaware they have uncontrolled hypertension

Key takeaways:

• In over 3,000 adults, over half were unaware they had hypertension and nearly three-quarters had uncontrolled hypertension.
• Most adults with uncontrolled hypertension had no health care visits in the past year.

A significant percentage of adults in the United States are unaware they have hypertension, according to results from a cross-sectional analysis published in JAMA Network Open.

Based on a nationally representative sample, the findings show that uncontrolled hypertension among those being treated with for the condition is highly prevalent as well, especially among younger adults aged younger than 45 years.

“The study has serious implications for the nation’s overall health given the association of hypertension with increased risk for CVD,” LaTonia C. Richardson, PhD, from the CDC’s Division for Heart Disease and Stroke Prevention, told Healio.

According to Richardson and colleagues, the hypertension control cascade “is a nested framework for understanding and intervening on hypertension at different levels including awareness, treatment, and control.”

The study examined the prevalence of cascade control outcomes within adults with uncontrolled hypertension to determine which strategies and interventions would be most useful in this population.

Researchers did this by analyzing National Health and Nutrition Examination Survey (NHANES) data from March 2017 to January 2020 on 3,129 respondents aged 18 years and older, who equaled a population estimate of 100.4 million adults.

Cascade control outcomes assessed included patient awareness of hypertension, medication use and treatment recommendations.

The researchers found that 57.6% of study participants — equal to 57.8 million adults — were unaware that they had hypertension.

Additionally, among participants who were aware they had hypertension and were eligible for antihypertensive medications, 70% took the medication but still had uncontrolled hypertension.

Among those aged 18 to 44 years, researchers reported an uncontrolled hypertension rate of 83.7% overall, including 91.8% among women and 94.3% among men.

Richardson and colleagues also pointed out that 75.7% of adults unaware they had uncontrolled hypertension had no health care visits in the last year, whereas over half (51.8%) of those that had two health care visits in the past year remained unaware.

There were several study limitations identified by the researchers. Antihypertensive medication use was self-reported, while the NHANES combined several diverse populations into “non-Hispanic other,” limiting interpretations of results in certain groups.

There were multiple implications from the results that the researchers highlighted.

They pointed out that the high prevalence of uncontrolled hypertension in those aged 18 to 44 years “is concerning given the importance of early cardiovascular health in preventing negative CVD outcomes later in life.”

“This finding may be explained by a recent study that found that younger people have more limited engagement with the health care system compared to older adults,” Richardson told Healio. “For the public, our overarching message for younger adults when it comes to hypertension is that younger adults should have their BP checked more regularly and encourage their peers to do the same. Even if they feel healthy, it is important to have their BP checked regularly.”

She added that primary care providers “play a key role and can help to ensure accurate BP measurements during patient encounters, which starts with adopting the latest evidence-based hypertension guidelines.”

“PCPs can also ensure appropriate medication dosage, encourage medication adherence, assist patients with accurately self-monitoring their BP, and frequently follow-up with patients,” she said.