National Health Statistics Reports

Number 106  September 19, 2017

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Characteristics of Visits to Primary Care Physicians by 

Adults Diagnosed With Hypertension 

by Jill J. Ashman, Ph.D., Pinyao Rui, M.P.H., Susan M. Schappert, M.A., and Alexander Strashny, Ph.D., 

Division of Health Care Statistics

Abstract

Objective—This report describes the demographic, state, and regional differences 

in hypertension control and pharmaceutical treatment among visits to primary care 

physicians made by hypertensive adults during 2013–2014.

Methods—Data are from the 2013–2014 National Ambulatory Medical Care 

Survey (NAMCS), a nationally representative survey of visits to nonfederal, 

office-based physicians. The sample design for the 2013–2014 NAMCS included 

oversampling in selected states. Estimates are provided for the 18 states oversampled 

in both years. Estimates are also presented for the nine census divisions. The study 

population includes all primary care physician visits made by nonpregnant adults 

who have hypertension, as defined by documentation of hypertension in their medical 

record. Hypertensive visits indicating hypertension control as well as those with 

mention of a hypertensive medication were examined by selected demographic 

characteristics as well as by region and state. Sample weights were applied to each 

case to provide national estimates of health care utilization.

Results—During 2013–2014, in the United States, hypertension control was 

indicated [a blood pressure (BP) measurement of less than 140/90 mm Hg] at an 

estimated 66.0% of hypertensive visits. There was mention of at least one hypertensive 

medication documented in the medical record at 72.0% of hypertensive visits. 

Hypertension control was indicated at a lower percentage of hypertensive visits made 

by non-Hispanic black persons (57.4%) than hypertensive visits made by all other 

racial or ethnic groups. Hypertension was under control or there was mention of a 

hypertensive medication at a lower percentage of hypertensive visits made by adults 

aged 18–44 than hypertensive visits by older adults. The percentage of visits with 

an indication of hypertension control varied widely by state (ranging from 53.7% in 

Tennessee to 73.2% in Florida) and region (ranging from 60.1% in the East South 

Central division to 71.1% in the New England division). Among the 18 states, the 

percentage of hypertensive visits that had mention of a hypertensive medication 

ranged from 57.1% in Georgia to 85.0% in Washington.

Conclusion— The demographic and geographical differences identified in this 

report may help inform state and local policies aimed at controlling hypertension.

Keywords: high blood pressure • chronic conditions • office-based physicians • NAMCS

Introduction

Hypertension, defined as having 

a systolic blood pressure greater than 

or equal to 140 mmHg or diastolic 

blood pressure greater than or equal to 

90 mmHg, is a leading risk factor for 

cardiovascular disease and stroke (1), 

two of the five leading causes of death 

in the United States (2). The disease 

affects almost one-third of adults in the 

United States and often has no signs or 

symptoms (1). Findings from a recent 

study estimated that 53% of hypertensive 

adults had their hypertension controlled 

during 2011–2014 (3).

The prevalence of hypertension 

increases with age, from 7% among those 

aged 18–39 to 65% among those aged 60 

and over (3,4). According to data from 

the 2013 National Ambulatory Medical 

Care Survey (NAMCS), 34% of all adult 

visits to office-based physicians were 

made by those with hypertension (5). 

NAMCS data can be used to make 

national, regional, and some state-based 

estimates of office-based physician 

health care utilization. State and regional 

estimates may help inform interventions 

and policies designed to improve blood 

pressure control and disease outcomes, 

as well as highlight the effectiveness of 

existing policies. Increasing awareness, 
Page 2 National Health Statistics Reports  Number 106  September 19, 2017

treatment, and control of hypertension 

will lead to reduced morbidity, mortality 

and costs associated with treatment, 

the burden of which will become 

increasingly more apparent as the 

population of older Americans continues 

to grow (6). 

This report describes demographic, 

regional, and state estimates of all visits 

made during 2013–2014 to a patient’s 

primary care physician by nonpregnant 

adults who have hypertension (referred 

to as “hypertensive visits”). Controlled 

hypertension (the documentation of a 

blood pressure [BP] measurement of 

less than 140/90 mm Hg in the medical 

record for that visit) and hypertensive 

medication (documentation of at least 

one hypertensive medication in the 

medical record for that visit [referred to 

as “hypertensive medication”]) (7,8) are 

examined (both separately and jointly).

Methods

All estimates are from the 

2013–2014 NAMCS, a nationally 

representative survey of visits to 

nonfederal, office-based physicians. The 

survey is conducted annually by the 

National Center for Health Statistics, 

Division of Health Care Statistics. 

NAMCS uses a stratified two-stage 

sample, with physicians selected in the 

first stage and visits in the second stage. 

List samples of physicians were used to 

produce separate estimates for individual 

states. The survey data are inflated or 

weighted to produce national annual 

estimates of office visits. The unweighted 

visit response rate for the 2013 survey 

was 41.1% (40.4% weighted) and for 

2014 was 38.7% (39.0% weighted) (7,8).

The sample design for the 2013–

2014 NAMCS included oversampling in 

selected states. Estimates are provided for 

the 18 states oversampled in both years. 

Estimates are also presented for the nine 

census divisions (see the Technical Notes 

for a list of the states included in each 

census division). Both state and division 

estimates are compared with the national 

estimate for each outcome examined. A 

set of maps and a set of charts (Figures 

1–12) are presented for each outcome. 

The charts display outcome estimates 

for each of the 18 states, and the maps 

display outcome estimates for each of the 

nine divisions.

Estimates are based on a sample of 

10,288 hypertensive visits (visits made to 

primary care physicians by nonpregnant 

adults aged 18 and over diagnosed with 

hypertension), representing a weighted 

total of 121.9 million annualized visits. 

Diagnosed hypertension is based on 

documentation in the patient’s medical 

record of a diagnosis of hypertension, 

regardless of the diagnosis for the current 

visit. Hypertensive visits with missing 

data for either systolic or diastolic 

blood pressure (403 records [3.8%]) or 

an indication of pregnancy (23 records 

[0.2%]) were excluded from the study 

population. See the Technical Notes for 

definitions of terms used to define the 

study population.

Differences among subgroups were 

evaluated using two-tailed t-tests 

(p < 0.05). Data analyses were performed 

using the statistical packages SAS version 

9.4 (SAS Institute, Cary, N.C.) and 

SUDAAN version 11.0 (RTI International, 

Research Triangle Park, N.C.).

There are limitations to this 

analysis that should be considered 

when interpreting the findings. Patients 

with incomplete blood pressure 

measurements were excluded from this 

study, and although the proportion of 

visits with missing blood pressure was 

relatively small (3.8%), this might have 

introduced bias to the final estimates. 

Also, NAMCS only collects single BP 

measurements, which may affect the 

validity of the measurement. Because 

this analysis was limited to primary 

care physician visits made by patients 

with diagnosed hypertension, and so, 

did not include patients unaware that 

they have hypertension, estimates 

may underestimate the true health care 

burden of uncontrolled hypertension. 

Additionally, the BP measurements 

were recorded by hand from the medical 

record and typed into an automated data 

collection tool, a procedure that may have 

been subject to measurement error.

Estimating rare events, see Figure 

12 for example, proved difficult because 

for many of the states, the sample size 

was too small to report reliable estimates. 

Another limitation is the ability to make 

state estimates for only 18 states and 

having to limit analyses to regional 

estimates for the remaining states. 

Finally, NAMCS collects medications 

that were ordered, supplied, administered, 

or continued during a patient visit, as 

opposed to collecting information on 

medication taken by the patient. As a 

result, medication adherence was not 

examined in this report.

Results 

Variation in controlled 

hypertension at visits to 

a patient’s primary care 

physician

Demographic variation 

● During 2013–2014, hypertension was

under control at an estimated 66.0%

of hypertensive visits by patients in

the United States (Table 1).

● Hypertension was under control at

a lower percentage of hypertensive

visits by patients aged 18–44 (55.2%)

than hypertensive visits by older

patients (65.3% by patients aged

45–64, 68.4% by patients aged

65–74, and 67.6% by patients aged

75 and over).

● Hypertension was under control at

a lower percentage of hypertensive

visits by non-Hispanic black persons

(57.4%) than visits by non-Hispanic

white (66.9%), Hispanic (69.2%),

and non-Hispanic other (67.3%)

persons.

● Hypertension was under control at

a lower percentage of hypertensive

visits by patients with no insurance

(52.7%) than visits by insured

patients (64.9% by patients with

private insurance, 67.5% by patients

with Medicare, and 67.0% by

patients with Medicaid).

● Hypertension control did not differ

by sex.

Regional variation

● Among the nine divisions,

hypertension was under control at

a majority of hypertensive visits,

ranging from 60.1% in the East

South Central division to 71.1% in

the New England division (Figure 1,

Table 2).
National Health Statistics Reports  Number 106  September 19, 2017 Page 3

● Hypertension was under control 

at 70.6% of hypertensive visits in 

the West North Central division, 

which was higher than the national 

percentage of 66.0%. 

● Hypertension was under control 

at 60.1% of hypertensive visits in 

the East South Central division, 

which was lower than the national 

percentage of 66.0%.

State variation

● Among the 18 states, hypertension 

was under control at a majority of 

hypertensive visits, ranging from 

53.7% in Tennessee to 73.2% in 

Florida (Figure 2, Table 2).

● Hypertension was under control 

at 73.2% of hypertensive visits in 

Florida, which was higher than the 

national percentage of 66.0%. 

● Hypertension was under control 

at 53.7% of hypertensive visits in 

Tennessee, which was lower than the 

national percentage of 66.0%.

Variation in the mention of 

at least one hypertensive 

medication documented in 

the medical record at visits

Demographic variation

● During 2013–2014, an estimated 

72.0% of hypertensive visits 

in the United States included a 

hypertensive medication (Table 1). 

● A lower percentage of hypertensive 

visits by patients aged 18–44 

included a hypertensive medication 

(63.8%) compared with hypertensive 

visits made by older patients 

(71.4% by patients aged 45–64, 

72.8% by patients aged 65–74, and 

74.5% by patients aged 75 and over). 

● The percentage of hypertensive 

visits with a hypertensive medication 

did not differ across the four racial 

and ethnic groups examined (nonHispanic white, non-Hispanic black, 

Hispanic, and non-Hispanic other).

● No statistically significant 

differences by sex, race and 

ethnicity, or insurance status in the 

percentage of hypertensive visits 

with a hypertensive medication were 

observed.

Figure 1. Percentage of hypertensive visits with hypertension under control, by geographic 

area: United States, 2013–2014

 

 

Figure 2. Percentage of hypertensive visits with hypertension under control, by state: 

United States, 2013–2014
Page 4 National Health Statistics Reports  Number 106  September 19, 2017

Regional variation

● Among the nine divisions, the 

percentage of hypertensive visits 

with a hypertensive medication 

ranged from 63.7% in the New 

England division to 77.2% in 

the Mountain division (Figure 3, 

Table 2). However, none of the 

division estimates were statistically 

significantly different from the 

national estimate of 72.0%.

State variation

● Among the 18 states, the percentage 

of hypertensive visits with a 

hypertensive medication ranged 

from 57.1% in Georgia to 85.0% in 

Washington.

● The percentage of hypertensive visits 

with a hypertensive medication was 

higher than the national percentage of 

72.0% in Washington (85.0%) and 

Wisconsin (81.0%) (Figure 4, Table 2).

● The percentage of hypertensive visits 

with a hypertensive medication was 

lower than the national percentage of 

72.0% in Georgia (57.1%) and New 

York (57.2%). 

Variation in controlled 

hypertension with and 

without the mention of at 

least one hypertensive 

medication documented in 

the medical record at visits

Demographic variation

● During 2013–2014, an estimated 

46.9% of hypertensive visits 

indicated hypertension control and 

had a mention of a hypertensive 

medication (Table 1), whereas 19.2% 

of hypertensive visits indicated 

hypertension control without 

any mention of a hypertensive 

medication.

● An estimated 33.0% of hypertensive 

visits by patients aged 18–44 

indicated hypertension control and 

had a mention of a hypertensive 

medication, which was lower than 

the percentage by older patients 

(45.9% of visits by patients aged 

45–64, 49.0% by patients aged 

 

Figure 3. Percentage of hypertensive visits with mention of a hypertensive medication, by 

geographic area: United States, 2013–2014

Figure 4. Percentage of hypertensive visits with mention of a hypertensive medication, by 

state: United States, 2013–2014

 
National Health Statistics Reports  Number 106  September 19, 2017 Page 5

65–74, and 49.9% by patients aged 

75 and over).

● An estimated 39.1% of hypertensive 

visits by non-Hispanic black persons 

indicated hypertension control and 

had a mention of a hypertensive 

medication, which was lower than 

the percentages by non-Hispanic 

white (47.6%), Hispanic (49.8%), 

and non-Hispanic other (48.7%) 

persons.

● An estimated 35.5% of hypertensive 

visits by patients with no insurance 

indicated hypertension control and 

had a mention of a hypertensive 

medication, which was lower than 

the percentage by patients with 

private insurance (45.5%) and 

Medicare (48.5%).

● No statistically significant difference 

by sex was observed in the 

percentage of hypertensive visits 

that indicated hypertension control 

and had a mention of a hypertensive 

medication.

● No statistically significant 

differences by sex, race and ethnicity, 

and insurance status were observed 

in the percentage of hypertensive 

visits that indicated hypertension 

control without any mention of a 

hypertensive medication.

Regional variation

● Among the nine divisions, the 

percentage of hypertensive visits 

that indicated hypertension control 

and had a mention of a hypertensive 

medication ranged from 40.7% in the 

East South Central division to 54.1% 

in the West North Central division 

(Figure 5, Table 2). 

● An estimated 54.1% of hypertensive 

visits in the West North Central 

division indicated hypertension 

control and had a mention of a 

hypertensive medication, which 

was higher than the national 

percentage of 46.9%, but none of the 

division estimates were statistically 

significantly lower than the national 

estimate.

● The percentage of hypertensive 

visits that indicated hypertension 

control without any mention of a 

hypertensive medication ranged 

from 16.5% in the West North 

 

Figure 5. Percentage of hypertensive visits with an indication of hypertension control and 

mention of a hypertensive medication, by geographic area: United States, 2013–2014

Figure 6. Percentage of hypertensive visits with an indication of hypertension control and 

mention of a hypertensive medication, by state: United States, 2013–2014

 
Page 6 National Health Statistics Reports  Number 106  September 19, 2017

Central division to 27.5% in the New 

England division (Figure 7, Table 2).

● An estimated 27.5% of hypertensive 

visits in the New England 

division indicated hypertension 

control without any mention of a 

hypertensive medication, which 

was higher than the national 

percentage of 19.2%, but none of the 

division estimates were statistically 

significantly lower than the national 

estimate.

State variation

● Among the 18 states, the percentage 

of hypertensive visits that indicated 

hypertension control and had 

a mention of a hypertensive 

medication ranged from 32.6% in 

Tennessee to 58.1% in Wisconsin 

(Figure 6, Table 2).

● In three states, Florida (56.1%), 

Washington (57.2%), and Wisconsin 

(58.1%), the percentage of 

hypertensive visits that indicated 

hypertension control and had 

a mention of a hypertensive 

medication was higher than the 

national percentage of 46.9%.

● In two states, Georgia (32.8%) 

and Tennessee (32.6%), the 

percentage of hypertensive visits 

that indicated hypertension control 

and had a mention of a hypertensive 

medication was lower than the 

national percentage of 46.9%. 

● The percentage of hypertensive 

visits that indicated hypertension 

control without any mention of a 

hypertensive medication ranged from 

9.9% in Washington to 29.8% in 

New York (Figure 8, Table 2).

● In two states, Georgia (26.7%) and 

New York (29.8%), the percentage 

of hypertensive visits that indicated 

hypertension control without 

any mention of a hypertensive 

medication was higher than the 

national percentage of 19.2%.

● In two states, Washington (9.9%) and 

Wisconsin (12.4%), the percentage 

of hypertensive visits that indicated 

hypertension control without 

any mention of a hypertensive 

medication was lower than the 

national percentage of 19.2%.

Figure 7. Percentage of hypertensive visits with an indication of hypertension control and 

no mention of a hypertensive medication, by geographic area: United States, 2013–2014

 

Figure 8. Percentage of hypertensive visits with an indication of hypertension control and 

no mention of a hypertensive medication, by state: United States, 2013–2014

 
National Health Statistics Reports  Number 106  September 19, 2017 Page 7

Variation in uncontrolled 

hypertension with and without 

the mention of at least one 

hypertensive medication 

documented in the medical 

record at visits

Demographic variation

● During 2013–2014, an estimated 

25.2% of hypertensive visits 

indicated uncontrolled hypertension 

and had a mention of a hypertensive 

medication (Table 1), whereas 8.8% 

of hypertensive visits indicated 

uncontrolled hypertension without 

any mention of a hypertensive 

medication.

● An estimated 30.8% of visits by 

patients aged 18–44 indicated 

uncontrolled hypertension and 

had a mention of a hypertensive 

medication, which was higher than 

the percentage by older patients 

(25.5% of visits by patients aged 

45–64, 23.7% by patients aged 

65–74, and 24.6% by patients aged 

75 and over).

● An estimated 32.3% of hypertensive 

visits by non-Hispanic black persons 

indicated uncontrolled hypertension 

and had a mention of a hypertensive 

medication, which was higher than 

the percentages by non-Hispanic 

white (24.4%), Hispanic (23.1%), 

and non-Hispanic other (24.1%) 

persons.

● An estimated 37.1% of hypertensive 

visits by patients with no insurance 

indicated uncontrolled hypertension 

and had a mention of a hypertensive 

medication, which was higher than 

the percentage by patients with 

private insurance (24.8%) and 

Medicare (24.5%).

● An estimated 14.0% of hypertensive 

visits by patients aged 18–44 

indicated uncontrolled hypertension 

without any mention of a 

hypertensive medication, which was 

higher than the percentage by older 

patients (9.2% of visits by patients 

aged 45–64, 7.9% by patients aged 

65–74, and 7.8% by patients aged 75 

and over).

● An estimated 10.2% of hypertensive 

visits by patients with private 

insurance indicated uncontrolled 

hypertension without any mention 

of a hypertensive medication, which 

was higher than the percentage by 

patients with Medicare (8.0%) and 

Medicaid (6.7%).

● No statistically significant difference 

by sex was observed in the 

percentage of hypertensive visits that 

indicated uncontrolled hypertension 

and had a mention of a hypertensive 

medication.

● No statistically significant 

differences by sex, race and ethnicity 

were observed in the percentage of 

hypertensive visits that indicated 

uncontrolled hypertension without 

any mention of a hypertensive 

medication.

Regional variation

● Among the nine divisions, the 

percentage of hypertensive visits that 

indicated uncontrolled hypertension 

and had a mention of a hypertensive 

medication ranged from 20.1% in 

the New England division to 29.7% 

in the East South Central division 

(Figure 9, Table 2). However, none 

of the division estimates were 

statistically significantly different 

from the national estimate of 25.2%.

● The percentage of hypertensive 

visits that indicated uncontrolled 

hypertension without any mention 

of a hypertensive medication ranged 

from 6.2% in the Mountain division 

to 10.1% in the East South Central 

division (Figure 11, Table 2). None 

of the division estimates were 

statistically significantly higher than 

the national estimate of 8.8%.

● An estimated 6.2% of hypertensive 

visits in the Mountain division 

indicated uncontrolled hypertension 

without any mention of a hypertensive 

medication, which was lower than the 

national percentage of 8.8%.

State variation

● Among the 18 states, the percentage 

of hypertensive visits that indicated 

uncontrolled hypertension and 

had a mention of a hypertensive 

medication ranged from 19.5% in 

New York to 37.6% in Tennessee 

(Figure 10, Table 2).

● An estimated 37.6% of hypertensive 

visits in Tennessee indicated 

uncontrolled hypertension and 

had a mention of a hypertensive 

medication mention, which was 

higher than the national percentage 

of 25.2%.

Figure 9. Percentage of hypertensive visits with an indication of uncontrolled hypertension 

and mention of a hypertensive medication, by geographic area: United States, 2013–2014

 
Page 8 National Health Statistics Reports  Number 106  September 19, 2017

● An estimated 19.5% of hypertensive 

visits in New York indicated 

uncontrolled hypertension and 

had a mention of a hypertensive 

medication, which was lower than 

the national percentage of 25.2%. 

● The percentage of hypertensive 

visits that indicated uncontrolled 

hypertension without any mention 

of a hypertensive medication ranged 

from 7.0% in Michigan to 16.2% 

in Georgia (Figure 12, Table 2). 

However, none of the state estimates 

were statistically significantly 

different from the national estimate 

of 8.8%.

Summary

Multiple studies have reported 

variability among cardiovascular health 

indicators across the United States 

(9–11), but there is limited information 

on state and regional differences in 

the occurrence of adult hypertensive 

visits made to physician offices. This 

report aims to describe the variation in 

hypertension control and pharmaceutical 

treatment among patients accessing 

health services through their primary care 

physicians by selected demographic and 

geographic characteristics. 

During 2013–2014, 46.9% of all 

visits to primary care physicians by 

nonpregnant adults aged 18 and over 

were made by those with hypertension. 

Hypertension was under control at 

about two-thirds of hypertensive visits 

(66.0%), and a hypertensive medication 

was ordered or provided at almost threequarters (72.0%) of hypertensive visits by 

patients in the United States. 

Hypertension control and medication 

treatment varied by selected demographic 

characteristics. A smaller percentage 

of hypertensive visits made by those 

aged 18–44 had an indication of 

hypertension control or a mention of 

a hypertensive medication. A smaller 

percentage of hypertensive visits by 

patients with no insurance had an 

indication of hypertension control. There 

was no difference in the percentage of 

hypertensive visits with mention of a 

hypertensive medication by insurance. A 

smaller percentage of hypertensive visits 

by non-Hispanic black persons compared 

with visits by other racial and ethnic 

 

Figure 11. Percentage of hypertensive visits with an indication of uncontrolled hypertension 

and no mention of a hypertensive medication, by geographic area: United States, 2013–2014

Figure 10. Percentage of hypertensive visits with an indication of uncontrolled hypertension 

and mention of a hypertensive medication, by state: United States, 2013–2014

 
National Health Statistics Reports  Number 106  September 19, 2017 Page 9

groups had an indication of hypertension 

control. Despite this disparity, there were 

no statistically significant differences by 

race and ethnicity in visits with mention 

of a hypertensive medication.

Hypertension control and the 

mention of a hypertensive medication 

clustered geographically by state. For 

instance, New York and New Jersey 

had similar, relatively high percentages 

of hypertensive visits that indicated 

hypertension control (Figure 2). 

Michigan, Illinois, Indiana, and Ohio 

had similar percentages of hypertensive 

visits that indicated hypertension control 

and similar percentages of hypertensive 

visits that had mention of a hypertensive 

medication that hovered around the 

national estimate of each respective 

outcome (66.0% for hypertension control 

and 72.0% for mention of a hypertensive 

medication). 

Poor hypertension control at 

hypertensive visits was more widespread 

in states considered to be part of the 

“stroke belt,” which is an 11-state 

region in the southeast United States 

characterized by stroke death rates 

that are 10% higher than the U.S. 

average (12). The states included in 

the stroke belt are: Alabama, Arkansas, 

Georgia, Indiana, Kentucky, Louisiana, 

Mississippi, North Carolina, South 

Carolina, Tennessee, and Virginia (13). 

The geographic association seems to 

persist in the context of ambulatory care, 

with lower percentages of controlled 

hypertension around this region. 

When examining hypertension 

control and mention of a hypertensive 

medication jointly, the most common 

combination was an indication of 

controlled hypertension and mention of 

a hypertensive medication; followed by 

uncontrolled hypertension and mention 

of a hypertensive medication; controlled 

hypertension and no hypertensive 

medication mention; and uncontrolled 

hypertension and no hypertensive 

medication mention (Tables 1 and 2).

Variation by selected demographic 

characteristics existed when examining 

hypertension control and mention of 

a hypertensive medication jointly. 

Almost one-half of visits by patients 

with private insurance and Medicare 

indicated hypertension control and had 

a mention of a hypertensive medication 

compared with only about one-third of 

the visits by patients with no insurance. 

Compared with visits by other racial 

and ethnic groups, a smaller percentage 

of hypertensive visits by non-Hispanic 

black persons indicated hypertension 

control and mention of a hypertensive 

medication. Previous studies have 

documented a disparity in blood 

pressure control by race and ethnicity, 

in which blacks have lower BP control 

(14,15). Suggested explanations for the 

disparity include increased medication 

nonadherence and adverse effects 

of medications, as well as a higher 

prevalence of resistant hypertension 

being observed in black persons (12, 

16,17). 

Geographic variation was also 

found when examining hypertension 

control and mention of a hypertensive 

medication jointly. The percentages 

of hypertensive visits that indicated 

hypertension control and had a mention 

of a hypertensive medication were more 

than 10 percentage points lower than the 

national estimate (46.9%) in Tennessee 

(32.6%) and Georgia (32.8%). In 

Tennessee, 37.6% of hypertensive visits 

indicated uncontrolled hypertension, 

despite including a hypertensive 

medication, which was about 50% higher 

than the national estimate of 25.2%. In 

addition, in Georgia, of the hypertensive 

visits that did not include a hypertensive 

medication, 37.7% indicated uncontrolled 

hypertension, which represented 16.2% 

of all hypertensive visits in the state and 

was almost double that of the national 

estimate of 8.8%.

This report found wide variation 

in hypertension control and mention 

of a hypertensive medication by 

selected demographic and geographical 

characteristics. Analyses of office-based 

health care visits at the state and regional 

level may help inform local policies and 

initiatives to better improve hypertension 

control and use of hypertensive 

medications at the population level (18).

 

Figure 12. Percentage of hypertensive visits with an indication of uncontrolled hypertension 

and no mention of a hypertensive medication, by state: United States, 2013–2014
Page 10 National Health Statistics Reports  Number 106  September 19, 2017

References

1. Merai R, Siegel C, Rakotz M, Basch P, 

Wright J, Wong B, Thorpe P. CDC Grand 

Rounds: A public health approach to 

detect and control hypertension. MMWR 

Morb Mortal Wkly Rep. 65(45):1261–64. 

2016.

2. Centers for Disease Control and 

Prevention. Leading causes of death. 

https://www.cdc.gov/nchs/fastats/leadingcauses-of-death.htm. Updated October 7, 

2016. Accessed October 24, 2016.

3. Yoon SS, Fryar CD, Carroll MD. 

Hypertension prevalence and control 

among adults: United States, 2011–2014. 

NCHS data brief, no 220. Hyattsville, 

MD: National Center for Health Statistics. 

2015.

4. Health Resources and Services 

Administration. Hypertension control. 

Available from: https://www.hrsa.gov/

quality/toolbox/measures/hypertension.

5. Ashman JJ, Rui P, Schappert SM. Age 

differences in visits to office-based 

physicians by adults with hypertension: 

United States, 2013. NCHS data brief, no 

263. Hyattsville, MD: National Center for 

Health Statistics. 2016.

6. Centers for Disease Control and 

Prevention. The state of aging and health 

in cap 2013. 2013.

7. National Center for Health Statistics 2013 

NAMCS microdata file documentation. 

2016. 

8. National Center for Health Statistics 2014 

NAMCS microdata file documentation. 

2016.

9. Gebreab SY, Davis SK, Symanzik J, 

Mensah GA, Gibbons GH, Diez-Roux AV. 

Geographic variations in cardiovascular 

health in the United States: Contributions 

of state- and individual-level factors. J Am 

Heart Assoc 4(6). 2015.

10. Fang J, Yang Q, Hong Y, Loustalot F. 

Status of cardiovascular health among 

adult Americans in the 50 states and the 

District of Columbia, 2009. J Am Heart 

Assoc1(6). 2012.

11. Fang J, Moore L, Loustalot F, Yang 

Q, Ayala C. Reporting of adherence 

to healthy lifestyle behaviors among 

hypertensive adults in the 50 states and 

the District of Columbia, 2013. J Am Soc 

Hypertens 10(3)252–62. 2016.

12. Sim JJ, Bhandari SK, Shi J, Liu IL, 

Calhoun DA, McGlynn EA, et al. 

Characteristics of resistant hypertension 

in a large ethnically diverse hypertension 

population of an integrated health system. 

Mayo Clin Proc 88(10):1099–107. 2013.

13. National Institutes of Health: National 

Heart, Lung, and Blood Institute. NHLBI 

Stroke Belt Initiative. Available from: 

https://www.nhlbi.nih.gov/health-pro/

resources/heart/stroke-belt-initiative. 

14. Bosworth HB, Dudley T, Olsen MK, Voils 

CI, Powers B, Goldstein MK, Oddone 

EZ. Racial differences in blood pressure 

control: Potential explanatory factors. Am 

J Med. 119(1):70.e9–15. 2006.

15. Bosworth HB, Powers B, Grubber JM, et 

al. Racial differences in blood pressure 

control: Potential explanatory factors. 

J Gen Intern Med 23(5):692–8. 2008. 

16. Muntner P, Davis BR, Cushman WC, 

Bangalore S, Calhoun DA, Pressel SL, et 

al. Treatment-resistant hypertension and 

the incidence of cardiovascular disease 

and end-stage renal disease: Results from 

the Antihypertensive and lipid-lowering 

treatment to prevent heart attack trial 

(ALLHAT). Hypertension 64(5):1012–21. 

2014.

17. Egan BM, Zhao Y, Axon RN, Brzezinski 

WA, Ferdinand KC. Uncontrolled and 

apparent treatment resistant hypertension 

in the United States, 1988 to 2008. 

Circulation. 124:1046–58. 2011.

18. Department of Health and Human 

Services. Million Hearts. Available from: 

https://millionhearts.hhs.gov.
Table 1. Adult hypertensive visits to primary care physicians, by selected demographic characteristics, control, and medication status: United States, 201

Selected demographic characteristics All hypertensive visits Controlled hypertensive visits Hypertensive medication mention Controlled hypertensive visits with medication mention Controlled hypertensive visits with no medication mention 

Number of visits in thousands (standard error) Percent distribution (standard error) Number of visits in thousands (standard error) Percent (standard error) Number of visits in thousands (standard error) Percent (standard error) Percent distributi

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 121,889 (4,808) 100.0 ... 80,465 (3,378) 66.0 (0.8) 87,797 (3,795) 72.0 (1.1) 46.9 (1.0) 19.2 (0.8) SexWomen . . . . . . . . . . . . . . . . . . . . . . 68,898 (2,994) 56.5 (0.9) 45,650 (2,112) 66.3 (1.0) 49,327 (2,339) 71.6 (1.2) 46.7 (1.2) 19.6 (0.9) 

Men . . . . . . . . . . . . . . . . . . . . . . . . 52,991 (2,251) 43.5 (0.9) 34,815 (1,622) 65.7 (1.1) 38,470 (1,801) 72.6 (1.4) 47.1 (1.3) 18.6 (1.1) 

Age group in years 18–44 . . . . . . . . . . . . . . . . . . . . . . . 9,406 (600) 7.7 (0.4) 5,192 (374) 55.2 (2.3) 5,997 (401) 63.8 (2.4) 33.0 (2.1) 22.2 (2.0) 

45–64 . . . . . . . . . . . . . . . . . . . . . . 44,734 (1,911) 36.7 (0.8) 29,192 (1,335) 265.3 (1.0) 31,918 (1,533) 271.4 (1.4) 245.9 (1.3) 19.4 (1.1) 

65–74 . . . . . . . . . . . . . . . . . . . . . . 33,897 (1,655) 27.8 (0.7) 23,181 (1,250) 268.4 (1.2) 24,672 (1,359) 272.8 (1.5) 249.0 (1.4) 19.3 (1.3) 

75 and over . . . . . . . . . . . . . . . . . . 33,851 (1,681) 27.8 (0.8) 22,900 (1,301) 267.6 (1.5) 25,210 (1,368) 274.5 (1.7) 249.9 (1.7) 17.8 (1.5) 

Race and ethnicity Non-Hispanic white . . . . . . . . . . . . 86,531 (3,584) 71.0 (1.7) 57,854 (2,563) 366.9 (0.8) 62,242 (2,834) 71.9 (1.3) 347.6 (1.1) 19.3 (1.0) 

Non-Hispanic black . . . . . . . . . . . . 14,819 (1,264) 12.2 (0.9) 8,513 (786) 57.4 (1.9) 10,584 (1,053) 71.4 (2.6) 39.1 (2.3) 18.3 (1.7) Hispanic . . . . . . . . . . . . . . . . . . . . . 14,542 (1,882) 11.9 (1.4) 10,064 (1,489) 369.2 (3.3) 10,603 (1,436) 72.9 (2.2) 349.8 (3.2) 19.4 (1.9) Non-Hispanic other . . . . . . . . . . . . 5,997 (1,069) 4.9 (0.8) 4,034 (783) 367.3 (3.1) 4,368 (742) 72.8 (5.1) 348.7 (4.2) 18.5 (3.8) 

Insurance Private . . . . . . . . . . . . . . . . . . . . . . 43,760 (2,089) 35.9 (1.1) 28,422 (1,498) 464.9 (1.2) 30,782 (1,586) 70.3 (1.4) 445.5 (1.3) 19.5 (1.0) 

Medicare . . . . . . . . . . . . . . . . . . . . 61,988 (2,945) 50.9 (1.1) 41,872 (2,153) 467.5 (1.1) 45,263 (2,398) 73.0 (1.4) 448.5 (1.4) 19.0 (1.1) 

Medicaid . . . . . . . . . . . . . . . . . . . . . 6,602 (648) 5.4 (0.5) 4,425 (495) 467.0 (2.7) 4,648 (497) 70.4 (3.2) 44.1 (2.9) 22.9 (2.9) No insurance . . . . . . . . . . . . . . . . . 2,398 (323) 2.0 (0.3) 1,263 (194) 52.7 (5.0) 1,742 (270) 72.6 (4.8) 35.5 (4.8) 17.1 (3.7) Workers or other . . . . . . . . . . . . . . 2,067 (538) 1.7 (0.4) 1,225 (334) 59.3 (4.6) 1,398 (353) 67.6 (5.0) 40.3 (6.1) * * 

Unknown or blank . . . . . . . . . . . . . 5,073 (658) 4.2 (0.5) 3,258 (473) 464.2 (3.0) 3,963 (580) 78.1 (3.6) 450.0 (3.8) 14.2 (2.1) 

... Category not applicable. * Estimate does not meet standards of reliability or precision. 1The four groupings—controlled with and without medication mention and uncontrolled with and without medication mention—are mutually exclusive categories and together total all adult hypertensive visits to primary cathe percent distribution for that demographic characteristic. 2Statistically significantly different from 18–44 age group (p < 0.05). 3Statistically significantly different from non-Hispanic black persons (p < 0.05). 4Statistically significantly different from no insurance (p < 0.05). 5Statistically significantly different from private (p < 0.05). NOTE: Hypertensive visits are defined as visits made by nonpregnant patients aged 18 and over whose medical record indicated a diagnosis of hypertension, and whose provider responded affirmatively to the question, 

physician?” SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013–2014.
Table 2. Adult hypertensive visits to primary care physicians, by geographic area: United States, 2013–2014 Geographic area All hypertensive visits Controlled hypertensive visits Hypertensive medication mention Controlled hypertensive visits with medication mention Controlled hypertensive visits with no medication mention 

Number of visits in thousands (standard error) Percent distribution (standard error) Number of visits in thousands (standard error) Percent (standard error) Number of visits in thousands (standard error) Percent (standard error) Percent distribut

National 121,889 (4,808) 100.0 ... 80,465 (3,378) 66.0 (0.8) 87,797 (3,795) 72.0 (1.1) 46.9 (1.0) 19.2 (0.8) 

Division New England 6,291 (915) 5.2 (0.7) 4,476 (699) 71.1 (2.8) 4,007 (661) 63.7 (5.1) 43.6 (4.4) 227.5 (4.1) 

Middle Atlantic 19,140 (2,039) 15.7 (1.5) 12,650 (1,442) 66.1 (2.0) 13,199 (1,529) 69.0 (3.5) 45.0 (3.0) 21.0 (2.9) 

East North Central 17,983 (1,315) 14.8 (1.1) 11,998 (917) 66.7 (1.4) 13,434 (1,045) 74.7 (2.1) 48.8 (1.8) 17.9 (1.6) 

West North Central 5,378 (656) 4.4 (0.5) 3,795 (460) 270.6 (2.2) 4,124 (570) 76.7 (3.3) 254.1 (3.0) 16.5 (2.6) 

South Atlantic 28,165 (2,497) 23.1 (1.8) 18,904 (1,790) 67.1 (1.9) 20,379 (1,980) 72.4 (2.6) 48.6 (2.3) 18.5 (1.6) 

East South Central 7,093 (704) 5.8 (0.6) 4,266 (497) 260.1 (2.7) 4,997 (526) 70.5 (3.4) 40.7 (3.0) 19.4 (2.4) 

West South Central 12,037 (1,689) 9.9 (1.3) 8,086 (1,366) 67.2 (3.4) 8,437 (1,334) 70.1 (3.9) 46.9 (4.1) 20.3 (2.8) 

Mountain 6,213 (722) 5.1 (0.6) 4,000 (484) 64.4 (2.3) 4,793 (617) 77.2 (2.9) 47.7 (2.6) 16.6 (2.5) 

Pacific 19,589 (2,445) 16.1 (1.8) 12,291 (1,515) 62.7 (1.7) 14,427 (1,977) 73.6 (3.0) 45.3 (2.6) 17.5 (2.2) 

States Arizona 2,028 (359) 1.7 (0.3) 1,389 (270) 68.5 (3.6) 1,608 (312) 79.3 (3.8) 52.7 (3.9) 15.8 (3.3) 

California 14,789 (2,392) 12.1 (1.8) 9,203 (1,478) 62.2 (2.2) 10,438 (1,925) 70.6 (4.0) 42.3 (3.4) 19.9 (2.9) 

Florida 13,041 (2,063) 10.7 (1.6) 9,541 (1,565) 273.2 (3.2) 9,968 (1,723) 76.4 (3.8) 256.1 (3.4) 17.1 (2.6) 

Georgia 3,055 (677) 2.5 (0.6) 1,819 (379) 59.5 (3.3) 1,745 (363) 257.1 (5.9) 232.8 (4.3) 226.7 (3.7) Illinois 4,875 (728) 4.0 (0.6) 3,303 (503) 67.7 (2.8) 3,459 (546) 71.0 (4.1) 47.6 (3.8) 20.1 (3.4) 

Indiana 2,627 (399) 2.2 (0.3) 1,682 (276) 64.0 (3.6) 1,968 (296) 74.9 (4.7) 46.2 (3.7) 17.8 (3.8) 

Massachusetts 2,643 (598) 2.2 (0.5) 1,913 (468) 72.4 (4.5) 1,860 (492) 70.4 (6.9) 48.8 (5.9) 23.6 (6.0) 

Michigan 3,939 (631) 3.2 (0.5) 2,534 (433) 64.3 (2.7) 3,004 (510) 76.3 (4.3) 47.6 (3.3) 16.7 (3.2) 

New Jersey 4,206 (1,012) 3.5 (0.8) 2,789 (667) 66.3 (3.8) 3,099 (825) 73.7 (4.2) 49.9 (4.3) 16.4 (3.1) 

New York 8,237 (1,377) 6.8 (1.1) 5,561 (1,013) 67.5 (3.4) 4,709 (823) 257.2 (5.9) 37.7 (4.7) 229.8 (5.2) 

North Carolina 2,886 (595) 2.4 (0.5) 1,938 (457) 67.2 (4.6) 2,287 (525) 79.2 (6.1) 52.3 (6.8) *14.8 (4.7) 

Ohio 4,842 (764) 4.0 (0.6) 3,280 (541) 67.7 (3.3) 3,625 (635) 74.9 (4.9) 49.2 (4.2) 18.5 (3.4) 

Pennsylvania 6,697 (1,132) 5.5 (0.9) 4,300 (792) 64.2 (3.2) 5,391 (998) 80.5 (4.3) 51.1 (4.6) 13.2 (3.0) 

Tennessee 1,761 (302) 1.4 (0.3) 945 (214) 253.7 (5.5) 1,235 (196) 70.2 (6.6) 232.6 (5.0) 21.1 (6.0) 

Texas 8,352 (1,589) 6.9 (1.2) 5,905 (1,322) 70.7 (4.2) 6,083 (1,259) 72.8 (4.9) 51.6 (5.2) 19.1 (3.6) 

Virginia 3,278 (469) 2.7 (0.4) 2,191 (325) 66.8 (3.6) 2,269 (368) 69.2 (5.4) 45.8 (5.0) 21.0 (3.9) 

Washington 2,351 (327) 1.9 (0.3) 1,579 (233) 67.2 (2.5) 1,999 (288) 285.0 (2.0) 257.2 (2.5) 29.9 (1.5) 

Wisconsin 1,700 (242) 1.4 (0.2) 1,198 (176) 70.5 (2.7) 1,377 (208) 281.0 (3.2) 258.1 (3.0) 212.4 (2.3) 

... Category not applicable. * Estimate does not meet standards of reliability or precision. 1The four groupings—controlled with and without medication mention and uncontrolled with and without medication mention—are mutually exclusive categories and together total all adult hypertensive visits to primary cathe percent distribution for that geographic area. 2Statistically significantly different from national (p < 0.05). NOTES: Hypertensive visits are defined as visits made by nonpregnant patients 18 years and older whose medical record indicated a diagnosis of hypertension, and whose provider responded affirmatively to the questiophysician?” Numbers may not add to totals because of rounding. SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013–2014.
National Health Statistics Reports  Number 106  September 19, 2017 Page 13

Technical Notes

Census division 

The 50 states and the District of 

Columbia are divided into four census 

regions (Northeast, Midwest, South, and 

West), which are subdivided into nine 

census divisions:

East North Central—Indiana, 

Illinois, Michigan, Ohio, and Wisconsin

East South Central—Alabama, 

Kentucky, Mississippi, and Tennessee

Mid-Atlantic—New Jersey, New 

York, and Pennsylvania

Mountain—Arizona, Colorado, 

Idaho, New Mexico, Montana, Utah, 

Nevada, and Wyoming

New England—Connecticut, Maine, 

Massachusetts, New Hampshire, Rhode 

Island, and Vermont

Pacific—Alaska, California, Hawaii, 

Oregon, and Washington

South Atlantic—Delaware, Florida, 

Georgia, District of Columbia, Maryland, 

North Carolina, South Carolina, Virginia, 

and West Virginia

West North Central—Iowa, Kansas, 

Minnesota, Missouri, Nebraska, North 

Dakota, and South Dakota

West South Central—Arkansas, 

Louisiana, Oklahoma, and Texas

Controlled hypertension 

All visits made to the patient’s 

primary care physician by nonpregnant 

adult patients aged 18 and over with 

documentation in the medical record for 

both hypertension and a blood pressure 

(BP) measurement of less than 140/90 

mm Hg for that visit (4). 

Hypertension and other 

chronic conditions

Since 2005, the National Ambulatory 

Medical Care Survey has asked, 

“Regardless of the diagnosis for the 

current visit, does the patient now have 

(mark all that apply): hypertension, 

arthritis, asthma, cancer, cerebrovascular 

disease, chronic obstructive pulmonary 

disease, chronic renal failure, congestive 

heart failure, depression, diabetes, 

hyperlipidemia, ischemic heart disease, 

obesity, and osteoporosis.” This item 

has since changed to include additional 

chronic conditions. To be sure that the 

checkboxes are all-inclusive, during 

the data editing process, a consistency 

check is performed to be sure that any 

record with a visit diagnosis of any of 

the above chronic conditions, including 

hypertension, also has the checkbox 

marked. This report includes all visits 

made to a patient’s primary care 

physician by nonpregnant adults aged 

18 and over with documentation in the 

medical record of having hypertension. 

Managing hypertension is the reason 

for some of these visits, but many other 

reasons, such as a respiratory infection or 

an injury, are also included. 

Expected source of payment 

for this visit

 During data collection, all sources 

of payment were collected. These sources 

of payment were collapsed into one 

mutually exclusive variable (expected 

source of payment) that ranks payment 

sources based on the hierarchy shown 

below (7,8).

Medicare—Partial or full payment 

by Medicare plan includes payments 

made directly to the physician and 

community health center (CHC) provider 

as well as, payments reimbursed to 

the patient. Charges covered under a 

Medicare-sponsored prepaid plan are 

included.

Medicaid—Partial or full payment 

by Medicaid plan includes, payments 

made directly to the physician and CHC 

provider as well as payments reimbursed 

to the patient. Charges covered under 

a Medicaid-sponsored prepaid plan are 

included.

Private insurance—Partial or full 

payment by a private insurer (e.g., 

BlueCross BlueShield), either directly to 

the physician and CHC, or reimbursed 

to the patient. Charges covered under a 

private insurance sponsored prepaid plan 

are included.

Workers’ compensation and other—

Includes programs designed to enable 

employees injured on the job to receive 

financial compensation, regardless of 

fault. For this report, “other” includes 

any other source of payment not covered 

by the above categories, such as the 

Civilian Health and Medical Program 

of the Uniformed Services, state and 

local governments, private charitable 

organizations, and other liability 

insurance (e.g., automobile collision 

policy coverage).

No insurance—Includes self-pay, 

no charge, or charity. Self-pay is charges 

that are paid by the patient or patient’s 

family, which will not be reimbursed 

by a third party. Self-pay includes visits 

for which the patient is expected to be 

ultimately responsible for most of the 

bill, even if the patient never actually 

pays it. This does not include copayments 

or deductibles. No charge or charity are 

visits for which no fee is charged (e.g., 

charity, special research, or teaching). 

Unknown or blank—The primary 

source of payment is not known or all of 

the sources of payment listed above are 

left entirely blank.

Hypertensive medications 

A comprehensive list of 102 

hypertensive medications was compiled 

by a staff pharmacist from the National 

Center for Health Statistics. Any 

hypertensive medication documented 

in the medical record as having been 

ordered, supplied, administered, or 

continued at that visit was included. 

Up to 10 drug mentions were collected 

per visit in 2013, and 30 mentions 

were collected per visit in 2014. For a 

complete list of the 102 medications, 

please contact the Ambulatory and 

Hospital Care Statistics Branch at 301–

458–4600 or email ambcare@cdc.gov.

Patient’s primary care 

physician 

Affirmative responses to the 

question, “Are you the patient’s primary 

care physician or provider?” are included.

Uncontrolled hypertension

All visits made to the patient’s 

primary care physician by nonpregnant 

patients aged 18 and over with 

documentation in the medical record for 

both hypertension and a blood pressure 

measurement of more than or equal to 

140/90 mm Hg for that visit (4).
National Health Statistics Reports  Number 106  September 19, 2017

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Suggested citation

Ashman JJ, Rui P, Schappert SM, Strashny 

A. Characteristics of visits to primary 

care physicians by adults diagnosed with 

hypertension. National health statistics reports; 

no 106. Hyattsville, MD: National Center for 

Health Statistics. 2017.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate Director 

for Science

Division of Health Care Statistics

Denys T. Lau, Ph.D., Acting Director

Alexander Strashny, Ph.D., Associate Director 

for Science

Acknowledgments 

The authors would like to thank John Watts, Pharm.D., for compiling the list of hypertensive medications.