NCHS Data Brief

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hypertension Awareness, Treatment, and Control —

Continued Disparities in Adults: United States, 2005–2006

Yechiam Ostchega, Ph.D., RN; Sung Sug Yoon, Ph.D.; Jeffery Hughes, M.A., M.P.H.; and Tatiana Louis, M.S.,

Division of Health and Nutrition Examination Surveys

No.3 January 2008

Highlights

Data from the 

National Health and 

Nutrition Examination 

Surveys.

► In 2005–2006, 29% of all 

U.S. adults 18 years and older 

were hypertensive (systolic BP ≥ 

140 mmHg or diastolic BP ≥ 90 

mmHg or taking medications for 

hypertension). The prevalence 

of hypertension was nearly equal 

between men and women.

► In 2005–2006, an 

additional 28% of U.S. adults had 

prehypertension (systolic BP 

120–139 mm Hg or diastolic 

BP 80-89 mm Hg, and not 

pharmacologically treated 

for high BP).

► In 2005–2006, 7% of the total 

U.S. adult population had a systolic 

BP ≥ 140 mmHg or diastolic BP ≥ 

90 mmHg, but had never been told 

by a health care provider that they 

had high BP.

► Among hypertensive adults, 

78% were aware of their condition.

► Overall, 68% of adults with 

hypertension were using 

anti-hypertensive medication.

► Over 64% of adults who were 

taking antihypertensive medication 

achieved BP less than 

140/90 mm Hg.

Importance

High blood pressure (BP) is a modifiable risk factor for cardiovascular disease 

(CVD) (1). High BP increases the risk of heart attack, heart failure, stroke, and 

kidney disease (2–4). Conversely, favorable BP levels are associated with a greater 

probability of survival to age 85 as well as increased longevity without major comorbidities (5,6). Increasing the awareness, treatment, and control of hypertension 

will reduce morbidity and mortality. This is a goal of national public health programs 

and initiatives such as the National High Blood Pressure Education Program (7). Data 

on levels of this risk factor in the U.S. population help to identify subgroups where 

risk may be greatest and prevention efforts might be targeted. Comparison over time 

can also show if the population is experiencing improvement in controlling elevated 

levels of BP.

Keywords: hypertension ● prevalence ● trends

Findings

Has the prevalence of hypertension in U.S. adults declined since 1999?

• There was no significant change in hypertension prevalence from 1999 to 2006.

Figure 1. Age-adjusted prevalence of hypertension in adults: United States, 

1999–2006 Percent

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

0

25

30

35

Men Women

Total

1999–2000 2001–2002 2003–2004 2005–2006

The overall age-adjusted prevalence varied only slightly between 28% and 30% 

during the period 1999 to 2006. There were no changes in hypertension prevalence 

by gender, age, or race/ethnicity.
No.3 January 2008

NCHS Data Brief

2

Are some groups more likely to have hypertension compared with others?

• Hypertension varied by age and race/ethnicity.

The prevalence of hypertension increased with age from 7% among those aged 18–39 years 

to 67% among those aged 60 years and older. The non-Hispanic black population had a 

significantly higher prevalence of hypertension than the non-Hispanic white and 

Mexican- American populations(41% vs. 28% and 22%, respectively). The prevalence 

was also significantly higher for the non-Hispanic white population compared with the 

Mexican-American population.

Figure 2. Age specific and age-adjusted prevalence of hypertension 

in adults: United States, 2005–2006

Percent 1

Statistically significant difference between ages 18–39 and 40–59 years. 

2

Statistically significant difference between ages 40–59 and 60 years and over. 

3

Statistically significant difference between the non-Hispanic white and Mexican-American populations.

4

Statistically significant difference between the non-Hispanic white and non-Hispanic black populations.

5

Statistically significant difference between the non-Hispanic black and Mexican-American populations.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Non-Hispanic black

Non-Hispanic white

 Mexican American

Women

Men

60 years and over

40–59

18–39

(1)

(2)

(3)

(4,5)

0 20 40 60 80 100

What proportion of U.S. adults have prehypertension?

• Overall, 28% of adults had prehypertension, that is, they had a systolic BP 120–139 mm 

Hg or diastolic BP 80–89 mm Hg, and were not pharmacologically treated for high BP.

The prevalence of prehypertension was significantly higher in men compared with women 

(34% and 22%, respectively). The prevalence of prehypertension was significantly different 

among the age groups and it was the lowest among persons aged 60 years and older (18%) 

compared with those aged 18–39 and 40–59 years (29%, and 34%, respectively). The 

Mexican-American population (31%) had a significantly higher prevalence of prehypertension 

than the non-Hispanic black population (27%). There was no statistically significant 

difference in the prevalence of prehypertension between the non-Hispanic white (29%) and 

the non-Hispanic black populations.
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No.3 January 2008

NCHS Data Brief

Figure 3. Age specific and age-adjusted prevalence of prehypertension 

in adults: United States, 2005–2006 

Percent

1

Statistically significant difference between ages 18–39 and 40–59 years. 

2

Statistically significant difference between ages 18–39 and 60 years and over.

3

Statistically significant difference between ages 40–59 and 60 years and over.

4

Statistically significant difference between men and women.

5

Statistically significant difference between the non-Hispanic black and Mexican-American populations.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Non-Hispanic black

Non-Hispanic white

Mexican American

Women

Men

60 years and over

40–59

18–39

0 20 40 60 80 100

(1)

(4)

(5)

(2,3)

Are adults with hypertension aware that they have it?

• Overall, 78% of hypertensives were aware of their condition. Awareness of 

hypertensionvaried by age, gender, and race/ethnicity.

Figure 4. Awareness of hypertension among hypertensives adults: 

United States, 2005–2006

1

Statistically significant difference between the two age groups.

2

Statistically significant difference between men and women aged 18–59 years.

3

Statistically significant difference between the non-Hispanic black and Mexican-American populations. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Percent

0 20 40 60 80 100

Women(2)

Total(1)

Total

Women

Men(1)

Men

Non-Hispanic black

Non-Hispanic white

Mexican American

60 years

and over

18–59

(3)
No.3 January 2008

NCHS Data Brief

4

Among hypertensives aged 18–59 years, men (63%) were less likely to be aware of 

theircondition compared with women (87%). There was no difference in awareness 

amonghypertensive men (84%) and women (81%) aged 60 years and older.

Among hypertensive men, awareness of hypertension increased with age from 63% for those 

aged 18–59 years to 84% for men aged 60 years and older. Awareness of hypertension did not 

differ by age for women.

Non-Hispanic blacks with hypertension were more likely to be aware of their hypertension 

compared with Mexican Americans with hypertension. There was no significant difference in 

the awareness of hypertension between non-Hispanic white and non-Hispanic black or between 

non-Hispanic white and Mexican-American hypertensives.

• Overall, 6.6 % of U.S. adults had a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg, 

but had never been told by a health care provider that they had high BP (data not shown).

The proportion of U.S. adults who had high BP but who had never been told by a health care 

provider that they had it was significantly higher for men compared with women (8.2% and 

4.7%, respectively). Prevalence was 5.0% in those aged 18–59 and 12.1% for those ≥60 years.

What is the current proportion of people with hypertension who are treated with

antihypertensive medication?

• Overall, 68% of hypertensives were treated with antihypertensive medication.

Figure 5. Treatment of hypertension among hypertensives adults: 

United States, 2005–2006

1

Statistically significant difference between the two age groups.

2

Statistically significant difference between men and women aged 18–59 years.

3

Statistically significant difference between the non-Hispanic white and Mexican-American populations.

4

Statistically significant difference between the non-Hispanic black and Mexican-American populations.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. 

Percent

(3)

(4)

Women(2)

Women

Total(1)

Total

Men(!)

Men

Non-Hispanic black

Non-Hispanic white

Mexican American

60 years

and over

18–59

0 20 40 60 80 100
5

No.3 January 2008

NCHS Data Brief

The prevalence of hypertension treatment among hypertensives increased with age from 59% 

in those aged 18–59 years to 77% in those aged 60 years and older.

Among hypertensives aged 18–59 years, men (47%) were less likely to be treated compared 

with women (74%), but there was no difference in treatment between hypertensive men (78%) 

and women (75%) aged 60 years and older.

A smaller proportion of Mexican-American hypertensives (50%) were currently taking 

antihypertensive medication than non-Hispanic white (69%) and non-Hispanic black 

(72%) hypertensives.

What percentage of people treated with antihypertensive medication have their

BP controlled?

• Overall, 64% of hypertensives who were treated with antihypertensive medication had 

successfully controlled BP.

Figure 6. Control of hypertension among treated hypertensives adults: 

United States, 2005–2006

1

Statistically significant difference between the two age groups.

2

Statistically significant difference between men and women aged 60 years and over.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Women

Women(1)

Men(2)

Men

Total(1)

Total

Non-Hispanic black

Non-Hispanic white

 Mexican American

60 years

and over

18–59

Percent

0 20 40 60 80 100

Among treated hypertensives, those aged 18–59 years (72%) were more likely to have 

controlled their BP than those aged 60 years and older (58%).

Success in hypertension control among treated hypertensives was significantly higher in 

men aged 60 years and older than in women in the same age group (64 % for men and 

53% for women).

There were no significant differences in blood pressure control between non-Hispanic white 

(65%), non-Hispanic black (58%), and Mexican-American (64%) hypertensives who were 

currently taking antihypertensive medication.
No.3 January 2008

NCHS Data Brief

6

Summary

Overall, 29% of adults aged 18 years and older had hypertension. This includes approximately 

7% of the total population of adults whose BP was high but who had never been told so by a 

health care provider. The prevalence of hypertension did not change during 1999–2006. Among 

hypertensives, 78% were aware of their hypertension and 68% were taking antihypertensive 

medication. Among those taking medication, 64% had controlled BP (under 140/90 mm Hg).

Various age, gender, and race/ethnic disparities in hypertension prevalence, awareness, 

treatment and control were present. Older individuals (aged 60 years and older) had a higher 

prevalence of hypertension compared with those in younger age groups, and non-Hispanic 

blacks had higher prevalence compared with non-Hispanic whites and Mexican Americans. 

Awareness of hypertension and treatment with antihypertensive medication among those with 

the condition were higher in women aged 18–59 years compared with men in the same age 

group, whereas awareness and treatment were comparable between men and women aged 

60 years and older. Control of BP among those who were currently taking antihypertensive 

medication was similar for men and women aged 18–59 years, but the proportion with 

controlled BP was higher for men than for women aged 60 years and older. Mexican 

Americans with hypertension were less likely to be aware of their condition compared with 

non-Hispanic blacks and less likely to be treated compared with non-Hispanic blacks and 

non-Hispanic whites. There were no race/ethnic differences in the proportion who had 

controlled blood pressure among those taking medication.

Despite recent advances in medical treatment of hypertension and public health campaigns 

to reduce the prevalence of hypertension, this condition remains a significant public health 

problem in the United States. Information about awareness of hypertension, treatment, and 

control of BP among those with the disease provide a basis for targeting public health efforts to 

reduce blood pressure levels and the prevalence of hypertension.

Definitions

Hypertension: systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg or currently taking 

medication to lower high BP. 

The average of up to three brachial systolic and diastolic BP readings was used for systolic 

and diastolic BP values. All BP readings were obtained at a single examination visit. BP 

was measured in a mobile examination center (MEC) by trained physicians following 

a standard protocol. Appropriate BP cuff sizes were used for participants based on 

measurement of mid-arm circumference.

Prehypertension: systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg, and not 

pharmacologically treated for high BP.

Awareness of hypertension: defined by an affirmative response to the question “Have you 

ever been told by a doctor or health professional that you had hypertension, also called high 

blood pressure?”

Currently taking medication to lower BP: Among all hypertensives, defined by affirmative 

responses to the following questions: 1)“Because of your high blood pressure/hypertension, 
7

No.3 January 2008

NCHS Data Brief

have you ever been told to take prescribed medicine?” and 2)“Are you now following this 

advice to take prescribed medicine?”

Controlled Hypertension: Systolic BP <140 mmHg and diastolic BP < 90 mmHg among 

those currently taking medication to lower BP.

Data source

The National Health and Nutrition Examination Survey (NHANES) data were used for 

these analyses. NHANES is designed to monitor the health and nutritional status of the U.S. 

population. The survey consists of interviews conducted in participants’ homes, standardized 

physical examinations conducted in specially outfitted MECs, and laboratory tests utilizing 

blood and urine specimens provided by participants during the physical examination.

The NHANES sample is selected through a complex, multistage design that includes selection 

of primary sampling units (counties), household segments within the counties, and finally 

sample persons from selected households. The sample design includes oversampling in order 

to obtain reliable estimates of health and nutritional measures for population subgroups. In 

2005–2006, African Americans, Mexican Americans, persons with low income, persons 12–19 

years of age, and persons 60 years and older were oversampled. In 1999, NHANES became 

a continuous survey, fielded on an ongoing basis. Each year of data collection is based on a 

representative sample covering all ages of the civilian, noninstitutionalized population. 

Public-use data files are released in 2-year cycles.

Sample weights, which account for the differential probabilities of selection, nonresponse 

and noncoverage, were incorporated into the estimation process. The standard errors of the 

percentages were estimated using Taylor Series Linearization, a method that incorporates the 

sample weights and sample design.

Estimates for the total population were age adjusted to the 2000 U.S. standard population 

using three age groups, 20–39, 40–59, and ages 60 years and older (8). Differences between 

groups were evaluated using a univariate t-statistic. Trend tests were done to evaluate changes 

in estimates over time. All significance tests were two-sided using p < 0.05 as the level of 

statistical significance. For comparison of estimates by age and race/ethnicity, adjustments for 

multiple comparisons were made using the Bonferroni method by dividing 0.05 by the number 

of comparisons (9). All differences reported are statistically significant unless otherwise 

indicated.

Statistical analyses were conducted using the SAS System for Windows (release 9.1; SAS 

Institute Inc, Cary, N.C.) and SUDAAN (release 9.0; Research Triangle Institute, Research 

Triangle Park, N.C.).

Acknowledgments

The data files for this report were prepared in the Division of Health and Nutrition Examination 

Surveys, Informatics Branch. This report was edited by Demarius V. Miller, CDC/CCHIS/

NCHM/Division of Creative Services, Writer-Editor Services Branch; layout, graphic 

production, and Internet preparation by Zorica Tomic-Whalen, CDC/CCHIS/NCHM/Division 

of Creative Services, NOVA contractor; Internet preparation and Internet posting by Christine 
Brown, Office of Information Services, Information Design and Publishing Staff. Printing management by Patty 

Wilson, CDC/MASO.

Suggested citation

Ostchega Y, Yoon SS, Hughes J, Louis T. Hypertension awareness, treatment, and control -- continued disparities in 

adults: United States, 2005–2006. NCHS data brief no Hyattsville, MD: National Center for Health Statistics. 2008.

References

1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual 

blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. 

Lancet. 2002 Dec 14;360(9349):1903–13.

2. Wang JG, Staessen JA, Franklin SS, Fagard R, Gueyffier F. Systolic and diastolic blood pressure lowering as determinants of 

cardiovascular outcome. Hypertension. 2005 May;45(5):907–13.

3.Chobanian AV, Bakris GL, Black HR, Cushman WC, et al. The seventh report of the joint national committee on prevention, 

detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560–72.

4. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. U.S. population data. Arch 

Intern Med. 1993 Mar 8;153(5):598–615.

5. Vasan RS, Larson MG, Leip EP, Evans JC, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. 

N Engl J Med. 2001 Nov 1;345(18):1291–7.

6. Terry DF, Pencina MJ, Vasan RS, Murabito JM, et al. Cardiovascular risk factors predictive for survival and morbidity-free 

survival in the oldest-old Framingham Heart Study participants. J Am Geriatr Soc. 2005 Nov;53(11):1944–50.

7. National Heart Lung and Blood Institute. National High Blood Pressure Education Program. Available from: 

http://www.nhlbi.nih.gov/about/nhbpep/nhbp_pd.htm.

8. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. 

Hyattsville, MD: National Center for Health Statistics. 2001.

9. Miller RG. Developments in multiple comparisons, 1966–76. JASA 72:779–88. 1977.

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