Blood Pressure

Levels in Persons

18-74 Years of Age

in 1976–80, and

Trends in Blood

Pressure From 1960

to 1980 in the

United States

This report presents blood pressure levels

and prevalence rates of hypertension

among U.S. adults in 1976–80 by age,

sex, race, and education. Secular trends

for blood pressure and hypertension in

the period from 1960 to 1980 are also

presented.

Data From the National Health Survey

Series 11, No. 234

DHHS Publication (PHS) 86-1684

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

July 1986
. ——

Copyright information:

All material appearing in this report is in the public domain snd may be

reproduced or copied without permiaaion; citation as to source,

however, is appreciated.

Suggested Citation

National Center for Health Statistics, T. Drizd, A. L. Dannenberg, and

A. Engel: Blood pressure levels in persons 18–74 yeara of age in

1976-80, and trenda in blood pressure from 1960 to 1980 in the

United States. Vital and Health Statistics. Series 11, No. 234. DH H S

Pub. No. ( PHS 86-1684. Public Health Service. Washington. U.S.

Government Printing Office, July 1986.

Librery of Congrees Cataloging- in- Pubiicetion Data

Drizd, Terence.

Blood pressure Ievela in persons 18-74 yeara of age

in 1976-80, and trends in blood pressure from 1960 to

1980 in the United Statea.

(Series 11, Data from the national health suwey ;

no. 234) (DHHS publication : (PHS) 86-1 684)

Written by Terence Drizd, Andrew L. Dannenberg, and

Arnold Engel.

Bibliography p.

1. Hypertension-United States—Statistics.

2. 8100d pressure—United States—Statistics.

1. Dannenberg, Andrew L Il. Engel, Arnold.

* Ill. National Center for Health Statistics (U. S.)

‘ IV. Title. V. Series: Vital and health statistics.

)

Series 11, Data from the national health survey ;

,, no. 234. V1. DHHS publication ; (PHS) 86-1684.

[DNLM: 1. 8100d Pressure—United States—statistics.

2. Hypertansion— United States—statistics,

W2 A N148vk no. 234]

RA407,3.A347 no. 234 362.1 ‘0973021 S 85-32032

[RA645.H9] [61 6.1 ‘3200973021]

ISBN 0-8406-0330-4

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402
National Center for Health Statistics

Manning Feinleib, M. D., Dr. P. H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Director for Analysis

and Epidemiology

Garrie J. Losee, Associate Directorfor Data Processing

and Services

Alvan O. Zarate, Ph. D., Assistant Director for International

Statistics

Peter L. Hurley, Acting Associate Directorfor Interview

and Examination Statistics

Stephen E, Nieberding, Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for Program

Planning, Evaluation, and Coordination

Monroe G. Sirken, Ph. D., Associate Director for Research

and Methodology

Peter L. Hurley, Associate Director for Vital and Health

Care Statistics

Alice Haywood, Information Officer

Office of Interview and Examination Statistics Programs

Peter L, Hurley, Acting Associate Director

Mary Grace Kovar, Dr. P. H., Special Assistant for Dara

Policy and Analysis

Division of Health Examination Statistics

Robert S. Murphy, Director

Catherine Woteki, Ph. D., Deputy Director

Kurt Maurer, Chiej Survey Planning and Deve[oprnent

Branch

Suzanne Haynes, Ph. D., C’hiej Medical Statistics Branch

Clifford Johnson, Chief Nutrition Statistics Branch

Cooperation(//”rhr L’.S.Bureauo.f[he(’emt(.v

Under the Ieg]slation establishing the National Health Survey. !he Public Health Service

is authorized to use. insofar as possible, the sert>ices or facilities of other Federal. State.

or private agencies. In accordance with specifications established b), the National Center

for Health Statistics, the U.S. Bureau of the Censu~ panictpawd in the design and selection

of the sample and carried out the initial household interview stage of the data collection

and certain vans oftbe statistical !xocessing.
Acknowledgments

The authors would like to thank Drs. Paul Leaverton and

Eve Moscicki and Mr. Steve Clybum, from the National Heart,

Lung and Blood Institute, who provided invaluable technical

assistance in the preparation of sections of this report. Drs.

Mary Grace Kovar and Suzanne Haynes and Mr. Robert

Murphy from the National Center for Health Statistics offered

many helpfid comments during review of the manuscript.
Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data sources and statistical methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressure measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Statistical methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Findings-National Health andNutrition Examinations urveyII, 1976–80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Systolic blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diastolicbloodpressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education andbloodpressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Joint distributions ofSBPandDBP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Secular trends, 1960-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparisons ofresults amongthree National Health Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lktofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

I. Survey design and estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Statistical methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111.Demographic andsocioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. IJmitations ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List oftextfigures

1. Mean systolic bloodpressure among white andblackmen andwomenby age United States, 1976-80 . . . . . . . . . . . . . .

2. Mean diastolicbloodpressure amongwhite andblackmen andwomen by age United States, 1976-80 . . . . . . . . . . . . . .

3. Prevalenceofdefinitehypertensionemong adults 18-74yearsofagebyageandsex orrace: UnitedStates, 1976-80 . . .

4. Prevalence of borderline hypertension among adults 18-74 years of age by age and sex: United States, 1976-80......

5. Number and percentofhypertensives whowere diagnosed, bysex andage: United States, 1976-80 . . . . . . . . . . . . . . . . .

6. Prevalence of elevated blood pressure among white and black men and women by age: United States, 1976-80 . . . . . . .

7. Prevalence ofhypertension among white andblackmen andwomen 18-74 years ofageusingtraditional definitions and

definitions of the ThirdJoint National Committee forthe Detection, Evaluation, andTreatmentof High Blood Pressure:

United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Smoothedweightedfiequencydistribution ofthefwst systolic bloodpressure for white men ages 18–24years bysurvey:

United States, NHES 1(1960-62), NHANES 1(1971 -74), NHANESII (1976-80).. . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Smoothedweightedfrequencydistribution ofthefrstsystolicbloodpressurefor white men ages 65-74years bysurvey:

United States, NHESI(1960-62), NHANESI (1971-74), NHANESII (1976-80) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Age-adjusted prevalence ofdefmite hypertension among white and black men and womenby survey: United States,

NHESI(1960-62), NWNESI(1971-74), NWESII(1976-80) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2

3

3

3

4

6

6

6

8

8

13

19

19

20

24

27

30

63

65

66

67

7

9

11

12

14

16

17

21

21

23

v
List of text tables

A. Description of blood pressure measurement procedures for NHE,S I, NHANES I, and NHANES II . . . . . . . . . . . . . . . . 4

B. Mean systolic blood pressure by race, sex, and age: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

C. Mean diastolic blood pressure by race, sex, and age: United States, 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

D. Comparison of JNCIII andtraditional hypertension definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

E. Prevalence rates for mild, moderate, and severe hypertension combined, based on JNC III definitions, by race, sex, and

age United States, 1976–80. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . 17

F. DistributionofU.S. populationaccording to JNCIIU hypertensioncategories, by race, sex, andcategory: United States,

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 17

Symbols

. . . Data not available

. . . Categoty not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more tharl zero but less than

500 where numbers are roundedto

thousands

*

Figure does not meet standardof

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

vi
Blood Pressure Levels in

Persons 18-74 Years of Age

in 1976–80, and Trends in

Blood Pressure From 1960

to 1980 in the United States

Terence Drizd, M. S. P. H., National Center for Health

Statistics, Division of Health Examination Statistics;

Andrew L. Dannenberg, M. D., M. P. H., National Institutes

of Health, National Heart, Lung and Blood Institute, Division

of Epidemiology and Clinical Applications; and Arnold Engel,

M. D., M. P. H., National Center for Health Statistics, Division

of Health Examination Statistics

Introduction

Essential hypertension is a major risk factor for mrdiovascular dk,ease. It markedly increases the risk of death from

cerebrovascular accident, kidney failure, and coronary heart

disease.l Clinical intervention trials have shown decreases in

morbidity and mortality from hemorrhagic strokes, congestive

heart failure, renal failure, and aortic dissections when blood

pressure is reduced? Cardiovascular mortality has decreased

steadily in the United States since the mid-1960’s3 and, although the reasons for this decline have not been completely

established, a reduction in uncontrolled hypertension is a leading hypothesis. Previous estimates suggest that in the early

1970’s as many as 60 million Americans had elevated blood

pressures.4

The objectives of this report are twofold. The first part

presents current estimates of mean systolic and diastolic blood

pressure and of the prevalence of hypertension in the civilian

noninstitutionalized portion of the U.S. population between the

ages of 18 and 75 years. Differences among age, race, sex, and

educational groups are examined. These estimates can be used

by (a) clinicians, to compare individual blood pressures against

national norms, (b) epidemiologists, to compare local or special

study samples against national norms, or(c) various public and

private agencies in planning strategies to combat high blood

pressure.

The second part of this report focuses on trends in blood

pressure and hypertension in U.S. adults since 1960. These

data and the age-standardized analyses derived from them

specifically address changes in mean blood pressures and in

the prevalence of various kinds of hypertension, particularly

concerning differences by race, sex, and age. These data should

be particularly useful in evaluating the effectiveness of various

programs instituted to promote the detection and treatment of

hypertension. These data may provide baseline information

useful in documenting the proportion of the population under

treatment for hypertension and, of particular concern, those

under treatment for mild hypertensions

Three cross-sectional surveys conducted by the National

Center for Health Statistics during 1960-80 provide the data

on which the report is based. The surveys included are the first

National Health Examination Survey ( 1960–62) and the first

and second National Health and

veys (1971 –74 and 1976–80,

Nutrition Examination Surrespectively). Each of the

surveys was designed to assess the health of a nationally representative probability sample of the U.S. civilian noninstitutionalized population at the time the survey was conducted.

Every examined person received a basic physical examination,

and selected subsets of the samples of the later two surveys

received additional examination components. Medical history

data were collected for all examined persons. The standardized

examinations were performed in specially constructed mobile

examination centers that were moved about the country to each

of a number of previously selected primary sampling areas.

GeneraJ descriptive data for each of the three surveys are as

follows (for the subsets of examined persons used for this

report):

National Health Examination Survey 1:

Time span . . . . . . . . . . . . . . . . . . . . . . . . . .

Sample person ages . . . . . . . . . . . . . . . . . .

Sample size . . . . . . . . . . . . . . . . . . . . . . . . .

Number of examined persons . . . . . . . . . .

Response rate...............,.. . . . . .

National Health and Nutrition Examination

Survey 1:t

Time span . . . . . . . . . . . . . . . . . . . . . . . . .

Sample person ages . . . . . . . . . . . . . . . . . .

Sample size . . . . . . . . . . . . . . . . . . . . . . . . .

Number of examined persons . . . . . . . . . .

Reaponse rate . . . . . . . . . . . . . . . . . . . . . . .

National Health and Nutrition Examination

Survey 11:

Time span . . . . . . . . . . . . . . . . . . . . . . . . . .

Sample person ages . . . . . . . . . . . . . . . . . .

Sample size . . . . . . . . . . . . . . . . . . . . . . . . .

Number of examined persons . . . . . . . . . .

Response rate . . . . . . . . . . . . . . . . . . . . . . .

1960-62

18-79 years

7,710

6,672

86.5

1971-74

18-74 years

19,572

13,645

69.7

1976-80

18-74 years

18,209

12,504

68.7

tData from the NHANES I Augmentation Survey were not included

in thase analysea.

A more detailed description of survey design and sampling

procedures is in appendix 1. Statistical notes on the sample

design, including sample size and national population estimates, reliability of data, and sampling and measurement error

are included in appendix II. Demographic and socioeconomic

terms are defined in appendix 111.Data limitations are described

in appendix IV.

1
The analyses presented in this report, which are summarized below, address questions concerning recent levels of blood

pressure and trends in blood pressure levels and hypertension

in the U.S. civilian noninstitutionalized population ages 18–74

years. Although the midpoints of the three surveys were 1961,

1972, and 1978, the three surveys spanned the periocl from

1960 to 1980. Because some segments of the U.S. population

are not represented in this subsample (children, adults ages 75

years and over, military personnel, and institutionalized persons), the total number of hypertensives in the U.S. population

cannot be estimated directly from these data. However, some

researchers have used these and other data to develop such

estimates.b

The recently published report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood

Pressure (called JNC III) has recommended new and more

detailed definitions for a variety of hypertension categories.7 In

that report the traditional categories of borderline and definite

hypertension have been merged and redefined as “mild” (diastolic blood pressure (DBP) of 90 to 104 mmHg), “moderate”

(DBP of 105 to 114 mmHG), and “severe” (DBP of 115 or

more mmHg) hypertension. In addition, newly created categories include “high normal” for adults with DBP between 85

and 89 mmHg, and other categories related to isolated systolic

hypertension. The data presented in this report can be used to

estimate prevalence rates for these new categories.

However, the major analyses of hypertension described in

this report are based on the following definitions: (a) definite

hypertension is defined as systolic blood pressure (SBP) equal

to or greater than 160 mmHg and/or DBP equal to or greater

than 95 mmHg and/or taking antihypertensive medication, (b)

borderline hypertension is defined as SBP equal to or greater

than 140 mmHg but less than 160 mmHg and/or DBP equal to

or greater than 90 mmHg but less than 95 mmHg and not taking

antihypertensive medication, and (c) isolated systolic hypertension is defined as SBP equal to or greater than 160 mmHg

and DBP less than 90 mmHg. The decision to employ the

traditional definitions was motivated primarily by a desire to

facilitate the analyses of trends that constitute the latter part of

thk report and to enhance comparisons with previously pub

lished work.

The following conclusions highlight the findings from the

NHANES II survey, conducted from 1976 to 1980, with

March 1, 1978, as the midpoint of the survey:

. About 25 million U.S. adults ( 17.7 percent) had definite hypertension, either diagnosed or undiagnosed. Definite

2

hypertension was more prevalent among black than white

adults (25. 7 versus 16.8 percent, respectively).

Of the 25 million adults with definite hypertension, about

6.6 million (26.4 percent) had not been diagnosed that is,

told by a doctor that they had hypertension or high blood

pressure.

Another 17 million adults (12.0 percent) had borderline

hypertension.

Mean SBP levels were higher among black than white

adults in most age groups.

Mean DBP levels were generally higher among men than

women and were generally higher among black than white

adults.

The prevalence rate for hypertension based on the newly

created JNC III definition (DBP equal to or greater th~

90 mmHg and/or SBP equal to or greater than 140 mmHg

and/or medicated) was 29.7 percent (about 42 million

adults), about two-thirds h&her than the 17.7 percent

estimated using the traditional definition (DBP equal to or

greater than 95 mmHg and/or SBP equal to or greater

than 160 mmHg and/or medicated).

Findings from the three surveys conducted in the period

1960–80 include the following

●

●

●

●

●

Mean SBP decreased by 5 mmHg among white adults and

by 10 mmHg among black adults across the period spanned

by the three surveys.

The prevalence of elevated SBP decreased 5.3 percent

among white adults and 12.6 percent among black adults.

Improvements in mean SBP were greater among older

than younger adults.

The prevalence of definite hypertension among black adults

decreased from 33.6 to 28.6 percent, but the difference did

not reach statistical significance. No similar decline was

observed among white adults.

The prevalence of undiagnosed hypertension decreased

from 52.0 to 29.2 percent, the proportion of hypertensiyes

taking antihypertensive medication increased from 30.3 to

45.4 percent, and the proportion of medicated hypertensive whose hypertension was controlled increased from

39.3 to 51.7 percent.
Data sources and statistical

methods

The three cross-sectional surveys that provided the data

on which this report is based were quite similar in design and

objectives, but differed in content, size, and response rates.6

The first National Health Examination Survey (NHES I) had

as its primary objectives establishing baseline or normative

estimates for adults in a broad variety of medical subject matter

areas and estimating the prevalence of certain disease conditions.8 The first and second National Health and Nutrition

Examination Surveys (NHANES I and II) also were designed

to provide data for normative and disease prevalence estimates,

but had as an additional focus the assessment of the nutritional

status of the Nation.9J0 Some blood pressure fmdmgs from

these surveys have been published previously. 11-‘4

All three surveys were designed to provide data on a nationally representative probability sample of the U.S. civilian

noninstitutionalized population at the time the survey was conducted. To this end, specially constructed mobile examination

centers were moved around the country to previously selected

primary sampling units (PSU’s, usually a county or group of

counties). The selection of the PST-J’Swas part of a stratfled

multistage probability design that assured, at the end of the

survey and after appropriate statistical weighting, that the persons selected from within the PSU’S and actually examined

were as respresentative of the U.S. population as possible.

Not all of those persons selected to participate were examined and the response rates varied among the three surveys.

In NHES I, 6,672 persons were examined out of the 7,710

adults selected, yielding a response rate of 86.5 percent. For

NHANES I and II, comparable response rates were 69.7

(13,645 out of 19,572) and 68.7 percent (12,504 out of 18,209).

Following the conclusion of each survey, statistical weights

involving the probability of selection, adjustment for nonresponse, and poststratification by age, race, and sex were generated for each examined person.

Each examined person completed a medical history and

other questionnaires, and each received a physical examination,

including at least one blood pressure determination by a physician, body measurements, and blood testing. Selected subsets

of the NHANES I and II samples received additional examination components such as electrocardiogram tests, hearing

tests, and chest x rays. Further discussion of the content is

limited to results important to this report.

Medical history

Specially trained interviewers obtained a medical history

for each sample person. This history included questions on

whether the individual had ever been told by a doctor that he or

she had high blood pressure or other selected chronic conditions, including those commonly associated with long-term

elevated blood pressure. Other questions were asked as to

whether the individual was taking any medication for high

blood pressure currently (or, in the case of NHANES I, within

the previous 6 months) andlor was pursuing nonpharrnacologic

therapy.

Blood pressure measurement

Table A provides data relevant to the collection of blood

pressure data for NHES I and NHANES I and II. In all three

surveys a blood pressure reading was taken by the physician at

the beginning of the physician’s examination with the examinee

seated. Additional readings were taken near the middle and at

the end of the 20-minute examination in NHES I. In NHES”I

all blood pressure (BP) measurements were taken while the

exarninee was sitting, and all were taken by the physician. The

NHANES I sample was divided into two groups: (a) the Nutrition sample-those examinees who received the general nutrition examination and a limited battery of physical tests, and

(b) the Detailed sample-a one-fifth subsample of the Nutrition

sample who received an additional battery of physical tests. In

the Nutrition sample of the NHANES I survey, only a single

sitting measurement was taken. b the Detailed sample of the

NHANES I survey conducted from 1971–74 and in the

NHANES II survey, a second measurement was taken while

the examinee was supine and a third immediately after with the

examinee sitting, both at the end of the examination. In some

instances the nurse took the second or third measurements.

(See the analysis of secular trends for more details.)

Blood pressure was measured indirectly using a standard

clinical sphygmomanometer. The middle of the cuff was placed

over the bulge in the upper right arm. Using the bell of the

stethoscope, the physician noted and recorded the systolic

pressure (when the sound was frost heard) and the diastolic

pressure (when the sounds disappeared or, if the sounds did not

disappear, when they first became muffled). The following

guidelines were provided for the physicians:

1. The manometer was at eye level for the reader to reduce

the possibility of reading errors caused by parallax.

2. While measuring, the rate of fall in pressure was maintained

at 2–3 mrnHg per heartbeat, which was slow enough to

detect the first and last sounds but sufllciently rapid to

avoid the intermittent trapping of blood between systolic

and diastolic levels.

3
Table A. Description of blood preaaure measurement procedures for NH ES 1, NHAN ES 1, and N HANES II

Measurement

Procedure 1St 2d 3d

Time during examination

NHES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Beginning Middle

NHANESl, Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

End

Beginning .

NHANESl, Detailed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . .

Beginning End

NHANES II....................,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

End

Beginning End End

Examiner

NHES 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physician Physician Physician

NHANESl, Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physician

NHANESl, Detailed. .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. .

Physician Physician/Nurse Physician/Nurse

NHANES II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, Physician Physician/Nurse Physician/Nurse

Posture

NH ES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sitting Sitting

NHANESl, Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sitting

Sitting

NHANESl, Detailed. .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

Sitting Supine

NHANES1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sitting

Sitting

Supine Sitting

3.

4.

For diastolic pressure, the level was recorded either at the

point of complete cessation of Korotkoff sounds (fifth

sound) or, if no cessation occurred, at the point of muffling

(fourth sound). In NHES I both the fourth and fifth

Korotkoff sounds were recorded.

Measurements were recorded to the nearest even millimeter on the scale.

Statistical methods

The tindings in this report are national estimates based on

weighted observations. The data obtained for each examined

person were weighted so that the sum of sampling weights for

all persons drawn from a subuniverse is equal to the number of

persons in that subuniverse at the midpoint of the survey, as

estimated by the U.S. Bureau of the Census. The weights take

into account the probability with which persons were drawn

into the samples, and certain adjustments based on the known

demographic characteristics of interviewed or examined persons versus all eligible persons, to minimize the effects of

nonresponse and bias. The chance of bias is greater when a

substantial proportion of the persons sampled from a particular

age-sex-income class were not examined than when response

rates are high. The additional bias that may be introduced by

nonrandom measurement error is addressed in the discussion

section and in appendix IV.

Unless otherwise specified, statistical significance was

based on the 5-percent significance level. Most of the analyses

presented here are based on t-tests comparing means or prevalence rates in two population subgroups. This test consists of

dividing the difference between the two means or prevalence

by the standard error of the difference. An approximation of

the standard error of a difference d = x – y of the two statistics

x and y is given by the formula

Sd = [s: + s; – 2 Cov (X,y)]lfz

where 5X and SY are the standard errors, respectively, of x and

y. The standard errors were calculated by a balanced replication

technique appropriate to the complex survey design and estimation procedure.15,’b For most of the analyses in this paper,

covariances were assumed to be zero.

For tests of trends across age groups, standard errors were

calculated using a method of Taylor series linearization of ap

proximate formulas incorporated in the computer programs

SURREGR17 and SE SUDAAN.18 Statistical tests for multivariate categorical data were performed with a method of

weighted least squares that produces statistics which are

asymptotically chi-square,’9 using the computer program

GENCAT.20 This program makes possible the construction of

multivariate tests of significance that take into account the full

variance-covariance matrix. These tests have greater statistical

power than tests based on comparison of paired estimates, as

described above and in appendix II.

Detailed tables 3 and 4 present means that have been

standardized for age by the direct method, as do tables 11– 17.

In tables 3 and 4 the age-standardized means have been calculated using the age-specific U.S. population estimates for

1978 for all educational groups combined. In tables 1,1–17 and

in the sections of the text where comparisons are macle between

surveys, the age-standardized means have been calculated for

the 1960–62 and 1971 –74 surveys using the reference population estimates at the midpoint of the 1976–80 survey. The

standardized means and proportions and the standard errors of

these statistics were estimated by the SESUDAAN program,

using Taylor series linearization.’ 8

The reader should be cautioned against making any inferences of a longitudinal nature based on data from these crosssectional surveys. These surveys did not reexamine study

subjects, as would be necessary for making longitudinal comparisons. In a single cross-sectional survey, differences in

mean blood pressures apparently related to increasing age are,

in fact, differences between individuals in different birth cohorts
and cannot be taken as descriptive of a particular individual’s

or group’s life experience. Apparent trends in the relationship

behveen age and blood pressure, when based on cross-sectional

dataj are somewhat misleading.

Cohort analysis of data from the Frarningham Heart Study,

for instance, portrayed markedly different patterns in blood

pressure for cohorts followed over time as compared with crosssectional analysis of data for selected age groups.21 In the

Frarningham data, cross-sectional mean blood pressures were

lower in women than men in early ages, rose to meet the pressures of men at middle age, and crossed over thereafter to higher

levels. In longitudinal analysis of the Framingham cohort,

where pressures were followed as people actually aged, the

crossover after middle age for women was not observed. Blood

pressures in women stayed lower than blood pressures in men

at all ages.21Because longitudinal inferences drawn from crosssectional data may incorrectly portray the effect of aging, an

attempt has been made to minimize the tendency to make such

inferences.

5
Findings— National Health

and Nutrition Examination

Survey 11, 1976–80

The principal findings in this section regarding the distribution of systolic blood pressure ( SBP) and diastolic blood

pressure (DBP) levels, and the estimates for the prevalence of

hypertension derived from them for U.S. adults ages 18-74

years, are based on the mean of the three blood pressure

measurements obtained on the adult examinees in the 1976–

80 National Health and Nutrition Examination Survey

(NHANES II). The mean of the three blood pressure measures

generally provides a better predictor of fiture blood pressure

and is less subject to regression toward the mean than a single

measurement.22 Hence, the mean provides a physiolo~cally

more representative measure than a single pressure for estimating the prevalence of hypertension.

Systolic blood pressure

As shown in table B, figure 1, and table 1, mean SBP

levels were significantly higher for men than for women in the

age groups 18–24, 25–34, and 35–44 years. However, for the

age groups 45 –54 and 55-64 years, no significant differences

were observed between the sexes. By age 65–74 years the

mean SBP level among women was significantly greater than

that among men (146 versus 142 mrnHg, respectively).

Observed mean SBP levels for black men were less than

those for white men in the age groups 18–24 and 25–34 years,

but the difference in the 25–34 year age group was not statistically significant (table B). In the age groups 35–44, 45–54,

and 55 –64 years, the mean SBP levels were significantly greater

for black men. The mean SBP levels were equal for black and

white men ages 65 –74 years.

Racial differences in SBP between white and black women

were very consistent In every age group, the observed means

for black women were greater than those for white women

(table B). The differences in mean SBP between black and

white women increased from a low of 1 mmHg for ages 18–24

years to a maximum of 11 mmHg for those ages 45–54 years

and were statistically significant for the age groups 35 years

and over.

The mean SBP levels were significantly higher across SUG

cessive age groups for all four race-sex groups (table B). The

difference in mean SBP between extreme age groups was greater

for women than men (ffom 111 to 146 mmHg for women, and

from 124 to 142 mmHg for men).

The difference in mean SBP between extreme age groups

was greater for black adults than for white adults (table B).

SBP means for black men changed from 121 to 142 mmHg

over the age span studied, while the comparable figures for

white men were 124 to 142 mmHg. Among black women, SBP

means changed 39 mmHg across the age range studied (from

112 to 151 mmHg), while SBP means among white women increased 34 mmHg (from 111 to 145 mmHg).

Diastolic blood pressure

As shown in table C, figure 2, and table 2, mean DBP

levels were significantly greater for black men than for white

Table B. Mean systolic blood pressure by race, sex, and agsx United States, 1976-80

Age

18– 74 18-24 25-34 35-44 45-54 55-64

Race and sex

65-74

years years years years years years years

All races Systolic blood pressure in millimeters mercury

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 117 118 123 130 137

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

144

129 124 125 126 131 137 142

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 111 112 119 129 137 146

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 117 118 122 129 137 144

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 124 125 126 131 137

Women, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

142

123 111 112 119 127 137 145

Black adults

Both sexes . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 128 116 118 128 137 145 147

Men, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 121 124 131 136 144 142

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 ’112 114 126 138 146 151

6
I

1!50

140

130

120

110

100

.

/

o

160

150

140

130

120

110

100

Men

18-24 25-34 35-44 45–54

years years years years

Age

~ White women

~ Black womerr

~ 95 percent confidence interval

T

E!%

55-64

years

T

65-74

years

T

18-24 25-34 35-44 45–54 55-64 65-74

years yaars years years yeara years

Age

NOTE Based on the average of 3 blood pressure measurements.

Figure 1. Mean systolic blood pressure among white and black men and women by ag= United States, 1976-80

7
Table C. Mean diastolic blood pressure by race, sex, and age: United State!s, 1976-80

Age

18– 74 18-24 25–34 35-44 45-54

Race and sex

55-64 65– 74

years years years years years years years

All races Diastolic blood pressure in millimeters mercury

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 73 76 80 83 84 82

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 76 79 82 85 85

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

83

77 70 73 78 82 82 82

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 73 76 79 83 83 82

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 76 79 82 85 84 82

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 70 73 77 81 82 81

Slack adults

Seth sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 73 77 84 89 88 85

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 75 80 86 88 90 86

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 71 75 82 89 87 85

men in all age groups 35–44 years and above. The amount by

which the mean DBP for black men was greater than the mean

DBP for white men varied between 3 mmHg for those ages 45–

54 years (88 versus 85 mmHg, respectively) to 6 mmHg for

those ages 55-64 years (90 versus 84 mmHg, respectively).

Mean DBP levels were significantly greater for black

women than for white women in all age groups 35–44 years

and above (table C). The difference in mean DBP levels between black and white women peaked at ages 45–54 years (89

versus 81 mmHg, respectively).

Mean DBP levels for all adults were significantly higher as

age increased, changing from 73 mmHg for those ages 18–24

years to 82 mmHg for those ages 65–74 years (table C). After

age 55, the mean DBP plateaued or decreased slightly. This

pattern of a rise followed by a plateau was apparent for both

men and women. Among men, the change in mean DBP between ages 18–24 years and 45–54 years was 9 mmHg. For

women, the comparable change was 12 mmHg. In each age

group from 18–24 years to 55–64 years, the mean DBP levels

of men were significantly greater than those of women. The

mean DBP levels for men and women ages 65–74 years were

not significantly different.

The change in mean DBP among black men over the 18–

74 year age span (from 75 to 86 mmHg) was greater than that

among white men (from 76 to 82 mmHg). The change in mean

DBP among black women (from71 to 85 mmHg) was significantly greater than that among white women (from 70 to 81

mmHg). However, for each race-sex group the peak mean

DBP occurred before ages 65–74 years, after which the means

decreased. This flattening or downward turn to the DBP curve

was not found in the Framingham longitudinal analysis,21 and

may be attributable to selective survival.

Education and blood pressure

Several investigators have suggested that education is inversely associated with mean blood pressure level.z3-25This

relationship was also found in the NHANES II data reported

here. Mean SBP levels were lowest among persons with the

most years of formal education and highest among those with

the least education (table 3). An exception to this relationship

was found for black men, for whom no significant differences

were observed between extreme educational groups. As education among adults ages 18–74 years increased from less than 9

years to more than high school, the age-standardized mean

SBP decreased significantly, from 129 to 124 mmHg. This inverse relationship held for both men and women. The 7-mmHg

dflerence between less than 9 and 13 or more years of education among women (from 127 to 120 mmHg) was more than

twice that of men (from 131 to 128 mmHg), and both differences were statistically significant.

Mean DBP levels also showed an inverse relationship with

educational level for adults 18–74 years of age (table 4). The

mean, age-standardized DBP among adults at the highest educational level was 78 mmHg, 3 mmHg less than that among

adults in the lowest educational level, 81 mmHg. The difference

between women in the extreme educational categories was

3 mmHg (76 versus 79 mmHg), while that between men in the

same categories was 2 mmHg (80 versus 82 rnmHg). Both

differences were statistically significant. Again, for black men

an inverse relationship was not observed between mean DBP

level and education.

The inverse relationship between education and blood

pressure level was evident among both white and black adults.

Among white adults, the mean SBP decreased 4 mmHg across

the educational levels (from 128 to 124 mmHg), and the mean

DBP decreased 2 mmHg (from 80 to 78 mmHg). Among black

adults the comparable figures were 3 and 2 mmHg (SBP from

131 to 128 mmHg and DBP from 82 to 80 mmHg). For both

races and for both SBP and DBP, the differences across educational levels among women substantially exceeded the differences among men.

Hypertension

Epidemiologic studies have established that elevated systemic arterial blood pressure increases the risk of coronary

artery disease and cerebrovascular accident.2b-32Studies con8
100

90

80

70

.

.

0

100

90

80

~ White men

~ Blackrnen

I x percent conficience interval

T

Men

1- T

18-24 25-34 35-44 45-54

years years years yea rs

Age

55-64 65-74

years years

~ White vmnwn

~ Black worms.

~ 95 percent confidence interval

T

T

18-24 25-34 35-44 45-54 55-64 65-74

years years years years years years

Age

NOTE: Baaed on the average of 3 blood pressure measurements

Figure 2. Mean diastolic blood pressure among white and black men and women by age: United States, 1976-80

9
ducted by the Veterans Administration have clearly demonstrated that this risk is reduced by lowering blood pressure .33’34

‘The Hypertension Detection and Follow-Up Program (HDFP)

has also demonstrated the benefit of lowering BP in reducing

coronary events. The HDFP trial showed a 17-percent reduction in overall mortality, a 45-percent reduction in deaths from

cerebrovascular diseases, and a 26-percent reduction in deaths

from myocardial infarction for those in the stepped care (SC)

group as compared with the referred care (RC) group, many of

whom were also receiving medication.35’3b

Prevalence estimates of the extent and distribution of

hypertension in the U.S. adult population as determined from

the average of the three blood pressure measures obtained in

this study are shown in table 5. The following criteria were

used for these estimates, irrespective of diagnostic status:

●

●

●

●

Definite hypertension: SBP equal to or greater than 160

mmHg and/or DBP equal to or greater than 95 mmHg

and/or currently taking antihypertensive medication.

Borderline hypertension: SBP equal to or greater than

140 mrnHg and less than 160 mmHg and/or DBP equal to

or greater than 90 mrnHg and less than 95 mmH~ and not

takiig antihypertensive medication.

Isolated systolic hypertension: SBP equal to or greater

than 160 mmHg and DBP less than 90 mmHg.

Normotension: SBP less than 140 mmHg and DBP less

than 90 mmHg, and not taking antihypertensive nnedication.

Definite hypertension

An estimated 25.1 million civilian noninstitutionalized

U.S. adults ages 18-74 years had definite hypertension, based

on the above definition. For all ages combined, the prevalence

rate was 17.7 percent, increasing monotonically with age fkom

a low of 2.0 percent for adults ages 18–24 years to a high

of 45.1 percent for adults ages 65–74 years (table 5 and

figure 3).

Definite hypertension was about equally prevalent among

adult men and adult women (17.4 and 18.0 percent, respectively)

(figure 3). The prevalence rates changed rapidly for men in the

younger and middle ages, rising from 2.8 percent for those ages

18–24 years to 25.7 percent for those ages 45-54 years. The

prevalence rates among men in the age groups 45–54 years

and over changed less rapidly, rising from 25.7 percent for

those ages 45–54 years to 38.1 percent for those ages

65–74 years.

Prevalence rates for definite hypertension among women

increased in a stepwise fashion through the age span 18–74

years, rising from 1.4 percent for women ages 18–24 years to

50.4 percent for women ages 65–74 years.

The overall prevalence rate for definite hypertension among

whhe adults was 16.8 percent (figure 3). The prevalence rate

varied with age, changing from 1.9 percent for white adults

ages 18–24 years to 43.7 percent for adults ages 65–’74 years.

The prevalence rates observed among white men (table 5) were

significantly greater than those among white women in all age

groups under 55 years. The rate for white women ages 65-74

years was significantly greater than that for white men in the

same age group (48.3 versus 37.5 percent, respectively). The

10

age-adjusted overall rate for white men, 17.1 percent for men

ages 18–74 years, was not significantly different from that for

white women, 16.6 percent.

The age-adjusted overall prevalence rate for definite

hypertension among black adults was more than 1.5 times

greater than that for white adults, 25.7 versus 16.8 percent

(figure 3). Again, the rate increased with age, from 2.9 percent

for black adults ages 18–24 years to 59.9 percent for black

aldults ages 65–74 years. In every age group 25–34 years and

over the rate for black adults was significantly greater than that

for white adults.

Most of the difference between black and white adults was

attributed to the much higher rates observed for black women

compared with white women (table 5). The age-adjusted overall

prevalence rate for black men (21. 1 percent) significantly exceeded that for white men (17. 1 percent) by roughly one-fourth.

In contrast, the overall rate for black women (29.5 percent)

was almost 1.8 times greater than that for white women (16.6

]percent). In the age groups 35–44 and 45–54 years, the rates

observed for black women were approximately three times

greater than the rates for white women, suggesting that hypertension may occur considerably earlier among the black female

population than among the white female population. The tendency for an early rise in prevalence rates was mirrored in black

men, although not as strongly.

The relatively small number of younger black adults with

definite hypertension in the sample limited conclusions about

age-sex-specific differences between black men and women to

those 45 years of age and over. Among the latter age groups,

black women were significantly more likely to be classified as

definite hypertensive than black men (table 5). Observed rates

ranged from 26.0 to 46.4 percent for black men in the three

older age groups, and from 58.3 to 72.8 percent for black

women in the same age groups. The observed rates for black

women in these age groups were at least 1.3 times greater than

those for black men in the corresponding age groups. The

prevalence rate for definite hypertension among black women

ages 65–74 years, 72.8 percent, was the highest age-race-sexspecific rate found in the study. Definite hypertension afflicted

black women over age 44 years more than any other population

subgroup considered.

Borderline hypertension

In addition to the 25.1 million adults ages 18–74 years

with definite hypertension, there were 17.1 million adults of

those ages with borderline hypertension, a rate of 12.0 per 100

adults. Prevalence rates increased consistently throughout the

age span 18–74 years (table 5 and figure 4).

The observed rates for men significantly exceeded those

for women in all but the 55-64-year age group (table 5). The

overall rate for men was also significantly higher than that for

women. As with definite hypertension, the increase in the

prevalence of borderline hypertension with age was more rapid

for women than men.

The overall age-adjusted prevalence rate for borderline

hypertension for white adults ages 18–74 years was 11.9 percent, while that for black adults was 12.5 percent (table 5). The

age-adjusted overall prevalence rate for black men was similar
60

50

40

30

20

10

0

Sex

~ Adults of both sexes

~ Men

~ Women

~ 95 percent confidence interval

18-74 18-24 25-34 35-44 45-54 55-64 65-74

..

>

al

‘&

20

10

n

R?N

yeara years yeara

Race

Age

70

1-

~ Adults of all races

~ White adults

60

~ 81ack adults

~ 50

I $)5 percent confidence interval

o

&

: 40

%.

~

g 30

years years yeara years

T

18-74 18-24 25-34 35-44 45-54 55-64 65-74

years years years yeara years years years

Age

NOTE Based on the average of 3 blood pressure meaaurementa. Definite hypertension ia defined as systolic blood pressure> 160 mmHg and/or disstolic blood

pressure >95 mmHg and/or taking antihypertensive medication.

Figure 3. Prevalence of definite hypertension among adults 18-74 years of age by age and sex or race United States, 1976-80

11
30

25

20

0

0

&0.

al

G.

u 15

c1

c

U

-6

$

a

10

5

0

~ Adults of both sexes

~ Men

~ Women

~ 95 percent confidence interval

T

l-. T

-r18-74 18-24 25-34 35-44 45-54 55-64 65-74

years years years yea rs yea rs years yaars

Age

NOTE: Baaed on the average of 3 blood pressure measurement. Borderline hypertension is defined aa systolic blood preaaure ? 140 mmHg but less than

160 mmHg and/or diastolic blood pressure >90 mmHg but less than 95 mmHg, and not taking antihypertensive medication.

Figure 4, Prevalence of borderline hypertension among adults 18-74 years of age by age and sex United States, 1976-80

to that for white men (16.9 versus 15.4 percent, respectively).

The rate for black women was nearly identical to that for white

women (8.9 versus 8,8 percent, respectively). None of the

overall age-adjusted differences reached statistical significance.

No age-specific comparisons were made between white and

black adults or between black men and women because most of

the age-specific rates for black adults did not meet D?ational

Center for Health Statistics standards of statistical reliability.

In contrast to definite hypertension, where the prevalence

rates for black adults were markedly greater than those for white

adults, race was not significantly associated with the prevalence

of borderline hypertension. The ratio of age-adjusted overall

prevalence rates for borderline hypertension for black and

white adults was 1.05 (12.5/1 1.9), in contrast to the ratio

of overall prevalence rates for definite hypertension of 1.53

(25 .7/1 6.8). On the other hand, the difference in prevalence

rates between the sexes was large for borderline hypertension

and small for definite hypertension. The ratio of age-adjusted

12
prevalence rates for borderline hypertension for men and

women was 1.74 (15.5/8.9), while that for defite hypefiension

was 0.97 (17.4/18.0).

Isolated systolic hypertension

Isolated systolic hypertension is a subcategory of definite

hypertension, restricted to those definite hypertensives with an

SBP equal to or greater than 160 mmHg but with a DBP of less

than 90 mmHg.7 As seen in table 5, this condition was rare

below age 55 years; ahnost all the cases found in the NHANES

II sample occurred in the age range 55–74 years. The condition

was significantly more likely to occur in women than men in

the age range 55-74 years (6.3 versus 4.5 percent, respectively).

The prevalence rate was higher for black persons ages 55–74

years than for white persons in the same age group (8.1 versus

5.2 percent, respectively), but the difference did not reach

statistical significance.

Diagnosed dafinite hypertension

Among the estimated 25.1 million U.S. adults 18–74 years

of age with definite hypertension, 18.4 million (73.6 percent)

reported that they had been told by a doctor that they had high

blood pressure or hypertension (table 6). The proportion increased significantly with age, rising from about 44 percent for

those ages 18–24 years to about 80 percent for those ages 65–

74 years.

The age-adjusted prevalence of diagnosed hypertension

was substantially greater among women than among men overall (80.5 versus 66.4 percent respectively) (table 6). This sex

differential was especially marked among adults under 45 years

of age. The rates of diagnosed hypertension for each sex were

essentially identical in the age groups 45-54, 55–64, and 65–

74 years. The diagnosed rates for hypertensives in these age

groups varied between 83 and 84 percent for women and between 71 and 72 percent for men. The diagnosis rates in these

older age groups were hkgher than the diagnosis rates in the

younger age groups.

The rates presented above suggest that undiagnosed hypertension is particularly a problem among adults under 45

years of age and is a somewhat more significant problem for

men than for women. However, an analysis of the absolute

number of persons with undiagnosed hypertension suggests a

different pattern (table 5 and figure 5). Among women, the

number of hypertensives in the United States who were not

diagnosed rose with age from a low of 69,000 in the age group

25–34 years to about 661,000 in the age group 65–74 years.

Among men, the number of undiagnosed hypertensives tripled

between those in the age group 18–24 years and the age group

25–34 years (247,000 and 783,000, respectively). Within the

four age groups 25–34 years to 55–64 years, the number of

undiagnosed male hypertensives was markedly greater than the

number of undiagnosed female hypertensives. These data suggest that, from a public health perspective, the most benefit

would be gained by focusing available resources on programs

that insure that men begin regular blood pressure checkups in

early adulthood.

The probability of being diagnosed was somewhat higher

for black adult hypertensives than for white adult hypertensives

(80.9 versus 72.3 percent, respectively) (table 6). This was

true for men (69. 1 versus 65.9 percent for black and white

hypertensives, respectively), as well as for women (87.6 versus

79.3 percent for black and white hypertensives, respectively),

although only the latter difference was statistically significant.

The more favorable diagnostic experience for black adult

hypertensives overall was due primarily to the higher diagnosis

rate among black female hypertensives. Black female hypertensive ages 35 years and over represent a group of particular

interest, reporting a remarkable average diagnostic rate of nearly

90 percent. The relatively small number of black adults with

definite hypertension in the sample prevented conclusions

about age-specific differences between white and black adults

of a given sex or between black men and black women.

Medication usage by hypertansives

Over three-fourths of all diagnosed definite hypertensives

reported taking antihypertensive medication “always,” “often,”

or “sometimes” (table 6). The proportion varied with age 40.9

percent of definite hypertensives ages 18–24 years took medication compared with 85.4 percent of those ages 65–74 years.

Female adult definite hypertensives who had been diagnosed were more likely than their male counterparts to be

medicated (79.3 versus 68.9 percent, age-adjusted to the combmed population) (table 6). The proportion of male hypertensive taking medication increased from a low of 37.6 percent

for those ages 18–24 years to a high of 81.8 percent for men

ages 65–74 years. The pattern for women was not as consistent

as that for men, but again the proportion increased with age,

from a low of 44.0 percent for women in the 18-24 year age

group to a high of 87.2 percent for women in the 65–74 year

age group. In every age group, the observed proportion of diagnosed female hypertensives taking medication was greater than

that for diagnosed male hypertensives.

The proportion of diagnosed white adult hypertensives

who were medicated was similar to the proportion of diagnosed

black adult hypertensives who were medicated (75.1 versus

72.7 percent, respectively). Diagnosed female hypertensives of

both races were more likely to be medicated than diagnosed

male hypertensives of the same race (8 1.0 and 68.8 percent for

white females and males, respectively, and 75.9 and 66.0 percent for black females and males, respectively). Black female

hypertensives in the age group 65–74 years repted the highest

rate of medication, 88.9 percent. Thus, for every 10 black

women diagnosed as hypertensive, 9 reported taking medication. Once again, the relatively limited number of hypertensive

black adults in the sample proscribed much age-specific statistical testing.

Joint distributions of SBP and DBP

The recently published report of the third Joint National

Committee for the Detection, Evaluation, and Treatment of

High Blood Pressure (JNC III), among other recommendations,

defined new categories of elevated blood pressure to assist

practitioners in classi~ing patients’ degrees of cardiovascular

risk.7 Newly created categories include “high normal” for

13
900

800

700

600

500

400

300

200

100

0

100

80

60

40

Number

~ Men

~ Women

L

::::::::: :.:.:.:.: ...O

. . . . . . . . .

. . . ...+..

. . . .

:.:.:.:>:

. . . . . ...<

. . . . . . . . .

. . . . ..O.O

. . . .

:,:0: <:,:

. . . .

. . . . . . . . .

:+:4 :.:,:

. . . .

. . . . .

. . . .

;,:.:.:.:

. . . .

. . . . . . . . .

18-24 25-34 35-44 45-54 55-64 65-74

years years years years years years

Age

Percent

~ Men

20

0

18–24 25–34 35-44 45–54 55-64 65-74

yea rs years years yeara years years

Age

NOTE: Based on the average of 3 blood pressure measurement. Definite hypertension ia defined as systolic blood pressure >160 mmHg andlor diastolic blood

pressure 295 mmHg and/or taking antihypertensive medication.

Figure 5. Number and percent of hypertensives who were diagnosed, by sex and age: United States, 1976-80

14
adults with a DBP between 85 and 89 mmHg, and other categories related to isolated systolic hypertension. (Table D

presents a side-by-side comparison of the traditional and the

JNC 111definitions of hypertension categories.) To more fully

meet the needs of those desiring to assess the implications of

these new categorizations, tables 7– 10 provide cumulative frequency distributions for demographic subgroups within commonly used SBP categories by DBP categories.

These distributions for age, race, and sex population subgroups allow the reader to determine what proportion of the

subgroup falls below or above any of the commonly used univariate or bivariate definitions of elevated blood pressure. For

instance, focusing on the definition of elevated blood pressure

based on an SBP of 140 mmHg or more or a DBP of 90 mmHg

or more (which includes all the JNC III hypertensive categories), it can be seen in figure 6 and table E that, for all four

race-sex subgroups, the proportion with elevated blood pressure

rose with age, Standard errors for these rates are not provided

in tables 7– 10 but can be obtained from Terence Drixd at the

National Center for Health Statistics. Among white men the

proportion increased significantly as age increased, from 16.0

percent for those ages 18-24 years to 53.0 percent for those

ages 65–74 years. Among white women, the proportion with

elevated blood pressure at ages 18-24 years was 2.0 percent,

significantly lower than the rate for white men of the same age.

However, the proportion of white women with elevated blood

pressure rose rapidly after menopause (ages 45-54 years),

resulting in 56.2 percent of white women 65–74 years of age

having elevated blood pressure.

The increase across age was also evident for black men

and women. For black men, the increase across the age span of

18–24 years to 65–74 years was from 10.8 to 58.5 percent.

The comparable rise for black women was from 8.0 to 66.5

percent. Again, the rapid rise in the prevalence of elevated

blood pressure among women after the menopause years can

be seen. The data also show an earlier rise in the prevalence

rates for elevated hypertension for black men and women than

for whhe men and women. This phenomenon was noted above

in the section on definite hypertension.

For every age and sex group except males ages 18-24

years, the prevalence rates for elevated blood pressure were

higher for black adults than for white adults. The differences

were particularly pronounced in the age range 35–64 years,

where the rates for black adults exceeded those for white adults

Table D. Comparison of J NC III and traditional hypertension definitions

by 10–20 per 100. By ages 65–74 years, the rates for white

adults approached the rates for black adults.

Similar analyses can be conducted for any of the hypertension categories defined by JNC III. As mentioned earlier,

those definitions provide a more detailed or specific classification for assessing the degree of risk experienced by those persons with elevated blood pressure. Because the JNC III definitions establish lower values of DBP and SBP to be used as

thresholds for a diagnosis of hypertension, table F shows a

greater proportion of the population characterized as hypertensive when the JNC III definitions are used than when traditional definitions are used.

Based on the JNC III definitions, about one person in four

(26.4 percent) was hypertensive (that is, not “normal” or “high

normal”) in the period spanned by the NHANES II survey.

The proportion of women classified as “normal” (that is, DBP

less than 85 mmHg and SBP less than 140 mmHg) was significantly higher than the proportion of men so classified (72.1

versus 60.0 percent, respectively), as was the proportion of

white versus black adults (67.2 and 59.5 percent, respectively).

Approximately 37.4 million U.S. civilian noninstitutionalized adults between the ages of 18 and 74 years fell in one of

the five hypertension categories at the estimated midpoint of

the NHANES II survey. Hypertensive persons who have

pharmacologically reduced their blood pressure to less than the

threshold values would normally be added to this number in

estimating the total hypertensive population of the United

States, and the bottom line of table F shows the proportion of

race and sex groups that are classified as hypertensive if those

adults on antihypertensive medication are added to those adults

whose blood pressures are elevated. Using this definition, 29.7

percent (about 42.1 million) adults ages 18–74 years were

hypertensive.

Figwe 7 shows the proportions of white and black men

and women with hypertension, using the traditional (that is,

WHO) and the JNC III definitions. The proportions of adults

who were determined to be hypertensive using the expanded

JNC III definition were between 30 and 95 percent higher

(relatively) than the rates for hypertension using the traditional

definition, depending on which race-sex group is considered.

The excess prevalence among black adults of both sexes was

maintained by the new definition. A slight excess of hypertension was found among white men compared with white women

(32.5 versus 25.4 percent, respectively, using the 140 mmHg

Hypertension category JNC Ill Traditional

DBP<85mmHg and SBP<140mmHg. . . . . . . . . . . . . . . . . . . . . . . . . . Normal Normal

DBP85-89mmHg and SBP<140mmHg . . . . . . . . . . . . . . . . . . . . . . . . High normal Normal

DBP90-94mmHg and SBP<160mmHg . . . . . . . . . . . . . . . . . . . . . . . . Mild hypertension Mild hypertension

DBP90-94mmHg and SBP>160mmHg. . . . . . . . . . . . . . . . . . . . . . . . Mild hypertension Definite hypertension

DBP95-104mmHg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mild hypertension Definite hypertension

DBP105-l 14mmHg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate hypertension Definite hypertension

DBP>115mmHg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Severe hypertension Definite hypertension

DBP<90mmHg and SBP 140-159 mmHg . . . . . . . . . . . . . . . . . . . . . . . Borderline isolated systolic hypertension Mild hypertension

DBP<90mmHg and SBP>160mmHg . . . . . . . . . . . . . . . . . . . . . . . . . Isolated systolic hypertension Isolated systolic hypertension

NOTE JNC Ill = Third Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Preaaurw DBP = diastolic blood pressure; SBP = systolic

blood prassure.

15
70

60

50

40

30

20

10

/

/

o

80

70

60

50

40

30

20

10

/

o‘L

White

- ‘r

~ White . . .

~ White women

I ~, percent confidence interval

T

18-24 25-34

years years

~ Black men

~ !31ackwormsn

I ,, per. ent confidence interval

T

35-44

yaara

45-54 55-64

yeara years

Age

Black

T.

TT

65-74

years

T

18-24 25-34 35-44 45-54 55-64

years

65-74

yesrs yeara years yeara years

Age

NOTE: Baaed on the average of 3 blood pressure measurements with systolic pressure >140 mmHg and/or diastolic pressure >90 mmHg.

Figure 6. Prevalence of elevated blood pressure among white and blaclk men and women by age: United States, 1976-80

16
Table E. Prevalence rates for mild, moderate, and severe hypertension ‘combined, based on JNC 111definitions, by race, sex, and agsr

United States, 1976-80

[Rates are per 100]

White men White women Black men Black women

Age Rate SE Rate SE Rate SE Rate SE

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.0 1.87 2.0 0.50 10.8 2.37 8.0 2.14

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.6 1.99 4.4 0.79 23.3 3.03 12.2 3.05

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.3 2.64 14.9 1.33 41.8 7.99 31.1 4.24

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40.0 2.23 29.1 2.44 51.6 6.34 53.7 4.88

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.0 2.30 41.3 2.63 62.9 5.08 59.0 3.47

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.0 2.53 56.2 2.11 58.5 3.38 66.5 5.29

Table F. Distribution of U.S. population according to J NC III hypertension cate90riee. by race, se% and cete90W United Statea, 1976-80

White Black White White Black Black

High blood pressure categoty All adults adults Men Women men women men women

Percent

Normal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.4 67.2 59.5 60.0 72.1 60.5 73.3 54.8 63.4

High normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 7.2 7.3 9.1 5.5 9.0 5.6 9.5 5.5

Elevated blood pres$ure:

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.4 25.6 33.2 30.9 22.3 30.5 21.1 35.8 31.1

Mild high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.9 14.4 19.1 18.6 11.6 18.4 10.7 20.8 17.8

Moderate high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . 1.6 1.4 3.1 1.9 1.4 1.8 1.1 2.9 3.2

Severe high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.5 ‘i .4 0.7 0.5 0.5 0.4 2.1 0.8

Borderline isolated systolic hypertension. . . . . . . . . . . . . . . 7.7 7.8 7.7 8.4 7.1 8.4 7.2 8.7 6.9

Isolated systolic hypertension . . . . . . . . . . . . . . . . . . . . . . . . 1.5 1.5 1.9 1.3 1.8 1.3 1.7 1.2 2.3

Elevated blood pressure or medicated . . . . . . . . . . . . . . . . . . . 29.7 28.8 38.2 32.9 26.8 32.5 25.4 38.0 38.4

50

[

~ Systolic blood pressure> 160 mmHg and/or diastolic blood pressure> 95 mmHg and/or medicated

~ Systolic blood pressure> 140 mmHg and/or diastolic blood pressure> 90 mmHg and/or medicated

~ 95 percent confidence interval

40 T T

30

20

10

0

White men White women Black men Black women

Figure 7. Prevalence of hypertension among white and black men and women 18-74 years of age using traditional definitions and definitions

of the Third Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Pressure United States, 1976-80

17
and 90 mmHg definition), and the difference was statistically an SBP of less than 140 mmHg, regardless of medication status.

significant. Mild hypertension was significantly more prevalent among men

Of the 37.4 million adults with hypertension in the United than women (18.6 versus 11.6 percent, respectively) and among

States, over one-half fell in the category defined as mild hyper- black adults than among white adulta (19.1 versus 14.4 percent,

tension, that is, with an average DBP of 90 to 104 mmHg and respectively).

18
Secular trends, 1960–80

History

Until the 1950’s, safe and effective medication for longterm outpatient treatment of hypertension was not available.

Prior to that time, antihypertensive drugs were very potent, and

their use often resulted in adverse side effects.37Consequently,

only malignant hypertension was treated and such therapy was

generally performed in emergency rooms or hospitals. Diuretics

came into use in the late 1950’s as the first effective hypertension treatment with an acceptably low incidence of adverse

effects.

The advent of the modern period of hypertension treatment

was signaled by a widespread recognition of hypertension as an

important public health problem in the 1960’s. The Framingham

Heart Study and the Tecumseh Study demonstrated an increased risk of stroke and myocardial infarction associated with

elevated blood pressure.28’38-42The Veterans Administration

Cooperative Study showed that lowering blood pressure in

persons with moderate or severe hypertension (diastolic blood

pressure (DBP) of 105 mmHg or more) reduced the risks of

stroke and congestive heart failure.33’34’43About 1968, the first

long-term public programs were developed to begin screening

and treatment of hypertension.

In 1972, the National High Blood Pressure Education

Program (NHBPEP) was initiated.44 This program was designed to develop national recognition of hypertension as a

public health problem of major importance. The National High

Blood Pressure Coordinating Council was formed by the National High Blood Pressure Education Program to help coordinate the efforts of the many groups that had become involved

in hypertension control. Such groups included a wide variety of

volunteer and professional organizations. The Coordinating

Council fimctions today as a forum for consensus and action

for these groups.

In 1975, the first Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure issued

its report, distributing it to health care providers and organizations.45 Its recommendations included treatment of all adults

with DBP’s of 105 mmHg or greater as well as those with

DBP’s of 90– 104 mmHg if other risk factors were present, a

formalized stepped care approach to treatment, and avoidance

of ineffective or inappropriate drugs. These recommendations

formed one of the first common treatment gqjdelines for hypertension.

In 1979 the results of the Hypertension Detection and

Follow-Up Program (HDFP) were published.36,46This multicenter, community-based, randomized, controlled trial compared the effects of a systematic antihypertensive treatment

program (Stepped Care) and referral to community-based

medical therapy (Referred Care). Those persons with a DBP

of 90 mmHg or more assigned to the Stepped Care group

achieved consistently better control of their elevated blood

pressure and experienced a 5-year, all-cause mortality 17 percent lower than those in the Referred Care group. Mortality

was also significantly lower for the Stepped Care subgroup

with mild hypertension (entry DBP of 90 to 104 mmHg) compared with the corresponding Referred Care subgroup. The

results suggested that systematic effective management of hypertension has the potential to reduce mortality for the large

numbers of persons with elevated blood pressure in the population, including those with mild hypertension.

In 1980, following a review of the results of the HDFP,

the second JNC report was published.47 It offered guidelines

for the extent of evaluation of persons with elevated blood

pressure, recommended treatment of persons with diastolic

blood pressures of 90 mmHg or more, made guarded recommendations on isolated systolic hypertension, and updated the

stepped care treatment guidelines to include the beta blockers.

These updated guidelines also suggested weight reduction in

obese patients and sodium control as adjunctive therapy for the

management of hypertension.

Following the development of new antihypertensive agents

and the publication of the results of new clinical trials in the

early 1980’s, the report of the JNC III was recently published.’

It emphasized increased targeting for screening programs and

increased use of nonpharmacologic methods initially and during

long-term management of hypertension. As pointed out earlier,

persons with diastolic blood pressure of 85 to 89 mmHg were

newly categorized as having “high normal blood pressure.”

Other new categories were created related to isolated systolic

hypertension. The stepped care recommendations were updated

to include the beta blockers as acceptable Step 1 agents and the

angiotensin-converting enzyme inhibitors and calcium channel

blockers as acceptable agents in later steps. “Stepdown” therapy

was mentioned for use in selected patients.

Data from repeated cross-sectional blood pressure surveys

have been published for Minnesot%4s’49Baltimore, Md.;50 the

State of Marylan~51 Chicago, 111.;52Charleston, S.C.;53North

Karelia, Finlan@54 and the State of Connecticut.55 These

studies appear to have demonstrated improvements in blood

pressure control in a number of populations in recent years.

The National Health Examination Survey (NHES) and the

National Health and Nutrition Examination Survey (NHANES)

results presented here strengthen these findings by documenting

19
blood pressure trends in a representative sample of the entire

U.S. adult population ages 18-74 years over a 20-year period.

Comparisons of results among three

National Health Surveys

As described in the introduction, during the period

1960– 1980 the NationaJ Center for Health Statistics conducted

three cross-sectional surveys designed to assess the health of

the civilian noninstitutionalized adult population of the United

States. The first National Health Examination Survey (NHES

I) was conducted in 1960–62.8 The first National Health and

Nutrition Examination Survey (NHANES I) was conducted

in 1971 –74.’ The second NHANES, conducted in 1976–80,

was the subject of the first part of this report.9,10 The three

surveys differ in regard to subject matter covered but generally

permit time-related comparisons of selected measures.

Differences among the three surveys dictated the choice of

the first blood pressure determination for comparisons among

surveys rather than the mean of three blood pressures, vvhich

was the source of the analyses in the first part of this report.

Only the first blood pressure (BP) determination is available

for all examinees for all surveys. In NHANES I only 33.3

percent of the adult examinees received the detailed examination in which three blood pressure measurements were made.

Also, in all three surveys only the first blood pressure measurement was taken under the following identical circumstances:

● Only the first determination was always performed with

the examinees in a seated position. In NHANES I and

NHANES II the examinee was recumbent for the second

determination.

● The first determination was always made by a physician.

The second and third determinations in NHANES I were

usually made by a nurse.

● In all three surveys the fwst determination was made at the

start of the physician’s examination.

Other factors were considered before accepting the premise

that there were no survey-specific biases inherent in the first

determination. Standard mercury sphygmomanometers were

used in all three surveys. Regular size adult cuffs (12.5 cm

long) were used on adults in all three surveys. Examination

room temperatures did not differ substantially among the surveys. In all of the surveys the first measurement was taken

while the examinee was seated on the examination table, without support for the back. The hours of examination were identical for all three surveys, so any diurnal variations were constant for all three surveys. The chronologic relationship between

the physician’s examination and other, possibly stressful, examination components was random in all three surveys. Observer differences were discounted because of survey design

considerations or as a result of postsurvey analyses. The pos-

*NHANES I was augmented by a separate but similar subsemple measured in

1974-75. The augmentation subsample consisted only of detailed examinees

who were not weighted to be part of the numerically much kwger 1971 –74

sample. Consequently, the augmentation asmple was omitted from further

anrdysis.

sibility of orthostatic hypotension was discounted, because the

first determination was always made at the start of the physician’s examination and was always done with the examinee

seated, with no immediately previous recumbent period.

The possibility exists that the first blood pressure may

have been slightly elevated because of exarninee anxiety, (Compnring tables 1 and 11, for instance, which present means for

the average of three blood pressure measurements and for

the first blood pressure alone for NHANES H, suggests that

the difference is about 3 mmHg. If all three pressures used in

the average had been sitting measurements, and if the last

measurement had not been subjected to bias due to orthostatic

hypotension, this difference would have been less.) However,

thlere was nothing to suggest that the degree of elevation was

any greater or lesser for any one of the surveys. No sources of

survey-specific bias in the first blood pressure measurement

were found.

The systolic blood pressure (SBP) was chosen as the primary measure for comparison among the surveys. Numerous

studies have found that the determination of SBP is more reliable

than that of DBP. In one study comparing clinic and home

blood pressure readings on hypertensive patients it was found

that 69 percent of the variance in home SBP readings was predicted by clinic SBP readings, while only 30 percent of the

variance in home DBP readings was predicted by clinic DBP

readings.56 Superior reliability of systolic readings was also

i%und in the Framingham study.57 A study by Wilcox on blood

pressure variability using a sound motion picture device for

testing also found a greater variability in the DBP reaclings.58

Reliance solely on an SBP determination detracts little

from an evaluation of BP-associated morbidity and mortality.

For instance, one prospective study, using a multiple logistic

model to evaluate the relationship of various cardiovascular

risk factors to total cardiovascular disease mortality in Evans

County, Georgia, retained SBP pressure while dropping out

DBP pressure.59 This greater predictive ability, and the fact

ihat most factors which confound blood pressure measurement

seem to have greater impact on the DBP than on the SBP,

recommends the SBP as the measure of choice in an analysis

of trends.

The results of the three surveys showed significant improvement in mean SBP for white and black races and both

sexes over the period covered by the three NCHS surveys

(table 1I).b The age-adjusted mean SBP for white men ages

18–74 years was 133 mmHg in 1960–62, 131 nlmHg in

197 1–74, and 129 mmHg in 1976–80. For white women ages

18-74 years, the age-adjusted mean SBP fell from 129 mmHg

in 1960–62 to 128 mmHg in 1971–74 to 123 mmHg in 1976–

80. For black men, these means were 138 mmHg, 136 mmHg,

and 130 mmHg for the three surveys, respectively. The corresponding means for black women were 138 mmHg, 135

mmHg, and 126 mmHg. The differences between the earliest

and latest means were significant in each of the four race-sex

groups.

bA more complete presentation of the basic data from NHES I and NHANES I,

including sample sizes for specific age-race-sex subgroups, has been publishe~ll-ls

20
In general, the age-adjusted mean SBP declined more in figures 8 and 9). During the 20-year period, the mean SBP

black adults than in white adults and more in women than in among white adults ages 18–24 years fell only 1 mmHg (from

men over the period. Specifically, the age-adjusted mean SBP 118 to 117 mmHg), while for white adults ages 65–74 years it

declined 4 mmHg in white men, 6 mmHg in white women, 8 fell 12 mmHg (from 157 to 145 mmHg).

mmHg in black men, and 12 mmHg in black women. The One of the original intentions of this report was to examine

amount of improvement in SBP was greater for the older age the proportion of the population with an SBP equal to or greater

groups than it was for the younger age groups (for example, see than 160 mmHg. Many individuals with an SBP in the range of

30

20

E

a

s

2

10

0

..”gfzl..e — 1960-62

.+ . . . . . . 1971-74

~ ●“+* -- 1976-80

, +4 f) Median

E Mean

4

0

/( 90 100 110 120 130 140 150 160 170 180

First systolic blood pressure in millimeters mercury

Figure 8. Smoothed weighted frequency distribution of the first systolic blood pressure for whtie men ages 18–24 yeara by survey United States,

NHES I (1960-62), NHANES I (1971-74), and NHANES II (1976-80)

20 r

15

10

5

/) I

,/’-,.**”@xe*

_ 1960-62

■ ===== 1971-74

/% -- 1976-80

0 Median

❑ Mean

//

1/

1

0 ~/ 1

-. t 1 I & I I

.*A 1

0 80 100 120 140 160 180 200 220 240

First systolic blood pressure in millimeters mercury

Figure 9. Smoothed weighted frequency distribution of the first systolic blood prassura for white men ages 65-74 years by survey Unitad States,

NHES I (1960–62), NHANES I (1971-74), and NHANES II (1976-80)

21
140– 159 mmHg will not be treated, while some individuals

with an SBP initially in excess of 159 mmHg may have their

pressures reduced to less than 160 mmHg after treatment is

begun. However, the small number of sample persons in the

race-sex-specific younger and middle age groups with SBP

over 160 mmHg resulted in estimated proportions that did not

reach minimum standards for reliability. Consequently, attention was redirected to the proportion of the population with an

SBP of 140 mmHg or more.

The age-adjusted proportions of persons with SBP equal

to or greater than 140 mmHg decreased across the three surveys

for both races and both sexes (table 11). Specifically, the ageadjusted proportion of white men in that category decreased

from 32.4 percent in 1960-62 to 27.0 percent in 1976-80.

The proportion for white women declined from 26.1 to 21.1

percent, for black men from 41.2 to 28.3 percent, and for black

women from 39.6 to 26.7 percent over the 20-year time period.

Thus, the magnitude of the decline in the proportion of persons

with SBP equal to or greater than 140 mmHg was similar

among men and women of the same race, but substantially

greater for black adults than for white adults. Given the higher

proportion of persons with SBP equal to or greater than 140

mmHg among black adults in the 1960–62 survey, and given

the larger decline in that proportion among black adults since

that time, the proportion of such persons is similar among the

four race-sex groups in the 1976-80 data 27.0, 21.1, 28.3,

and 26.7 percent for white men and women and black men and

women, respectively.

The age-specific proportions of persons with SBP equal to

or greater than 140 mmHg declined over the three surveys for

both races and both sexes (table 11). The magnitude of the

decline was greater among the older age groups than among the

younger age groups for both races. In all three surveys the

older age groups consistently had higher proportions of persons

with SBP equal to or greater than 140 mmHg than the younger

age groups. For example, this proportion exceeded one-half for

most race-sex groups ages 55 –74 years, while it was less than

one-fifth for most race-sex groups ages 18–34 years.

In contrast to the significant improvements noted for SBP

over the three surveys, the results for DBP do not demonstrate

any consistent changes for any race-sex group (table 12). These

results are somewhat contrary to what was expected and may

have been the product of problems in the determination of DBP

in the later two surveys. (This issue is explored fimther in the

Discussion section.) Findings in regard to DBP are presented

here as a preface to analyses of trends in hypertension.

Age-adjusted mean DBP levels showed variable fluctuations with no discernible trend overtime for all race-sex groups

except white males (table 12). Among white males, the ageadjusted mean DBP increased from 79 mmHg in NHES I to

83 mmHg in NHANES H, and the difference was statistically

significant. For all three surveys, black adults had higher mean

DBP levels than white adults, and males generally had higher

DBP levels than females, consistent with similar race and sex

relationships for mean SBP measurements. The age-specific

DBP means also showed no consistent trends over the three

surveys (table 12).

The proportion of the population with definite hypertension

(SBP equal to or greater than 160 mmHg and/or DBP equal to

or greater than 95 mmHg, and/or taking antihypertensive medication) by age, race, and sex is presented in table 13 for the

three surveys. The age-adjusted proportion of white adults with

definite hypertension rose from 18.0 percent in 1960–62 to

21.0 percent in 1976–80. Among black adults, the age-adjusted

proportion fell from 33.6 percent in 1960-62 to 28,6 percent

in 1976–80, but the decline was not statistically significant.

The small increase among white adults was more evident in

men than in women, while the larger decrease in black adults

c~ccurred for both sexes similarly (figure 10). The age-specific

proportions of persons with definite hypertension generally reflected trends similar to their respective race-sex groups over

time.

The proportion of the population with elevated blood pressure ( SBP equal to or greater than 140 mmHg and/or DBP

equal to or greater than 90 mmHg, regardless of medication

status) is presented in table 14 by age, race, and sex for the

three surveys. The age-adjusted proportion of adults with elevated blood pressure was essentially unchanged over the span

of the three surveys, increasing by only 1.1 percent. The ageadjusted proportion for males rose by 2.9 percent and fell for

females by 0.6 percent, but the differences did not reach statistical significance. Among white adults the age-adjusted proportion increased by 1.5 percent, and among black adults fell

by 4.1 percent, but again the differences were not statistically

significant. Observed age-specific rates tended to increase

among those less than 55 years of age and decreased among

those age 55 years and over.

The data presented in tables 15–17 and described below

include the proportion of persons in each of the hypertension

rubrics as a percent of the total U.S. adult population. This

choice of presentation is intended to address the needs of those

comparing chronic heart disease rates for the overall LJ.S. population, or demographically defined subgroups of that population. On the other hand, some users of these data may wish to

study proportions for medically defined subgroups of that population (for example, persons taking antihypertensive medication as a proportion of all those with hypertension). These

readers are referred to table 18, which presents much of the

data from tables 15-17 with the proportions calculated by this

alternate method.

As shown in table 15, the proportion of persons with undiagnosed hypertension has declined in the period covered by

the three surveys. Although slight increases were noted for

some race-sex groups between the 1960–62 and 1971 –74 surveys, the downward trend between the 1960–62 and. 1976–80

surveys was significant for each of the four race-sex groups

except white males, Over the period from 1960–62 to 1976–

80, the age-adjusted proportion of white adults with undiagnosed hypertension fell 1 or 2 percent (from 10.7 to 9.8 percent

in men, and from 7.7 to 5.6 percent in women). In contrast, the

rates among black adults of both sexes were more than halved,

falling from 21.1 to 9.9 percent among black men and from

13.2 to 4.5 percent among black women.

The declines in age-specific proportions of persons with

undiagnosed hypertension were substantially larger among

black adults than white adults in most age groups. While some

22
White women

r

35

r

White men

30

t

1960 1965 1970 1975 1980

Year

45

r

Black men

40

t

35

15

10

5

0

T

1960 1965 1970 1975 1980

Yea r

I

~ NHES 1

~ NHANES I

~ NHANES ,[

~ 95 percent conficlence interval

I 1-

1960 1965 1970 1975 1980

Year

r

Black women

I —

r “1 T

1960 1965 1970 1975 1980

Year

---- . . . .

I-lgure 1u. Age-adJusted prevalence of definite hypertension among white and black men and women by survey: United States, NHES I

(1960-62), NHANES I (1971-74), and NHANES II (1976-80)

23
of the age-specific proportions for black adults were twice as

high as those for white adults in the 1960–62 study, most of

the age-specific proportions for black adults were very close to

those of white adults in the 1976–80 survey. In fact, for black

women ages 55–74 years in the 1976–80 survey, the proportions with undiagnosed hypertension were actually lower than

for white women in the same age groups, although the differences did not reach statistical significance.

The proportions of persons taking antihypertensive medications are shown in table 16 for each of the three surveys.

(The reader is cautioned that the question addressing medication use asked of the respondents in the 1971–74 survey was

slightly different from those used in the 1960–62 and 1976–80

surveys. The questions used in those two surveys referred only

to current medication use, while that used in NHANES I asked

about use in the previous 6 months. This difference would be

expected to result in a slight upward bias of the 1971–74 estimates, but the amount of that bias has not been quantified.)

This proportion rose between 1960–62 and 1976-80 for each

race-sex group. Most of the increase was noted between

NHANES I and NHANES II, even though the period between

NHES I and NHANES I was nearly twice the period between

NHANES I and II. The age-adjusted proportion of persons

taking antihypertensive medications rose fi-om 3.8 percent in

1960-62 to 7.6 percent in 1976-80 for white men, from 7.0 to

11.1 percent for white women, from 6.0 to 9.2 percent for black

men, and from 15.9 to 19.3 percent (not statistically siW”ticant)

for black women. While the age-adjusted proportion of persons

taking such medications was generally higher among black

adults than among white adults and among women than men,

the amount of increase from NHES I to NHANES II was

similar for each of the four race-sex groups.

With regard to age-specific rates, the largest absolute increases in the proportion taking antihypertensive medications

occurred generally among persons ages 45–64 years, while the

smallest changes occurred among the age groups 18–34 years.

As shown in table 17, the proportion of persons with controlled hypertension markedly increased between NHES I and

NHANES II. This proportion at least doubled for each racesex group: From 1,5 to 3.4 percent for white men, from 2.9 to

6.3 percent for white women, from 0.6 to 3.3 percent for black

men, and from 6.0 to 11.6 percent for black women. The increase

was statistically significant for each race-sex group.

The absolute proportion of persons with controlled hypertension (that is, DBP less than 95 mmHg and SBP less than

160 mmHg) changed the least among those ages 18–34 years

over the 20-year period. The age-specific proportions increased

most among the older age groups; for example, the proportion

more than doubled for whhe persons in each of the age groups

between 45 and 74 years. For white adults ages 65–74 years,

the proportion of the population subgroup with pharmacologically controlled blood pressure more than doubled, rising from

6.7 to 15.2 percent over the 20-year period. Comparable figures

for black adults ages 65-74 years describe over a fivefold increase, from 5.2 percent in 1960–62 to 26.4 percent in

1976-80.

The data in tables 18–20 can be used to estimate the proportion of all hypertensives who were able to control their

hypertension with medication. In particular, marked changes

were observed for persons 45–74 years of age. During the

period of the NHES I survey, 11.3 percent of hypertemives in

this age range were controlled (1,859 out of 16,423 (in thousands)). This proportion increased to 16.0 percent (3,250 out

of 20,318) in 1971–74 and then to 27.3 percent (6,203 out of

22,747) in 1976-80.

Tables 18–20 also present the number and proportion of

medicated hypertensive who successfully controlled their

hypertension. Among all medicated hypertensives ages 45-74

years, the proportion with blood pressures less than 140/90

mmHg was 33.8 percent in 1960–62, 42.7 percent in 1971–

7’4, and 51.2 percent in 1976–80. The proportion rose within

each of the four race-sex groups when only those ages 45–74

years were considered. The increase for white men in this age

g?OUP, 7.4 percent, was the smallest observed, while that for

black men, 39.5 percent, was the largest observed. These

changes were not tested for statistical significance because of

limited sample sizes in some cells.

Discussion

A number of previous studies have suggested that detection

,andcontrol of hypertension have improved in some communities

over the past decade. Surveys of blood pressure levels in Baltimore, Md.; Birmingham, Ala.; and Davis, Calif., were done

in 1973–74 as part of the HDFP and again in 1977–78 to ‘

,assess changes in these communities.60 The surveys measured

the blood pressures of nonoverlapping random samples of adults

~ages30–69 years in the three cities. The mean DBP decreased

fi-om83.2 mrnHg in 1973–74 to 81.7 mmHg in 1977-78 when

adjusted for age, race, sex, and center.60 The prevalence of

elevated DBP (>95 mmHg) and elevated SBP (> 160 mmHg)

decreased for almost every age, race, and sex subgroup studied.

The proportion of persons aware of their elevated blood pressure status and receiving treatment also increased. The proportion of persons with actual hypertension who were on treatment

and under control increased from 28 to 43 percent for black

men, 47 to 61 percent for black women, 28 to 44 percent for

white men, and 52 to 69 percent for white women over the 5

years studied.bo

Blood pressure levels in the Mhmeapolis-St. Paul area were

measured through surveys in 1973–74 and 1980–8 1.48’49In

those surveys adults ages 25–59 years (about 95 percent of

whom were white persons) had mean age-adjusted blood pressure decreases of 3 mmHg for men and 2 mmHg for women

over the period examined. Mean blood pressure levels improved

over time for both SBP and DBP. With regard to hypertension

detection and control, the surveys found improvements in the

proportion of hypertensive persons with adequately controlled

blood pressures (from 40.4 to 76.1 percent), with inadequately

controlled blood pressures (from 13.7 to 8.5 percent), with

diagnosed but untreated hypertension (from 20.4 to 8.8 percent), and with undetected hypertension (from 25.5 to 6.6

percent).

The Connecticut High Blood Pressure Program has also

recently reported general improvements (since 19’78–79) in

the proportion of that State’s adult population who were aware,

24
treated, and controlled.ss Their findings suggest that, at least in

one State, the trends observed in the HDFP centers and in

Minneapolis-St. Paul between 1973 and 1981 may well be

continuing into the present.

These findings are reflected in the National Center for

Health Statistics (NCHS) surveys reported here. A significant

reduction was also found in mean SBP and in the proportion of

persons within race-sex groups with elevated SBP. The proportion of persons with undiagnosed hypertension declined significantly in the period spanned by the three surveys. The proportion of persons taking antihypertensive medication increased,

as did the proportion of the population whose hypertension was

controlled. The findings of the surveys described in the first

part of this discussion were consistently in agreement with the

NCHS surveys conducted in the same period. The level of

agreement between the proportions of controlled hypertensives

observed in these nationally representative surveys (table 18)

and those observed in the three HDFP centers discussed above60

was remarkable.

The significant improvement in mean SBP for each racesex group over the three surveys provides supportive evidence

for the beneficial effects of efforts to identify and control elevated blood pressure in the U.S. population in recent years.

The decline in the proportion of persons with SBP greater than

or equal to 140 mmHg is consistent with the decline in mean

SBP, and similarly suggests that improvement in the control of

elevated blood pressure has occurred.

Previous reports have shown that the prevalence of elevated

blood pressure in black adults is consistently higher than in

white adults.60 The results of these three surveys suggest that

the difference in prevalence between the races has decreased,

and that the decreases in mean SBP and proportion of persons

with SBP equal to or greater than 140 mmHg have been larger

in black adults than in white adults.

The mean SBP and proportion of persons with SBP greater

than or equal to 140 mmHg was higher in persons in the older

age groups in all three surveys, which is consistent with other

studies. The extent to which this difference represents a natural

aging process (such as progressive loss of arterial elasticity) or

a widespread preventable form of pathology among the elderly

is uncertain. However, the larger improvements in SBP among

the older age groups compared with the younger age groups are

encouraging.

It is important to determine whether the changes in blood

pressure levels in the period spanned by the three surveys are

caused by factors that affected only those persons at highest

risk or by factors that affected the U.S. population as a whole.

The substantial decline in the proportion of the population with

SBP greater than 140 mrnHg suggests that the major factor has

been an increased identification and treatment of persons with

elevated blood pressure. The decrease in the median SBP over

the same time period is smaller but may be partly due to a

number of society-wide changes in lifestyle patterns resulting

from increased awareness of cardiovascular factors.

The absence of a clear decline in DBP levels over the time

period is somewhat puzzling, given that SBP and DBP levels

are highly correlated39 and that most regimens for treating

hypertension tend to focus on lowering the DBP to an acceptable level. A number of explanations are possible, but the most

likely involve insufficient attention to the determination of the

DBP by the examiners on the later two surveys, or environmental conditions in the examination centers which were more

likely to interfere with an accurate determination of the DBP

than of the SBP.

The issue of observer attention may be most productively

addressed by comparisons among the three surveys of the 5th,

50th, and 95th percentiles of DBP (table 12). These show that

there were almost no consistent differences among the three

surveys in the 95th percentile, a modest and fairly consistent

increase (2–4 mmHg) among the first and later two surveys in

the 50th percentile, and a larger (2–8 mmHg) increase in the

5th percentile. Such a pattern is possible if the examiners in the

later two surveys were inclined to release the pressure on the

cuff faster than the recommended 2 mmHg per second. This

practice would have the effect of raising the DBP, because the

examiner would be apt to miss the last pulse before the actual

cessation of Korotkoff sounds. It is also reasonable to suggest

that this effect would be more pronounced at the lower end of

the DBP distribution, where the examiners might be more likely

to rush the determination. This phenomenon would not be expected to be present for the fwstsurvey, in which the examiners

were required to record both the fourth and fifth Korotkoff

sounds. The difference between the fourth and fifth sounds can

be difficult to detect and requires close attention and adherence

to recommended techniques.

Observer inattention could have consequences in other

ways. In particular, because the examiners of the later two

surveys were not required to record both the fourth and fifth

sounds, it is possible that once the diastolic value was well

within the normotensive range, the physician may have listened

less meticulously for the disappearance of the Korotkoff sounds.

In general, the written instructions given to the physicians for

the reading and recording of blood pressures in the later two

surveys were less detailed than in the first survey, and no blood

pressure measurement retraining was provided for the physicians. As a consequence, the physicians may not have been

aware of the need for an accurate determination of DBP from

an epidemiological standpoint, regardless of the clinical significance of the value.

Some support for the hypothesis of observer inattention

can be found in the distribution of end digits for DBP measurements (see appendix IV). That analysis shows that the physicians of the later two surveys were more likely than those of the

first survey to report DBP values that ended in Oor 5, when in

fact all blood pressure measurements should have been evennumbered and equally likely, thus eliminating the possibility of

an end digit of 5.

The difference in character between the physicians of the

first survey and the physicians of the later surveys may have

had consequences for the accurate determination of DBP in

another way. It is possible that the older physicians of the later

two surveys may have suffered more from some degree of hearing loss associated with aging than the younger physicians of

the fwst survey, although it has not been possible to quanti~

this effect.

The trends in mean SBP, proportion of persons with SBP

25
greater than or equal to 140 mmHg, and proportion of persons

taking antihypertensive medications are unaffected by any difficulties with diastolic readings. The general trends in proportion

of persons with diagnosed, undiagnosed, and controlled hypertension rely on the accuracy of the diastolic reading only in the

upper end of the blood pressure distribution (diastolic greater

than or equal to 90 mmHg). Therefore, ddliculties with diastolic

readings primarily in the lower end of the distribution would

have little or no effect on the analysis of these trends.

The proportion of black adults with definite hypertension

decreased over the period covered by the three surveys (although

not significantly), suggesting that some preventive measures

may have had an impact on the prevalence of the disease in

black adults. However, no similar decline is evident in the proportion of white adults with definite hypertension. One might

speculate that the lack of a decline is a function of(a) the lessthan-perfect DBP measurements, (b) declining cardiovascular

disease mortality over the past two decades, keeping more

hypertensive white males alive and contributing to the overall

increase, (c) race-specific changes in lifestyle factors related to

hypertension, and/or (d) more mild hypertensives being medicated, thus “promoting” them into the definite category. Further

investigation is necessary before any conclusions can be drawn.

A significant decline in the proportion of persons with undiagnosed hypertension was noted for each of the four race-sex

groups over the 20-year period. This improvement provides

supportive evidence for the success of major public health

campaigns to increase public awareness of hypertension, to

increase physician interest in treating hypertension, and to

create blood pressure screening programs over that time.

The proportion of persons taking antihypertensive medication has increased over the period spanned by the three surveys.

The proportion of adults under age 35 years taking blood pressure medication is very low for several reasons. Such persons

have a low prevalence of elevated blood pressure when compared with older adults. In addition, physicians may tend to

treat elevated blood pressure in younger persons with nonpharrnacologic means more readily than older persons. Finally,

young men have fewer contacts with physicians and are, therefore, less likely to have their blood pressure taken.

Among adults age 35 years and older, the increasing pre

portion of blood pressure medication use with age is consistent

with the increasing prevalence of elevated blood pressure with

age. Persons ages 35–74 years were more likely to take Mood

pressure medications in 1976–80 than in 1960–62. This increa~seis consistent with the hypothesis of increasing awareness

and diagnosis of hypertension over that time period. In addition, part of the increased use of blood pressure medications

since 1960 may be a response to the recent interest in treating

even mildly elevated blood pressure, and to the development of

new antihypertensive drugs which are less toxic and more effective. The higher proportion of blood pressure medication

use among black adults than among white adults was consistent

with the higher prevalence of elevated blood pressure found in

black adults in all three surveys.

Finally, the proportion of persons with controlled hypertension increased significantly for each of the four race-sex

groups. Such results may have been expected, given the trends

in increased awareness and treatment over the 20-year period.

In summary, the changes in blood pressure levels in the

period spanned by the three surveys are in the anticipated directions. Overall, mean SBP has decreased, the prevalence of

elevated blood pressure has decreased, the use of antihypertensive medications has increased, the proportion of persons

with controlled hypertension has increased, and the improvements have been most marked in the population sub~~oups

most at risk at the beginning of the period. The reasons for

these changes are varied, but perhaps the three most significant

are (a) the advent of more effective treatment regimens, (b) a

greater awareness by physicians and the general public of the

rislcsinherent in high blood pressure and of the lifestyle factors

influencing blood pressure, and (c) a greater recognition by

physicians of the desirability of treating even mildly elevated

blood pressure. Although a direct causal relationship has not

been demonstrated, these results do provide suggestive evidence

that various private and public programs (such as the National

High Blood Pressure Education Program) have had some

beneficial effect.

26
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39w. B. Kannel, T. Gordon, and M. J. Schwartz: Systolic versus

diastolic Mood pressure and risk of coronary heart disease: The Framingham study. Am. J. Cardiol. 27:335–345, Apr. 1971.

‘W. B. Kannel, W. P. Castelli, P. M. McNamara, et al.: Role of

blood pressure in the development of congestive heart failure: The

Framingham study. N. Engl. J. Med. 287:781-787, Oct. 1972.

41F. H. Epstein, L. D. Ostrander, Jr., and B. C. Johnsorx EpidemioIogical studies of cardiovascular disease in a total communityTecumseh, Michigan. Ann. Intern. kled 72:1170-1187, 1965.

4*B. c. Johnson, F. H, Epstein, and M. O. Kjelsberg Distributions

and familial studies of blood pressure and serum cholesterol levels in a

total community—Tecumseh, Michigan. J. Chronic Dis. 18:147-160,

Feb. 1965.

lsveterms Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. III.

Circulation 45:991-1004, 1972.

44National Institutes of Health: National Conference on High Blood

Pressure Education: Report on Proceedings. DHEW Publication No.

(NIH) 73-486. Public Health Service. U.S. Department of Health,

Education and Welfare. 1973.

15RePofi of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure: A cooperative study.

JAMA 237:255-261, 1977. -

46Five-Year findings on the Hypertension Detection and FoIIow-UP

Program. 2. Mortality by race-sex and age. JAMA 242:2572-2577,

1979.

qTThe 1980 Report of the Joint National Committee on Detection,

Evaluation and Treatment of High Blood Pressure. Arch. Intern.

Med. 140:1280-1285, 1980.

48,.4 R Fo[som, R. v. Luepker, R. F. Gillum, et al.: Improvement in

hypertension detection and control from 1973-1974 to 1980-1981:

The Minnesota Heart Survey experience. JAMA 250:916-921,

1983.

@R. V. Luepker, D. R. Jacobs, J. W. Brown, et al.: Hypertension

control in two rural communities. Minn. Med. In press.

50A. Y. Apostolides, G. Entwisle, R. Oullet, et al.: Improving trend in

hypertension control in a black inner city community. Am. 1 Epidemiol.

107:113-119, 1978.

51G Entwisle, A. Y. Apostolides, S. Su, et al.: High blood pressure

control in the State of Maryland, abstracted, in American Heart Association Council on Epidemiology. CYDEpidemiol.News26:71, 1979.

5*D. M. Berkson, M. c. Brown, H, Stanton, et al.: Changing trends in

hypertension detection and controk The Chicago experience. Am. J.

Pub. Health 70:389-393, 1980.

53(3.V. McClure, J. E. Keil, M. C. Weinrich, et al.: Hypertension,

education, quetelet, and treatment Changes in prevalence 1960-79 in

Charleston, S.C. and their association with CVD decline, abstracted,

in American Heart Association Council on Epidemiology. C VD Epid.

News 31:32, 1982.

54P. Puska, J. Tuomilehto, J. Salonen, et al.: Changes in coronary risk

factors during a comprehensive five-year community pmgramme to

control cardiovascular diseases (North Karelia project). Brit. Med. J.

2:1173-1178, 1979.

55D. H. Freeman, Jr., A. M. Ostfeld, K. Hellenbrand, et al.: Changes

in the prevalence distribution of hypertension: Connecticut adults

1978-79 to 1982. J. Chronic Dis. 38:157–164, 1985.

56K. D. Laughlin, D. J. Shepard, and L. Fishe~ Comparison of clinic

and home blood pressure levels in essential hypertension and variables

associated with clinic-home differences. J. Chronic Dis. 33: 197–206,

1980.

57D. S. Shepard Reliability of blood pressure measurements: Implications for designing and evaluating programs to control hypertension.

1 Chronic Dis. 34:191-209, 1981.

58J. Wilcox: Observer factors in the measurement of blood pressure.

Nurs. Res. 10:4-17, 1961.

59D. C. Deubner, W. E. Wilkinson, M. J. Helms, et al.: Logistic model

estimation of death attributable to risk factors for cardiovascular disease in Evans County, Georgia. Am. J. Epidemiol. 112: 135–143,

hdy 1980.

60A. Y. Apostolides, G. Cutter, J. F. Kraus, et al.: Impact of hypertension information on high blood pressure control between 1973 and

1978. Hypertension 2:708–7 13, 1980.

28
61R Goodman and L. Kish Controlled selection-A tectilque in prob

ability sampling. J, Am. Statis. A. 45(251):350-373, Sept. 1950.

62National Center for Health Statistics, E. R Black Current estimates

from the Health Interview Survey, United States, 1976. Vi~a/ and

Health Statistics. Series 10, No. 119. DHEW Pub. No. (PHS) 78-

1547. Public Health Service. Washington. U.S. Government Printing

Ofice, Nov. 1977.

63R. N. Forthofer: Investigations of nonresponse bias in NHANES II.

Am. J. Epiderniol. 117(4):507-515, 1983.

b4A Comparison and Analvsis of Examined and Nonexamined Persons on Medical History characteristics for the First Round of the

Health and Nutrition Examination Sun*e-v.Contract HSM- 110-73-

371. Rockville, Md. Westat Inc., Jan. 24, 1974.

65The HANES stud-v. Health Services and Mental Health Administration Contract. Philadelphia. Institute for Survey Research, Temple

University, Apr. 1975.

66National Center for Health Statistics, H. W. Miller and P. Williams

Factors related to response in a health examination survey, United

States, 1960-62. Vital and Health Statistics. Series 2, No. 36. PHS

Pub. No. 1000. Public Health Service. Washington. U.S. GovernmentPrinting OffIce, Aug. 1969.

67National Center for Health Statistics: Memorandum from Wesley

L. Schaible, Acting Chief, Methodological Research Branch, to Arthur

J. McDowell, Director, Division of Health Examination Statistics.

June 21, 1974.

681. R Fisch and J. Frank Oral contraceptives and blood pressures.

JAMA 237:2499-2503, June 1977.

69National Center for Heakh Statistics, M. Rowland Basic data on

hearing levels of adults 25-74 years, United States, 1971-75. Vital

and Health Statistics. Series 11, No. 215. DHE W Pub. No. (PHS)

80– 1663. Public Health Service. Washington. U.S. Government

Printing Office, Jan. 1980.

70E. P. McCutcheon and R F. Rushme~ Korotkoff sounds. Circulation Res. 20149-161, Feb. 1967.

71L. A. Geddes, W. A. Spencer, and H. E. HotT Graphic recordings

of the Korotkoff sounds. Am. Heart J 57:361-370, 1959.

72w. H. Kir.endall, M. Feinleib, E. J). F&, et al: Recommendations

for human blood pressure determinations by sphygmomanometers.

H~pertension 3:509A-5 19A, 1981.

73E. Ellertsen and S. HumerfelL The observer variation in the measurement of arterial blood pressure. Acts Med. Scan. 184:145 – 157,

1968.

29
List of detailed tables

NHANES 11,1976–80

1. Systolic blood pressure by race, sex, and age with weighted

population estimates, means, standard deviations, standard

errors, and selected percentiles: United States, 1976–80. . .

2. Diastolic blood pressure by race, sex, and age with weighted

population estimates, means, standard deviations, standard

errors, and selected percentiles: United States, 1976–80. . .

3. Systolic blood pressure by race, sex, and educational level

with weighted population estimates, standardized means,

and standard errors: United States, 1976–80. . . . . . . . . . . .

4. Diastolic blood pressure by race, sex, and educational level

with weighted population estimates, standardized means,

and standard errors: United States, 1976 -80 . . . . . . . . . . . .

5. Number and percent of population in selected blood pressure categories, by race, sex, and age United States,

1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Number and proportion of definite hypertensives diagnosed,

medicated, and controlled, by race, sex, and age United

States, 1976 -80 . . . . . . . . . . . . . . . . . . ..-. . . . . . . . . . . . . . .

7. Joint cumulative frequency distributions of systolic blood

pressure categories by diastolic blood pressure categories

for white men by age: United States, 1976-80 . . . . . . . . . . .

8. Joint cumulative frequency distributions of systolic blood

pressure categories by diastolic blood pressure categories

for white women by age: United States, 1976 -80 . . . . . . . .

9. Joint cumulative frequency distributions of systolic blood

pressure categories by diastolic blood pressure categories

for black men by age: United States, 1976-80 . . . . . . . . . . .

10. Joint cumulative frequency distributions of systolic blood

pressure categories by diastolic blood pressure categories

for black women by age: United States, 1976 -80 . . . . . . . .

31

33

34

35

36

38

40

42

44

46

Trend tables

11, Systolic blood pressure by survey, race, sex, and age with

weighted population estimates, means, standard errors,

selected percentiles, and proportions at or above 140

mmHg United States, 1960–62, 1971-74, and 1976 -80...

12. Diastolic blood pressure by survey, race, sex, and age with

weighted population estimates, means, standard errors,

selected percentiles, and proportions at or above 90 and

95 mmHg United States, 1960-62, 1971-74, and

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Proportion of adult population with definite hypertension

by race, sex, age, and survey: United States, 1960-62,

1971 -74, and 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Proportion of adult population with elevated blood pressure

by sex, age, and race: United States, 1960-62, 1971-74,

and 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. Proportion of adult population with undiagnosed hypertension by race, sex, age, and survey: United States, 1960-62,

1971-74, and 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . ...!..

16. Proportion of adult population taking antihypertensive

medication by race, sex, age, and survey: United States,

1960-62, 1971 -74, and 1976-80 . . . . . . . . . . . . . . . . . . . . .

1’7. Propotiion ofadult population withcon&olled h~efiensiofi

by race, sex, age, and survey: United States, 1960-62,

1971 -74, and 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18. Number andproportion ofhypefiensives diagnosed, medicated, and controlled, by survey and age United States,

1960-62, 1971 -74, and 1976-80 . . . . . . . . . . . . . . . . . . . . .

19. Proportions of hypertensive diagnosed, medicated, (rind

controlled, by sex or race, survey, and age: United States,

1960-62, 1971 -74, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . .

20. Proportions of hypertensives diagnosed, medicated, and

controlled, by race, sex, survey. and age: United States,

48

51

54

55

56

57

58

59

60

1960-62, 1971 -74, 1976 -80:.’ . . . . ..~ . . . . . . . . . . . . ..~ 61

30
Table 1. Systolic blood pressure by race, sex, and age With Weighted population estimetes, mean% standerd deviations, standard errors. and

salected percentile= United States, 1976-80

Mean Percentiles

Population systolic blood Standard Standard

Raca, sex, and age estimate pressure deviation error 50th 75th 90th 95th

ALL RACES’

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WHITE ADULTS

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Woman

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

141,728

27,448

32,752

23,651

23,032

20,350

14,496

67,555

13,275

15,895

11,367

11,114

9,607

6,297

74,173

14,173

16,856

12,284

11,918

10,743

8,198

123,494

23,362

28,357

20,392

20,235

18,243

12,906

59,198

11,442

13,864

9,808

9,865

8,642

.5,576

64,296

11,919

14,494

10,584

10,369

9,601

7,329

Millimeters mercury

126 19.8 0.59

117

118

123

130

137

144

129

124

125

126

131

137

142

123

111

112

119

129

137

146

126

117

118

122

129

137

144

129

124

125

126

131

137

142

123

111

112

119

127

137

145

14.2

14.5

16.4

19.1

20.3

23.0

17.7

13.7

14.0

14.8

18.3

19.3

21.9

21.2

11.7

12.3

17.1

19.7

21.2

23.7

19.4

14.3

14.4

15.8

18.5

19.7

22.9

17.4

13.7

13.7

14.3

18.1

18.9

22.0

20.7

11.6

12.1

16.4

18.7

20.4

23.5

0.62

0.66

0.78

0.66

0.83

0.83

0.64

0.82

0.81

0.99

0.84

0.89

0.85

0.62

0.64

0.67

0.85

0.96

1.03

0.95

0.63

0.63

0.69

0.81

0.71

0.83

0.89

0.66

0.85

0.82

1.09

0.83

0.89

0.90

0.66

0.64

0.70

0.82

1.60

1.02

1.06

123

116

117

120

127

135

141

127

123

123

125

129

135

140

119

110

111

117

127

135

143

123

117

117

120

127

134

141

127

123

124

125

129

135

140

119

110

111

115

125

134

137

125

127

131

140

149

157

139

131

133

134

141

149

155

133

119

119

128

139

149

159

136

126

127

130

140

148

157

139

133

133

133

141

14B

155

133

118

119

127

137

149

151

136

137

143

154

164

173

151

141

141

145

155

163

170

152

125

127

140

154

165

177

151

136

137

141

153

163

173

151

141

141

143

155

163

170

150

125

127

139

151

163

143 158 177

163

142

143

151

164

175

187

162

147

148

152

165

175

183

163

132

133

150

163

175

190

162

143

143

150

162

171

186

162

147

147

151

165

171

183

162

131

133

149

159

172

188

llncludes rsces other thsn whits snd blsck. 31
Table 1. Systolic blood pressure by race, sex, and age with weighted population eetimatest means, atendard deviations, standard error% and

selected percentiles: United States, 1976-80—Con.

Mean Percentiles

Population systcvlic blood Standard Standard

Race, sex, and age estimate pressure deviation error 50th 75th 90th 95th

BLACK ADULTS

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . ...9. . . . . . . . . . . . . . . . . . . .

45-54 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

,35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands Millimeters mercury

14,740

3,406

3,499

2,527

2,259

1,760

1,288

6,592

1,533

1,546

1,112

1,044

801

555

8,1 4B

1,873

1,953

1,415

1,215

959

733

128

116

118

128

137

145

147

130

121

124

131

136

144

142

126

112

114

126

138

146

151

22.4 0.81

13.8 1.01

15.B 1,11

19.6 1.37

21.7 1.55

25.5 2.20

23.5 1.45

19.8 1.05

13.7 1.41

16.6 1.63

17.2 2.30

20.3 2.40

23.3 2.63

20.7 1.10

24,2 0.87

12.7 1.19

13.8 1.46

21.0 1.82

23.0 2.10

27.2 2.77

24.8 2.30

124 139 157 170

115 123 134 141

116 128 137 145

127 140 153 162

137 147 163 183

140 159 180 189

143 160 182 195

127 140 156 165

119 128 137 145

123 135 144 159

130 142 150 159

135 141 157 ’173

140 157 180 *184

140 156 170 183

121 139 159 173

111 119 126 139

114 121 130 135

124 139 153 162

137 150 167 183

139 163 180 193

146 165 186 200

32
Tabla 2. Diastolic blood pressure by race, sex, and age with weighted population estimates, means, standard deviations, standard errors, and

selacted percentiles: United States, 1976-80

Mean Percentiles

Population diastolic blood Stendard Standard

Race, sex. and age estimate pressure deviation error 50th 75th 90th 95th

ALL RACES’

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WHITE ADULTS

,8oth sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years................,,.. . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

141,728

27,44B

32,752

23,651

23,032

20,350

14,496

67,555

13,275

15,895

11,367

11,114

9,607

6,297

74,173

14,173

16,656

12,284

11,918

10,743

8,196

123,494

23,362

28,357

20,392

20,235

18,243

12,906

59,196

11,442

13,864

9,808

9,865

8,642

5,576

64,296

11,919

14,494

10,584

10,369

9,601

7,329

Millimeters mercurv

79 11.6 0.44 78 66 94 100

73 9.3

76 10.6

80 11.0

83 12.0

84 11.5

82 11.7

81 11.3

76 9.2

79 10.5

82 10.4

85 12.0

85 11.5

83 11.5

77 11.6

70 6.6

73 9.6

78 11.0

82 11.6

82 11.4

82 11.8

79

73

76

79

B3

83

82

81

76

79

82

85

84

62

77

70

73

77

81

82

81

0.36

0.51

0.59

0.58

0.51

0.49

0.46

0.44

0.64

0.71

0.63

0.57

0.53

0.45

0.45

0.53

0.61

0.71

0.53

0.58

72

75

79

83

83

81

80

75

79

82

84

85

81

76

70

72

77

80

81

81

79 85

82 90

87 94

90 99

91 98

89 98

88 96

81 87

66 93

89 96

93 100

93 99

90 98

83 92

75 81

79 85

84 92

B9 97

89 97

89 97

11.4 0.46 78 86 93

9.2 0.40 72 79 85

10.4 0.55 75 83 90

10.7 0.58 79 86 93

11.6 0.59 82 90 98

11.3 0.55 82 90 97

11.6 0.54 81 69 97

11.1 0.48 80 87 95

9.2 0.48 75 81 88

10.3 0.65 79 86 93

10.0 0.72 81 B7 95

11.8 0.64 84 92 101

11.1 0.61 83 92 99

11.4 0.56 81 89 98

11.3 0.47 75 83 91

8.3 0.45 70 75 81

9.4 0.56 71 78 85

10.7 0.59 76 83 91

11.1 0.73 80 BB 95

11.3 0.5B 81 89 97

11.7 0.63 81 88 97

89

95

100

103

103

102

101

91

97

101

105

105

103

98

84

89

97

101

102

102

99

89

95

98

103

103

102

100

91

97

100

105

103

102

97

83

89

96

99

102

102

llnclude~ races Otherthan whita and black.

33
Table 2. Diastolic blood pressure by race, sex, and age with weighted population estimates, means, standard deviations, standard errors, and

selected percentiles: United Statea, 1976-80—Con.

Mean Percentiles

Population diastolic blood Standard Standard

Race, sex, and age astimate pressure deviation error 50th 75th 9oth 95th

BL4CK ADULTS

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands Millimeters mercury

14,740

3,406

3,499

2,527

2,259

1,760

1,288

81 13.4 0.61

73 9.8 0.63

77 11.9 0.74

84 12.3 1.25

89 13.7 1.20

88 13.2 0.79

85 11.7 0.79

80

73

77

85

88

87

83

81

75

79

87

89

88

83

79

71

73

82

87

87

84

89

79

82

93

97

95

93

90

81

87

94

93

98

93

9!3

84

92

101

104

107

1Ocl

100

85

97

107

101

115

101

98

83

90

99

105

102

99

104

89

99

103

111

115

105

106

89

102

104

*111

“119

107

103

87

93

102

110

110

103

6,592

1,533

1,548

1,112

1,044

801

555

83 13.5 0.77

75 9.5 0.96

80 12.4 1.46

86 12.1 1.85

88 14.4 1.89

90 14.9 1.23

86 11.6 0.72

8,148

1,873

1,953

1,415

1,215

959

733

80 13.3 0.60

71 9.8 0.96

75 11.0 0.99

82 12.3 1.49

89 13.3 1.51

87 11.4 1.00

85 11.7 1.22

88

77

80

90

100

93

95

Table 3. Systolic blood prassure by race, sex, and educational level with weighted population estimates, standardized means, and standard

errors: United States, 1976-80

Education

Less than 9 years 9-12 years 13 years or more

Population Standard Population Standard Population

Race and sax

Standard

estimate Mean 1 error estimate Meanl error estimate Mean ~ error

All racesz

Both sexes . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

Millimeters

mercury

129 0.74

131 0.97

127 0.81

Number in

thousands

69,901

30,279

39,621

Millimeters

mercunf

Number in

thousande

Millimeters

mercury

18,997

9,404

9,593

126 0.56

130 0.68

123 0.58

48,126

25,550

22,576

124 0.66

128 0.66

120 0.75

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . .

15,944

7,962

7,982

128 0.76

131 1.05

126 0.84

61,858

26,862

34,997

126 0.60

130 0.73

123 0.61

44,703

23,945

20,757

124 0.68

128 0.67

120 0.79

Black adults

Both aexes . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . .

3,053

1,442

1,611

131 1.78

131 2.28

132 2.59

8,042

3,418

4,625

130 1.00

131 1.10

129 1.19

3,423

1,605

1,818

128 1.49

132 2.04

124 1.40

‘Age standardized by the direct method to the overall U.S. population at the midpoint of the survey.

‘Includes races other than white and black.

34
Tabla 4. Diastolic blood prassure by race. sex, and educational level with weighted population astimates, standardized means, and standard

errors Unitad States, 1976-80

Education

Less than 9 years 9-12 years 13 years or more

Population Standard Population Standard Population Standard

Race and sex estimate Mean 1 error estimate Meani error estimate Meanl error

Number in Millimeters Number in Millimeters Number in Millimeters

All racesz thousands mercury thousanda mercury thousands mercury

Both sexes . . . . . . . . . . . . . . . . . . . . . . 18,997 81 0.64 69,901 79 0.41 48,126 7B 0.55

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,404 82 0.73 30,279 82 0.47 25,550 80 0.56

Women . . . . . . . . . . . . . . . . . . . . . . . . . 9,593 79 0.74 39,621 77 0.43 22,576 76 0.59

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . . 15,944 80 0.68 61,858 79 0.43 44,703 78 0.55

Men . . . . . . . . . . . . . . . . . . . . . ...4. . . 7,962 82 0.78 26,862 82 0.51 23,945 80 0.56

Women . . . . . . . . . . . . . . . . . . . . . . . . . 7,982 79 0.77 34,997 77 0.44 20,757 75 0.61

Black adults

Both sexea . . . . . . . . . . . . . . . . . . . . . . 3,053 82 1.16 8,042 82 0.59 3,423 80 1.12

Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,442 82 1.31 3,418 84 0.77 1,605 82 1.26

Women . . . . . . . . . . . . . . . . . . . . . . . . . 1,611 83 1.76 4,625 81 0.70 1,818 77 1.03

‘Age standardized by the direct method to the overall U.S. population st the midpoint of the SUIVSY.

‘Includes races other than white snd black.

35
Table 5. Number and percent of population in selected blood pressure categories, by race, sex, and age: United States, 1976-80

Both sexes Men Women

—

Race and age N2 n3 Pa SE5 N2 n3 P4 &C5 N2 n3 p4 SE5

NORMOTENSIVE1

All races6

18-74 years7. . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . .

35-44 yaars . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . .

Whita adults

18-74 yeera7 . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . .

65-74 years,...............,..

Black adults

18-74 years7, ,, . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . .

25-34 years. . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 years. . . . . . . . . . . . . . . . . . .

DEFINITE HYPERTENSIVEa

All races6

18-74 years7 . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .

25-34 yeare . . . . . . . . . . . . . . . . . . .

35-44 yeare . . . . . . . . . . . . . . . . . . .

45-54 yeare . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . .

White adults

18-74 yeare7 . . . . . . . . . . . . . . . . . .

18-24 yeare . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . .

45-54 yeara. . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . .

81ack adults

18-74 years7 . . . . . . . . . . . . . . . . . .

18-24 yeare . . . . . . . . . . . . . . . . . . .

25-34 yeare, . . . . . . . . . . . . . . . . . .

35-44 yeare . . . . . . . . . . . . . . . . . . .

45-54 yeare . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . .

65-i’ 4 years . . . . . . . . . . . . . . . . . . .

99,601

24,953

28,284

18,047

13,524

9,624

5,169

87,933

21,260

24,614

16,307

12,286

8,986

4,751

9,111

3,064

2,837

1,526

861

513

310

25,065

562

2,155

2,891

5,861

7,065

6,531

20,805

443

1,768

2,126

4,820

6,013

5,636

3,790

98

348

645

980

948

772

7,923

1,864

1,919

1,196

848

1,179

917

6,991

1,577

1,643

1,069

766

1,095

841

769

241

227

101

62

76

62

2,901

46

150

205

380

919

1,201

2,371

37

117

152

300

763

1,002

485

8

31

48

78

143

177

70.3 0.96

90.9 0.95

86.4 1.06

76.3 1.67

58.7 1.48

47.3 1.59

35.7 1.39

71.2 1.03

91.0 1.03

86.8 1.18

78.6 1.65

60.7 1.56

49.3 1.67

36.8 1.52

61.8 1.60

90.0 1.10

81.’1 2.27

60.4 4.58

38.’1 4.06

29.1 2.33

24.1 2.94

17.7 0.58

2.0 0.41

6.6 0.79

12.2 1.12

25.4 1.36

34.7 1.18

45.1 1.23

16.8 0.62

1.9 0.42

6.2 0.87

10.4 1.09

23.8 1.48

33.0 1.24

43.7 1.33

25.7 1.09

*2.9 1.15

10.0 1.43

25.5 3.15

43.4 4.09

53.8 2.72

59.9 2.90

45,330

11,278

12,601

8,150

6,244

4.,559

2,449

3~1,948

S1,611

10,967

7,226

5,662

4.,216

2,265

4,088

1,368

1,180

631

458

266

185

11,748

369

1,472

1,520

2,856

3,128

2!,402

10,135

332

‘i ,236

11,184

2,584

2,707

2,092

‘1,388

37

205

264

272

372

239

3,634

835

844

522

395

570

468

3,194

708

710

469

359

525

423

361

106

108

38

29

42

38

1,292

32

95

108

176

410

471

1,086

28

77

86

157

343

395

183

4

17

19

19

61

63

67.1 1.26

85.0 1.67

79.3 1.83

71.7 2.55

56.2 2.20

47.5 2.03

39.7 1.97

67.5 1.38

84.0 1.87

79.1 1.97

73.7 2.58

57.4 2.09

48.8 2.05

40.6 2.17

62.0 2.12

89.2 2.37

76,3 3,00

56.8 8.13

43.8 7.29

33.2 4.38

33.3 3.31

17.4 0.82

“2.8 0.77

9.3 1.33

13.4 1.62

25.7 1.78

32.6 1.71

38.1 1.55

17.1 0.90

*2.9 0.82

8.9 1.43

12.1 1.59

26.2 1.93

31.3 1.79

37.5 1.60

21.1 1.46

*2.4 1.18

*13.3 2.41

*23.8 5.40

“26.0 5.69

46.4 3.93

42.9 4.63

54,270

13,675

15,683

9,897

7,280

5,065

2,670

47,985

11,649

13,647

8,811

6,624

4,769

2,485

5,022

1,696

1,657

895

403

246

125

13,317

193

683

1,371

3,005

3,936

4,129

10,670

111

532

942

2,235

3,306

3,544

2,403

61

143

381

709

576

533

4,289

1,029

1,075

674

453

609

449

3,797

869

933

600

407

570

418

408

135

119

63

33

34

24

1,609

14

55

97

204

509

730

1,285

9

40

66

143

420

607

302

4

14

29

59

82

114

73.2 0.80

96.5 0.67

93.0 0.87

80.6 1.51

61.’1 2.01

47.1 2.10

32.6 1.82

74.6 0.86

97.7 0.56

94.2 0.87

83.2 1.41

63.!3 2.29

49.’7 2.30

33.9 1.80

61.6 1.47

90.6 2.46

84.8 3.39

63.2 4.39

33.2 4.60

25.7 3.13

17.’1 3.98

18.0 0.53

*1.4 0.43

4.1 0.67

11,2 1.13

25.2 1.63

36.6 1.32

50.4 1.73

16.6 0.55

“0.9 0.37

3.7 0.73

8.9 0.97

21.6 1.82

34.4 1.46

48.3 1.80

29.5 1.62

*3.2 1.82

*7.3 1.81

*26.9 5.07

58.3 4.95

60.1 3,89

72.8 4.74

See footnotes at end of table,

36
Table 5. Number and percent of population in selected blood pressure categories, by race, sex, end age United Stetes, 1976-80—Con.

Both sexes Men Women

Rece and age N2 n3 P4 CJE5 N2 n3 P4 SES N2 “s P4 SE5

BORDERLINE HYPERTENSIVE

Al I racese

18-74 years7 . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . .

3!i-44 years . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

66-74 years . . . . . . . . . . . . . . . . . . .

White adulta

18-74 years7, . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . .

36-44 years . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . .

Black adults

18-74 yeara7 . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .

26-34 years . . . . . . . . . . . . . . . . . . .

35-44 years. . . . . . . . . . . . . . . . . . .

45-54 yesra . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . .

ISOLATED SYSTOLIC

HYPERTENSIVEIO,ll

All racese

18–74yaars7 . . . . . . . . . . . . . . . . . .

18-34 yeara . . . . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . . . .

55-74 years . . . . . . . . . . . . . . . . . . .

White adulta

18-74 yeara7 . . . . . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . . . .

55-74 year3 . . . . . . . . . . . . . . . . . . .

Black edults

18-74 years7. . . . . . . . . . . . . . . . . .

18-34 yeara . . . . . . . . . . . . . . . . . . .

35-54 years . . . . . . . . . . . . . . . . . . .

55-74 years . . . . . . . . . . . . . . . . . . .

17,062

1,933

2,312

2,713

3,647

3,661

2,796

14,757

1,659

1,976

2,230

3,129

3,244

2,519

1,839

244

315

356

418

1,680 12.0 0.49

144 7.0 0.80

168 7.1 0.70

188 11.5 0.88

225 15.8 1.02

458 18.0 1.21

497 19.3 1.03

10,476

1,628

1,822

1,697

2,014

1,919

1,396

9,115

1,499

1,661

1,399

1,619

1,719

1,219

1,116

128

161

217

315

163

132

857

89

60

708

759

63

60

637

82

26

0

56

990

121

128

115

119

247

260

15.5

12.3

11.5

14.9

18.1

20.0

22.2

0.67

1.54

1.15

1.57

1.34

1.78

1.81

6,586

305

490

1,016

1,633

1,742

1,400

5,641

160

315

831

1,510

1,525

1,300

723

116

154

139

103

137

74

1,315

7

122

1,186

1,113

7

122

984

191

0

0

191

8.9 0.51

*2.2 0.52

2.9 0.57

8.3 1.04

13.7 1.48

16.2 1.61

17.1 1.11

8.8 0.54

*1.3 0.32

*2.2 0.52

7.9 1.02

14.6 1.72

15.9 1.70

17.7 1.24

8.9 1.27

*6.2 2.31

*7.9 2.49

*9.9 3.79

*8.5 3.56

‘14.2 2.46

*lool 3.20

1.8 0.15

“0.0 0.02

“0.5 0.21

6.3 0.48

1.7 0.17

“0.0 0.03

“0.6 0.24

5.8 0.51

2.3 0.56

11.3 2.68

23

40

73

106

211

237

604

14

27

60

97

186

220

72

8

12

11

8

19

14

212

1

9

202

175

1

9

165

34

0

0

34

1,472 11.9 0.54

124 7.1 0.88

141 7.0 0.78

158 10.9 0.82

198 15.5 1.20

404 17.8 1.21

447 19.5 1.12

868

110

114

98

101

218

227

15.4

13.1

12.0

14.3

16.4

19.9

21.9

0.76

1.71

1.32

1.56

1.47

1.72

2.00

177 12.5 1.34

19 *7.2 1.62

26 “9.0 1.70

24 *1 4.1 3.64

22 *1 8.5 3.79

45 17.0 2.60

41 16.0 2.47

105

11

14

13

14

26

27

16.9

*8.4

*1 0.4

*1 9.5

“30.1

2.25

2.45

2.93

6.07

6.69

4.68

4.23

‘20.4

206 ‘23.7

2,172

96

181

1,895

1,872

70

181

1,620

273

26

0

248

338 11.5 0.11

8 “0.2 0.06

13 ‘0.4 0.12

317 5.4 0.36

126

7

4

115

1.3

“0.3

“0.3

4.5

0.13

0.12

0.14

0.44

287 1.5 0.12

6 *0. I 0.06

13 *0.4 0.14

268 5.2 0.37

112

5

4

103

1.3

“0.2

80.3

4.5

0.14

0.13

0.15

0.47

45 1.9 0.34

2 ‘0.4 0.15

0--

43 8.1 1.82

11

2

0

9

1.2 0.37

0.34

1.72

“0.8

*4.2

lSy~t~li~bl~~dpreasure(SB~ less than 140mmHg anddiaatolic blood presaure (DBP)Ieas than 90mmHgand n0ttaHn9antihYPefiensive medication.

2Population estimate in thousanda.

3Sample size.

%%ighted percent of population subgroup in blood preasura category.

5Standard error of percent.

‘Includes racea other than white and black.

‘Age adjuated bythedirect method to the overall U.S.population atthemidpoint of the survey.

8sBpequal toorgrastarthan 160mmHgand DBpequal toorgreater than 95mm Hg, and/or tatin9antihYPs~enaive medication.

‘SBPequsl toorgreater than 140mmHgbutlesa than 160mmHg and/or DBPequ61 toorgreater than 90mmHgbut leas than 95mmHg, andnotteKng entihypenensive

medication.

10sBp equaI to or graater than 160 mmHg and OBP Ieaa than 90 mmH9.

1lAdja~ant age groups merged to enhance statistical reliabili~.

37
Table 6. Number and proportion of definite hypertensive disgnosed, medicated, and controlled, by rata, sex, and age United States,

1976-80

Medicated

Definite Definite definite

hypertensive Definite hypertensive hypertensive

Sample Definite who were hypertensives who who were who were

Race, sex, and age size hypertensivesl diagnosed2 were madicated3 controlle d4 controlled

ALL RACES

Both sexas

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years, . . . . . . . . . . . . . . . . . . .

35-44 yesrs . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . .

Men

16-74 years5 . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . .

WHITE ADULTS

8oth sexes

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .. c.. . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

Men

18-74 years5 . . . . . . . . . . . . . . . . . . .

16-24 yeara . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

Women

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 yeare . . . . . . . . . . . . . . . . . . . .

35-44 yeare . . . . . . . . . . . . . . . . . . . .

45-54 yeare . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

2,901

46

150

205

380

919

1,201

1,292

32

95

108

176

410

471

1,609

14

55

97

204

509

730

2,371

37

117

152

300

763

1,002

1,086

28

77

86

157

343

395

1,285

9

40

66

143

420

607

Number in thousanda

25,065

562

2,155

2,891

5,861

7,065

6,531

11,748

369

1,472

1,520

2,856

3,128

2,402

13,317

193

683

1,371

3,005

3,936

4,129

20,805

443

1,768

2,126

4,820

6,013

5,636

10,135

332

1,236

1,184

2,584

2,707

2,092

10,670

111

532

942

2,235

3,306

3.544

18,438

246

1,139

1,807

4,518

5,517

5,211

7,603

122

689

797

2,017

2,237

1,743

10,835

124

450

1,011

2,501

3,280

3,468

15,105

186

932

1,274

3,638

4,616

4,460

6,538

100

587

592

1,819

1,917

1,524

8,567

66

345

682

1,819

2,699

2,937

Percent

.—

73.6

*43.8

52.8

62.5

77.1

78.1

79.8

66.4

‘-33.0

46.8

52.4

70.6

71.5

72.5

80.5

“64.4

66.0

73.7

83.2

83.3

84.0

72.3

*41 .9

52.7

60.0

75.5

76.8

79.1

65.4

“30.0

47.5

50.0

70.4

70.8

72.8

79.3

“77.5

64.8

72.5

81.4

81.6

82.9

Number in

thousands

13,975

101

655

1,111

3,289

4,370

4,450

5,213

46

331

474

1,249

1,687

1,426

8,763

55

324

637

2,040

2,683

3,024

11,610

62

527

786

2,700

3,728

3,807

4,496

34

283

331

1,140

1,460

1,248

7,114

28

244

456

1,560

2,268

2,559

Percent

74.6

“40.9

57.5

61.5

72.8

79.2

85.4

68.9

*37.6

48.1

59.5

61.9

75.4

81.8

79.3

*44.O

71.9

63.0

81.6

81.8

87.2

75.1

*33.2

56.6

61.7

74.2

80.8

85.4

68.8

*33.8

48.3

55.8

62.6

76.2

81.9

81.0

*32.5

‘70.7

66.8

85.8

84.0

87.1

Number in

thousands

8,637

92

458

656

1,908

2,800

2,724

2,890

37

184

243

596

961

870

5,747

55

274

414

1,313

1,838

1,854

7.331

53

375

483

1,576

2,464

2,380

2,543

25

160

202

538

866

753

4,788

28

216

282

1,038

1,598

1,626

Percent

61.8

*91 .2

69.8

59.1

58.0

64.1

61.2

55.7

“80.6

*55.4

*51 .2

47.7

57,0

61.0

65.9

“100.0

*64.6

65.0

64.3

68.5

61.3

63.2

*65.6

*71 .2

61.5

58.4

66.1

62.5

56.9

“73.7

*56.4

*6 I .0

47.2

59.3

60.3

67.7

*1 00.0

*68.4

*61 .8

[)6.5

;IO.5

63.6

38
Table 6. Number and proportion of definite hypertenaives diagnosed, medicated, end controlled, by race, sax, and aga: Unitad States,

1976-80—Con.

Medicated

Definite Definite definite

hypertensive Definite hypertensive hypertensive

Sample Definite who were hypertensive who who were who were

Race, sex, andage size hypertensive’ diagnosad= were medicated3 controlled controlled

BLACK ADULTS

Both sexes

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

Man

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

485

8

31

48

78

143

177

183

4

17

19

19

61

63

302

4

14

29

59

82

114

Number in thousands Percent

Number in

thousands

3,790 3,043

98 61

348 200

645 508

980 819

948 806

772 650

1,388 938

37 22

205 102

264 180

272 198

372 270

239 166

2,403 2,105

61 39

143 98

381 328

709 621

576 536

533 483

80.9

*62.1

*57.4

78.8

83.6

85.0

84.2

69.1

*59.5

*49.6

“68.2

*72.8

72.7

69.6

87.6

*63.6

*68.5

86.2

87.7

93.0

90.7

2,180

39

128

300

589

563

560

607

12

4B

119

109

189

130

1,572

27

80

181

480

375

430

Percent

72.7

*64.2

*64.1

59.1

71.9

69.9

86.2

66.0

“54.7

*47.2

*66.2

*55.2

69.8

78.5

75.9

*69.6

*81 .6

●55.2

77.3

69.9

88.9

Number in

thousands Percent

1,218

39

82

149

332

308

308

280

12

24

17

58

81

89

938

27

58

132

274

227

219

55.6

“100.0

*64.2

*49.5

*56.4

54.7

55.1

51.8

*1 00.0

●49.6

*13.9

‘53.1

*42.7

*68.5

58.6

‘100.0

“73.0

*72.9

*57.2

60.7

51.0

lBasedon average of3blood pressures. Systolic blOOdpressure (SBP)zl 60mmHg, diastolic blOOdpreaaure (DBp)~95mmHg, taking antihyPenensive medlcati0n.

2Physician diagnosed high blood presaure orhypertenaion.

3Reported taking antihypertensive medication’’always,’’’’o ften,” or’’aometimes.’+

4SBP<160mmHg and DBP <95 mmHg.

5Age-adjusted by the direct method to the combined population of hyperlensives at the midpoint of the survey.

39
Table 7. Joint cumulative frequency distributiona of systolic blood pressure categories by diastolic blood pressure categories for white men

by age United Statea, 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than All

Cumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 18-24 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . 11,442

Number in

thousands

Number in thousands

10,004 10,971 11,287 11,381 11,411 11,442

Percent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,442

7,754

9,454

10,600

11,218

11,413

11,442

87.4

64.2

76.9

84.0

87.0

87.3

87.4

95.9 98.6 99.5

67.0 67.7 67.8

81.3 82.3 82.6

90.3 92.2 92.5

95.0 97.3 97.8

95.8 98.5 99.3

95.9 98.6 99.5

99.7

67.8

82.6

92.6

98.0

99.5

99.7

100.0

67.8

82,6

92,6

98.0

99.7

100.0

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Leas thsn95mmHg. . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg. , . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 25-34 years Number in thousands

Population estimste . . . . . . . . . . . . . . . . . . . . . . . . 13,864 12,190 13,295 13,651 13,786 13,808 13,864

Number in

thouaanda

13,864

Percent

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.9

51.0

70.4

79.4

85.7

87.9

87.9

95.9 98.5

52.1 52.1

72.7 73.0

82.9 83.6

91.2 92.2

95.6 98.0

95.9 98.5

99.4

52.1

73.0

83.7

92.4

98.6

99.4

99.6

52.1

73.0

83.7

92.5

98.7

99.5

100.0

52.1

73.0

83.7

92.6

98.8

99.8

Leaathan 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Leaathan 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg. .,......,.,.. . . . . . . . . . .

Leaathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg. , . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg. ..,......,.,.. . . . . . . . .

7,225

10,124

11,600

12,844

13,701

13,831

Agea 35-44 years Number in thousends

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . 9,808 8,418 9,222 9,612 9,712 9,721 9,808

Number in

thousands Percent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,808 85.8 94.0 98.0 99.0 99.1 100.0

4,057

6,426

7,867

8,835

9,613

9,783

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less thsn90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Leaathan 95mmHg, . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Leas than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

40.4 41.4 41.4 41.4 41.4 41.4

62.2 65.2 65.5 65.5 65.5 65.5

74.7 79.1 80.1 80.2 80.2 80.2

82.2 87.9 90.0 90.1 90.1 90.1

85.8 93.6 97.0 97.7 97.8 98.0

85.8 94.0 96.0 98.9 99.0 99.7

Ages 45–54 yeers

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

9,865 7,131 8,490 9,087 9,533 9,730 9,865

Number in

thousands

9,865

Percent

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.3 86.1 92.1 96.6 98.6 100.0

Leas thsn80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Laaathan 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less then 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Leas thsn115mmHg . . . . . . . . . . . . . . . . . . . . . . .

3,266

5,264

6,619

7,992

9,359

9,696

32.0 32.8 33.1 33.1 33.1 33.1

50.0 52.1 53.1 53.4 53.4 53.4

60.0 65.3 66.6 66.9 67.1 67.1

68.7 77.0 79.3 80.5 80.9 81.0

72.1 84.7 90.5 93.5 94.4 94.9

72.3 86.1 92.1 96.1 97.8 98.3

40
Table 7. Joint cumulative frequency distributions of systolic blood pressure categories by diastolic blood pressure categories for white men

by age United States, 1976-80—Con.

Cumulative systolic blood prassures

Population Less than Less than Lass than Less than Less than All

Cumulative diastolic blood prassures estimata 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg lavels

Ages 55-64 years

Population estimata . . . . . . . . . . . . . . . . . . . . . . . .

All Ievela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 90mmHg . . . . . . . . . . . . ... . . . . . . ... . .

Lesathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Laasthan 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65–74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

8,642

Number in

thousanda

8,642

2,916

4,612

6,014

7,203

8,317

8,601

5.576

Number in

thousands

5,576

2,308

3,550

4,197

4,872

5,395

5,530

Numbar in thousands

5,160 6,645 7,580 8,131 8,424 8,642

Percent

59.7

29.5

44.7

54.0

57.9

59.6

59.7

2,783

76.9 87.7

32.2 33.0

50.1 52.0

63.4 67.0

71.9 78.7

76.7 86.5

76.9 87.7

Number in thousands

3,796 4,462

94.1

33.3

52.9

68.7

81.7

91.9

94.1

4,990

97.5

33.7

53.4

69.3

82.6

94.4

97.3

5,257

100.0

33.7

53.4

69.6

83.3

96.2

99.5

5,576

Parcent

49.9 68.1 80.0 89.5 94.3 100.0

30.7 36.7 38.8 40.2 41.1 41.4

42.6 53.7 58.5 61.7 62.8 63.7

47.0 60.9 67.9 72.1 74.2 75.3

49.5 66.0 76.0 83.0 85.6 87.4

49.8 67.9 79.6 88.4 93.0 96.8

49.9 68.1 80.0 89.5 94.3 99.2

41
Tabla 8. Joint cumulative fraquancy distributiona of systolic blood praaaura categoriaa by diastolic blood praasura categories for white woman

by aga: United Statas, 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than All

Cumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg fevals

Ages 18-24 years

Population eatimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . ,,, . . . . . . .

Less than 80mm Ha. .,, ,, . . . . . . . . . .,...,,,,

Less than Ei5mm Ha. . . . . . . . . . . . . , ..,...,,,,

Lesathan 90mm Ha. . .,, ,. .,.... . . . . . . . . . . .

Leas than 95mmHg. . . . . . . . . . . . . . , . . . . . . . . .

Leas than 105mmHg. , .,......,., , . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 25-34 yeara

Population estimate, . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 80mmHg, . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg. ,,, . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 105mm Ha.......,..,.. . . . . . . . . . .

Less thsn115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 35-44 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg, . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg, . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 45-54 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 80mm Ha . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mm Ha . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 95mm Ha . . . . . . . . . . . . . . . . . . . . . . . .

Leas than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Leas than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

11,919

Number in

thousands

11,919

10,381

11,409

11,768

11,844

11,909

11,919

14,494

Numbar in

thousands

Number in thousanda

11,769 11,866 11,902 11,919 11,919 11,919

Percent

98.7 99,6 9949 100.0 100.0 100,0

86.7 87.0 87.1 87.1 87,1 87.1

95.2 95.6 95.7 95.7 95.7 95.7

98.0 98.5 98.7 98.7 98.7 98.7

98.5 99.1 99.3 99.4 99.4 99.4

98.7 99.6 99.9 99.9 99.9 99.9

98,7 99.6 99.9 100.0 100.0 100.0

Numbar in thousands

14,212 14,392 14,419 14,485 14,485 14,494

Percent

14,494

11,590

13,149

13,909

14,194

14,435

14,485

10.584

Number in

thousands

10,584

6,647

8,379

9,294

10,009

10,389

10,537

10,369

Number in

thousands

98.1 99,3 99.5 99.9 99.9 100.0

79,8 80.0 80.0 80.0 80.0 80.0

90.6 90.7 90.7 90.7 90.7 90.7

95.6 96.0 96.0 96.0 96.0 96.0

97.2 97.8 97.8 97.9 97.9 97.9

98.1 99.2 99.4 99.6 99.6 99.6

98.1 99.3 99.5 99.9 99.9 99.9

Number in thousands

9,587 10,113 10,261 10,479 10,550 10,584

Percent

90.6 95.6 97.0 99.0 99.7 100.0

62.4 62.8 62.8 62.8 62.8 62.8

77.5 78.6 78.8 79.1 79.2 79.2

85.1 86,7 87.1 87.7 87.8 87.8

89.3 93.0 93.8 94.5 94,6 94.6

90.3 95.’1 96.4 97.9 98.1 98.2

90.6 95.6 97.0 99.0 99.5 99.6

Numbar in thousands

8,030 9,173 9,870 10,155 10,227 10,369

Percent

10,369

4,943

6,834

8,256

9,288

10,177

10,294

77.4 88.5 95.2 97.9 98.6 100.0

46.5 47.5 47.5 47.5 47.5 47.7

61.9 64.8 65.8 65.8 65.8 65.9

70.9 77.3 79.2 79.3 79.5 79.6

75.6 84.4 88.5 88.9 89.3 89.6

77.2 88.2 94.9 97.3 97.7 98.1

77.4 88.6 95.2 97.9 98.4 99.3

42
Table 8. Joint cumulative frequancy distributiona of systolic blood pressure categories by diastolic blood pressure categories for white women

by ege United States, 1976-80—Con.

Cumulative systolic blood pressures

Population Less then Less than Less than Less than Less than Alt

Cumulative diestolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 55-64 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Leas than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65-74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

9,601

Number in

thousands

9,601

4,263

6,175

7.564

8,467

9,313

9,512

7,329

Number in

thousands

7,329

3,315

4,733

5,676

6,406

7,098

7,278

Number in thousands

5,871 7,330 8,385 8,997 9,307 9,601

Percent

61.2 76.4 87.3 93.7 96.9 100.0

39.1 41.8 43.7 44.1 44.4 44.4

52.7 59.3 62.8 63.9 64.2 64.3

58.7 - 69.4 75.4 77.5 78.4 78.8

60.7 73.8 82.2 86.0 87.6 88.2

61.2 76.4 86.8 92.6 95.5 97.0

61.2 76.4 87.1 93.5 96.6 99.1

Number in thousands

3,298 4,567 5,623 6,308 6,748 7,329

Percent

45.0 62.3 76.7 86.1 92.1 100.0

32.7 38.9 42.6 44.6 45.0 45.2

40.4 51.3 59.1 62.0 63.8 64.6

43.8 57.9 68.4 73.4 75.8 77.4

44.8 60.8 73.8 80.6 84.1 87.4

45.0 62.3 76.6 85.4 91.0 96.8

45.0 62.3 76.7 86.1 91.9 99.3

43
Table9. Joint cumulative hequency &stributions ofsystolic blood pressure categories bydiastolic blood pressure categories for blaoknlen

by age United 8tates. 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than All

Cumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg Iavels

Ages 18-24 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

1,533 1,413 1,479 1,508 1,527 1,527 1,533

Number in

thousanda

1,533

Percent

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.2 96.5 98.4 99.6 99.6 100.0

Less than 80mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

1,040

1,365

1,465

1,517

1,527

1,533

64.4 67.3 67.3 67.8 67.8 67.8

83.3 87.6 88.5 89.0 89.0 89.0

89.2 93.5 95.0 95.6 95.5 95.5

92.2 96.5 98.4 98.9 98.9 98.9

92.2 96.5 98.4 99.6 99.6 99.6

92.2 96.5 98.4 99.6 99.6 100.0

Ages 25–34 years Number in thousands

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . . 1,546 1,325 1,445 1,475 1,534 1,540 1,546

Number in

thousands Percent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,546

788

1,100

1,280

1,382

1,488

1,534

85.7

47.4

66.0

76.7

83.3

85.7

85.7

93.5 95.4 99,2

51.0

71.2

82.8

89.4

96.3

99.2

99.6

51.0

71.2

82.8

89.4

96.3

99.2

100.0

51.0

71.2

82.8

89.4

96.3

99.2

49.5 51.0

68.6 70.1

80.2 81.7

86.8 88.3

91.7 93.6

93.5 95.4

Lesathan 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less thsn105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

980 1,059

Ages 35-44 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . . 1,112 790 1,069 1,088 1,112

Number in

thousands

1,112

Percent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.0 88.1 95.2 96.2 97.8 100.0

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

333

502

689

865

1,072

1,100

29.9 29.9 29.9 29.9 29.9 29.9

45.1 45.1 45.1 45.1 45.1 45.1

58.2 62.0 62.0 62.0 62.0 62.0

69.4 77.7 77.7 77.7 77.7 77,7

71.0 88.1 93.7 94.7 96.4 96.4

71.0 88.1 95.2 96.2 97.8 98.9

Ages 45-54 yaara Number in thousands

Population estimata . . . . . . . . . . . . . . . . . . . . . . . . . 1,044 684 903 942 991 1,003 1,044

Number in

thousands Percent

Alllavels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,044 65.5 86.5 80.2 95.0 96.1 100.0

272

434

673

830

970

1,003

25.3 25.3 26.1 26.1 26.1 26,1

34.6 40.8 41.6 41.6 41.6 41.6

48.4 63,6 64.5 64.5 64.5 64.5

60.2 78.7 79.5 79.5 79.5 79.5

65.5 86.5 89.1 92.9 92.9 92.9

65.5 86.5 90.2 95.0 96.1 96.1

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Leaathan 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lasathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Leaathan 115mm Ha . . . . . . . . . . . . . . . . . . . . . . .

44
Tabla 9. Joint cumulative frequency distributions of systolic blood pressura cetagories by diastolic blood pressura categories for black men

byag= United 8tataa, 1976-80-Con.

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than All

Cumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mml-lg 170 mmHg 180 mmHg levels

Ages 55-64 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . . 801

Number in

thousands

Number in thousands

373 566 630 678 713 801

Parcent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65-74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

801

205

300

424

558

683

734

555

Number in

thousands

46.6 70.6 78.6

22.6 24.3 24.8

28.8 33.8 36.1

37.1 46.3 48.6

44.2 58.1 63.7

46.6 68.7 75.3

46.6 70.6 78.6

Number in thousands

267 369 459

Percant

84.6

25.6

36.9

52.0

68.0

80.1

83.4

498

89.0 100.0

25.6 25.6

37.4 37.4

52.6 53.0

68.9 69.6

81.3 85.2

85.8 91.5

516 555

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 167

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 294

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 359

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 433

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . . 521

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . . 548

48.1 66.4 82.6 89.7 92.9 100.0

23.0 27.6 30.1 30.1 30.1 30.1

39.5 47.5 51.1 52.8 52.8 52.8

41.5 52.5 60.9 63.4 63.4 64.7

45.9 62.1 73.1 75.6 76.6 77.9

48.1 66.4 81.4 87.1 89.5 93.8

48.1 66.4 82.0 89.1 92.2 98.7

45
Tabla 10. Joint cumulative frequency distributions of systolic blood pressure categories by diastolic blood prasaure categories for black women

by age United Statea, 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than

Cumulative diastolic blood pressures

Less than All

estimate 140 mmiig 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 18-24 years

Population estimate.........,.. . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mm Ha, . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Ages 25-34 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

1,873

Number in

thousands

1,873

1,556

1,745

1,793

1,839

1,873

1,873

1,953

Number in

thousands

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mm Ha, . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg, . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg, . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 35-44 years

Population estimate, . . . . . . . . . . . . . . . . . . . . . . . .

1,953

1,452

1,677

1,737

1,869

1,905

1,953

1,415

Number in

thousands

All levels..........,.......,.. . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 45-54. years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

1,415

630

822

1,053

1,208

1,374

1,404

1,215

Number in

thousands

1,215

310

507

693

817

1,081

1,177

Number in thousands

1,782 1,861 1,873 1,873 1,873 1,873

Percent

95.2 99.4 100.0 100.0 100.0 100.0

81.7 83.1 83.1 83.1 83.1

90.1

83.1

93.2 93.2 93.2 93.2 93.2

92.0 95.8 95,8 95.8 95.8

94.0

95.8

98.2 98.2 98.2 98.2 98.2

95.2 99.4 100.0 100.0 100.0

95.2

100.0

99.4 100.0 100.0 100.0 100.0

Number in thousands

1,886 1,926 1,926 1,937 1,953 1,953

Percent

96.5 98.6 98.6 99.2 100.0 100.0

74.3 74.3 74.3 74.3 74.3 74.3

85.8 85.8 85.8 85.8 85.8 85.8

87.8 88.9 88.9 88.9 88.9 88.9

94.1 95.7 95.7 95.7 95.7 95.7

96.0 97.5 97.5 97.=5 97.5 97.5

96.5 98.6 98.6 99.2 100.0 100,0

Number in thousands

1,103 1,231 1,324 1,374 1,382 1,415

Percent

78.0 87.0 93.6 97.1 97.7 1Qo.o

43.0 43.0 44.6 44.6 44.6 44.6

55.8 56.5 58.1 58.1 58.1 58.1

68.9 72.0 74.4 74,4 74.4 74.4

72.9 79.3 82.4 85.4 85.4 85.4

77.3 85.6 92.3 95.8 96.3 97.1

78.0 87.0 93.6 97.1 97.7 99.3

Number in thousands

669 864 1,025 1,119 1,130 1,215

Percent

55.0 71.1 84.3 92.1 93.0 100.0

25.5 25.5 25.5 25.5 25.5 25.5

40.2 41.7 41.7 41,7 41.7 41,7

46.3 53.0 57.0 57.0 57.0 57.0

49.9 59.2 64.3 64.8 64.8 67,3

55.0 69.7 80.3 84.9 84.9 88.9

55.0 71.1 83.5 90.5 90.5 96.8
Table 10. Joint cumulative frequency distributions of systolic blood pressure categories by diastolic blood pressure categories for black woman

by age United States, 1976-80—Con.

Cumulative systolic blood pressures

Population Less than Less than Less than Less then Less than All

Cumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 55-64 years

Populatio neatimate ..<....,..,.. . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg. . . . . . . . . . . . . . . . . . . . . . . . .

Leas than 85mmHg. . . . . . . . . . . . . . . . . . . . . . . . .

Leas than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Leas then 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Leasthan 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65-74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

959

Number in

thousands

959

24S

426

627

759

880

948

733

Number in

thousands

Number in thousands

485 635 698 814 863 959

50.5

22.0

31.1

41.0

45.9

50.5

50.5

311

66.2 72.8

25.1 25.5

41.4 42.6

53.4 55.0

60.3 63.6

66.2 71.5

66.2 72.8

Number in thousands

394 495

Percent

84.9 90.0 100.0

25.9 25.9 25.9

43.0 43.4 44.4

61.8 63.2 65.4

72.3 76.2 79.1

83.2 87.5 91.7

84.9 90.0 98.8

585 626 733

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Leaathan 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

733

252

377

463

551

706

725

42.5 53.7 67.6 79.8 85.4 100.0

20.1 24.3 29.3 30.4 32.0 34.3

30.5 37.2 43,8 45.3 47.8 51.4

33.5 41.8 50.8 54.7 57.1 63.2

35.6 45.9 57.1 64.3 66.8 75.2

42.5 53.7 67.6 78.6 84.3 96.4

42.5 53.7 67.6 79.8 85.4 98.9

47
Table 11. Systolic blood pressure by survey, rata, sex, and age with weighted population estimatas, means, standard errors, selected

parcantiles, and proportions at or abova 140 mmHg Unitad Statas, 1960-62, 1971 –74, and 1976-80

Mean Percentiles

Population systolic blood Stendard Propotiion Standard

Suwey, race, sex, and age estimate pressure error 50th 95th >140 mmHg error

1960-62 (NHES 1)

White adults

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yesrsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both sexes

18-74 years’ . . . ...!.... . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1971-74 (N HANES 1)

White adults

Both sexes:

18–74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands Millimeters mercury

93,856

13,311

18,530

20,446

17,682

13,865

10,022

44,808

6,199

8,960

9,858

8,621

6,629

4,541

49,048

7,112

9,570

10,587

9,061

7,236

5,481

11,109

1,680

2,273

2,562

2,277

1,469

849

5,065

730

902

1,184

1,129

737

382

6,044

950

1,370

1,377

1,148

732

467

113,952

21,287

23,663

19,515

20,891

17,211

11,384

131

118

121

127

135

146

157

133

124

126

130

135

143

151

129

113

116

123

134

148

162

138

118

124

136

147

155

170

138

121

129

137

143

152

164

138

115

121

134

151

158

174

129

119

121

125

133

142

149

0.53

0.85

0.43

0.54

0.75

1.22

1.64

0.65

1.28

0.58

0.37

0.71

1.60

1.80

0.59

0.81

0.70

0.91

1.26

1.89

2.02

1.29

1.21

1.20

2.18

3.16

2.30

4.21

1.38

2.10

2.18

2.50

4,00

3.15

6.93

1.99

1.45

1.69

3.25

4.86

4.53

6.48

0.40

0.51

0.49

0.62

1.01

0.86

0.80

128

118

120

124

132

142

156

130

122

126

128

134

140

150

124

112

116

120

130

142

160

130

114

120

130

142

150

172

132

120

128

130

140

152

174

130

114

118

128

144

150

172

126

120

120

122

130

140

148

180

144

146

160

176

194

210

170

152

150

162

170

182

204

184

132

138

156

180

204

212

194

144

162

180

208

202

226

164

148

164

178

182

186

208

206

138

162

184

206

230

170

140

146

156

170

188

190

29.2

7.7

11.1

22.2

36.2

57.2

71.7

32.4

14.3

18.0

29.6

38.1

54.9

63.5

26.1

1.9

4.7

15.3

34.4

59.4

78.6

40.1

8.7

17.1

37.0

56.3

72.6

B5.2

41.2

15.8

21.8

40.1

54.1

68.3

76.8

39.6

3.4

14.0

34.4

58.4

76.9

92.1

27.4

9.2

11.1

19.0

35.4

51.6

65.7

0.s1

1.34

1.03

0.98

1.83

1,74

1.95

1.44

2.68

1.82

1.51

2.60

2.93

3.37

0.63

0.71

1.04

1.39

2.49

2.27

2.95

1.98

2.74

2.16

3.51

3.42

4.89

5.97

2.81

5.43

5.20

4.8B

6.99

5.07

8.80

1.95

2.05

2.60

4.73

5.95

6.64

6.31

0.85

1.20

0.95

1.57

1.99

1.75

1.54

lAge adjuated by the direct method to the overall U.S. population at the midpoint of tha 1976-80 survey.

48
Tabla 11. Systolic blood prassura by suwey, race, sex, and age with weighted population estimates, means. standard errors. seletied

percentiIas, and proportions at or abova 140 mmHg United States, 1960-62, 1971-74, and 1976-80—Con.

Mean Percentiles

Population systolic blood Standard Proportion Standerd

Survey, race, sex, and age estimate pressure error 50th 95th > 74(7 mm~g error

1971-74 (N HANES I)—Con.

White adults—Con.

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearaT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both aexas

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–64yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Man:

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lB-24yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1976-80 (N HANES 11)

White adults

8oth sexes

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numbar in

thousands Millimetare mercuw

54,377

10,207

11,559

9,441

10,073

8,166

4,931

59,575

11,080

12,104

10,074

10,818

9,045

6,454

12,850

2,841

2,770

2,308

2,265

1,569

1,097

5,689

1,293

1,160

1,007

1,042

707

480

7,161

1,548

1,610

1,301

1,224

861

617

123,494

23,362

28,357

20,392

20,235

18,243

12,906

59,198

11,442

13,864

9,808

9,865

8,642

5.576

131

124

125

127

135

140

146

128

115

116

123

131

143

152

135

117

125

133

146

149

159

136

123

129

136

142

144

157

135

113

122

130

150

153

162

126

117

118

122

130

138

145

129

123

124

125

132

139

144

lAge adjustedby the direct method to the overall U.S. population at the midpoint of the 1976-80 survey.

0.47

0.71

0.69

0.81

1.10

1.10

0.94

0.49

0.60

0.48

0.71

1.29

1.24

1.04

0.94

1.18

0.92

1.30

4.22

2.67

2.63

1.21

1.95

1.59

2.13

4.32

3.27

3.46

1.20

1.08

1.08

1.66

5.26

4.17

3.00

0.62

0.65

0.58

0.77

0.71

0.82

0.97

0.62

0.90

0.78

0.99

0.77

0.92

0.98

130

122

124

126

132

138

142

122

114

115

120

130

140

150

130

118

124

130

138

145

156

130

122

130

132

130

140

150

126

110

120

125

146

152

160

122

116

118

120

128

136

140

128

120

124

124

130

138

140

166

144

150

154

172

180

190

170

136

140

160

170

190

195

186

142

150

170

200

186

210

180

146

150

180

190

180

210

190

138

155

170

200

190

210

166

140

142

150

168

180

190

166

150

150

150

170

180

190

29.7

14.7

16.3

21.2

38.6

49.7

59.6

25.2

4.2

6.1

16.9

32.4

53.3

70.3

36.6

7.9

18.4

32.0

49.3

65.6

78.9

36.3

11.5

21.4

31.3

44.0

60.9

77.8

37.0

4.9

16,2

32.6

53.9

69.4

79.8

23.9

8.3

9.3

15.6

30.1

45.2

57.5

27.0

14.3

15,5

17.1

34.1

47.0

55.2

1.12

2.09

1.58

2.34

2.54

2.67

1.81

0.89

0.78

0.74

1.35

2.58

2,10

1.95

1.97

1.47

3.27

3.69

6.23

5.15

2.48

2.44

2.90

6.15

5.93

7.56

6.93

3.03

1.83

1.51

3.37

3.86

6.94

8.08

3.29

1.01

1.02

0.80

1.40

1.59

1.83

1.89

1.23

1.83

1.41

2.27

2.01

2.10

1.95

49
Table 11. Systolic blood pressure by survey, race, sex, and aga with waighted population estimates, means, standard errors, selected

percentiles, and proportions at or above 140 mmHg: United Statas. 1960-62, 1971-74, and 1976-80—Con.

Mean Percentiles

iDopulation systolic blood Standard Proportion Standard

Survey, race. sex, and age estimate pressure error 50th 95th > 140 mmHg error

1976-80 (N HANES 11)—Con.

White adulta—Con.

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

81ack adults

8oth sexas

18-74 years3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years.................,.. . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . .,, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

‘thousands Millimeters mercury

64,296

11,919

14,494

10,584

10,369

9,601

7.329

14,740

3,406

3,499

2,527

2,259

1,760

1,288

6,592

1,533

1,546

1,112

1,044

801

555

8,148

1,873

1,953

1,415

1,215

959

733

123

110

112

120

128

138

146

128

115

118

128

137

146

147

130

119

123

131

134

145

144

126

111

114

126

140

146

150

0.73

0.57

0.65

0.85

1.10

1.02

1.20

0.75

0.96

0.88

1.33

2.09

2.19

1.63

1.07

1.45

1.52

2.01

2.86

3.23

1.60

1.23

1.25

1.35

1.80

2.62

2.46

2.85

120

110

110

118

126

135

142

124

114

116,

126

130

140

142

126

1!8

120

130

130

140

140

120

110

110

124

138

140

148

168

130

136

150

166

180

190

172

142

150

160

180

196

198

170

142

150

158

170

194

190

176

134

140

160

182

200

200

21.1

2.6

3.3

14.2

26.3

43.6

59.2

27.5

7.4

10.2

29.2

40.0

57.6

60.5

28.3

11.3

14.8

34.6

29.1

57.8

56.5

26.7

4.3

6.5

25.0

49.5

57.5

63.5

1.05

0.60

0.74

1.16

2.00

2.40

2.61

1.41

1.70

1.06

4.09

4.45

3.05

3.96

2.16

2.91

2.42

6.96

7.31

6.08

3.73

1.78

1.28

1.83

4.51

3.54

4.29

6.54

‘Age adjusted by tha direct method to the overall U.S. population at the midpoint of tha 1976-80 survey.

50
Table 12. Diastolic blood pressure by survey, race, sex, and age with weighted population aatimatas, means. standard errors, selected

percentiles, and proportions at or above 90 and 95 mmHg: United States, 1960-62, 1971 –74, and 1976-80

Mean Percentiles

Population diastolic blood Stendard Propotiion Proportion

Survey, race, sex, and age estimete pressura error 5th 50th 95th >90 mrrrffg>95 mm/-Jg

1960–62 (NHES 1)

White adults

Both sexes:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both aexe~

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1971-74 (NHANES 1)

White aduita

Both sexe.%

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years, . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousanda Millimeters mercury

93,856

13,311

18,530

20,446

17,682

13,865

10,022

44,808

6,199

8,960

9,858

8,621

6,629

4,541

49,048

7,112

9,570

10,587

9,061

7,236

5,481

11,109

1,680

2,273

2,562

2,277

1,469

849

5,065

730

902

1,184

1,129

737

382

6,044

950

1,370

1,377

1,148

732

467

113,952

21,287

23,663

19,515

20,891

17,211

11,384

78

71

74

79

82

84

82

79

72

76

80

83

83

81

78

69

73

77

81

84

84

83

72

78

85

90

92

90

83

73

80

84

88

91

88

83

72

76

86

91

93

92

81

74

78

82

85

86

85

0.42

0.67

0.39

0.67

0.89

0.64

0.76

0.53

1.23

0.57

0.89

0.74

0.74

0.97

0.43

0.68

0.43

0.65

0.76

0.77

1.01

0.68

0.87

1.13

1.18

1.58

1.42

2.82

1.01

1.92

1.79

1.38

2.28

1.84

4.24

0.77

0.96

1.19

1.47

2.04

2.49

3.40

0.28

0.36

0.34

0.42

0.61

0.47

0.53

‘Age adjusted by the diract method to the overall U.S. population at the midpoint of the 1976-80 auruay.

60

50

58

60

64

66

62

60

48

60

60

64

64

64

60

50

58

60

62

66

62

60

52

58

66

66

68

64

60

52

60

66

66

70

68

60

58

58

66

68

68

64

60

58

60

62

66

70

68

78

70

74

7B

80

82

80

80

72

76

80

82

82

80

78

70

72

76

80

82

80

82

72

78

82

88

90

90

83

75

80

82

88

90

88

80

72

76

82

88

90

90

80

74

78

80

84

86

84

100

90

92

100

102

106

10B

100

92

94

100

102

102

106

100

86

90

96

102

110

110

112

90

100

110

124

120

120

110

90

100

110

120

112

114

116

90

100

110

124

126

124

102

90

95

102

108

108

108

17.6

5.5

8.0

18.0

24.5

32.9

27.9

19.4

9.1

10.8

23.5

26.3

30.2

25.7

16.1

2.3

5.5

12.9

22.8

35.4

29.7

30.6

7.4

18.9

34.9

45.9

55.5

54.8

31.7

8.7

28.2

34.1

44.8

56.3

40.5

30.2

6.4

12.9

35.7

46.9

54.7

66.5

24.1

6.3

14.1

24.7

34.6

40.5

37.6

8.9

2.8

3.5

9.1

13.7

14.8

15.8

9.5

4.4

4.9

11.8

14.8

12.3

13.7

8.4

1.4

2.1

6.5

12.6

17.2

17.5

21.5

2.9

12.5

26.9

32.7

38.3

42.4

22.9

3.5

19.6

26.7

31.4

39.6

37.8

20.8

2.4

7.9

27.1

34.1

37.1

46.2

12.8

2.5

5.5

12.6

19.3

23.7

21.9

51
Table 12. Diastolic blood pressure by survey, rata, sex. and age with Weigtlted population eatimata% meens, standard errors, selected

percentiles, and proportiona at or above 90 end 95 mmHg: United Stetas, 1960–62, 1971-74, and 1976-80—Con.

Mean Percentiles

Population diastolic blood Standard Proportion Propotiion

Survey, race, sex. and aga estimate pressure error 5th 50th 95th >90 mm/-/g >95 mmHg

1971-74 (N HANES I) —Con.

White adults—Con.

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both saxes:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

lB-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearal . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1976-80 (NHANES 11)

White adults

Both sexes

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara. c. . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl, . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yesrs. . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years. . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . .. l....... . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

54,377

10,207

11,559

9,441

10,073

8,166

4,931

59,575

11,080

12,104

10,074

10,818

9,045

6,454

12,850

2,841

2,770

2,308

2,265

1,569

1,097

5,689

1,293

1,160

1,007

1,042

707

480

7,161

1,548

1,610

1,301

1,224

861

617

123,494

23,362

28,357

20,392

20,235

18,243

12,906

59,198

11,442

13,864

9,808

9,865

8,642

5,576

Millimeters mercury

83

76

81

84

87

86

85

79

71

75

79

83

86

86

85

74

81

89

92

92

91

87

76

84

91

92

93

91

84

72

78

87

93

91

90

80

74

77

81

85

85

84

83

77

81

83

87

86

84

0.31

0.49

0.51

0.62

0.67

0.66

0.55

0.33

0.46

0.32

0.51

0.70

0.57

0.63

0.48

0.78

0.81

0.88

1.75

1.51

0.91

0.74

0.98

1.58

1.33

2.47

2.02

1.17

0.60

1.04

0.97

1.15

1,87

2.01

1.25

0.50

0.43

0.54

0.61

0.61

0.57

0.55

0.52

0.53

0.69

0.74

0.67

0.62

0.56

64

60

66

68

70

68

66

60

56

60

60

64

70

68

62

58

60

70

70

72

70

68

60

68

70

75

70

70

60

52

60

70

70

74

66

60

58

60

64

6B

6B

64

64

60

62

68

70

68

65

82

78

80

84

86

86

84

80

70

74

80

80

84

84

82

74

80

88

90

90

90

85

76

80

90

88

90

90

80

72

80

85

92

90

88

80

72

78

80

84

84

82

80

78

80

84

86

86

84

104

90

96

105

110

108

108

100

B8

90

100

105

108

108

110

90

104

110

120

115

120

110

94

106

110

120

118

116

110

90

102

110

116

110

120

100

90

98

100

106

104

106

102

96

100

100

110

108

105

28.6

9.2

19.9

30.9

43.1

42.8

37.9

20.0

3.6

8<5

18.9

26.7

38.5

37.3

35.2

8.1

23.9

47.6

52.7

57.2

52.4

58.4

11.2

32.5

54.7

45.6

57.4

56.6

32.7

5.6

17.6

42.1

58.8

57.1

49.1

26.5

10.3

18.1

26.7

39.7

39.0

35.7

32.2

16.5

27.0

33.4

45.7

43.1

34.9

14.7

4.0

7.7

16.4

23.2

24.4

20.7

11.0

1.2

3.3

9.0

15.7

23.1

22.8

23.3

3,4

12.3

31.2

38.6

43.7

35.9

25.0

4.1

15.4

36.3

35.0

47.4

:36.3

22.0

2.9

10.2

27.2

41.6

40.7

35.5

12.8

3.6

7.2

11.8

22.4

19.5

19.1

15.7

5.6

11.6

14.6

26.7

22.6

18.3

lAga sdjusted by the direct method to the overall U.S. population at the midpoint of the 1976-80 survey.

52
Table 12. Diastolic blood pressura by suwey. race, sax, and aga with weighted population estimates, means, standard errors, seleoted

percentiles, and proportions at or abova 80 and 95 mmHg: United Statas, 1960-62, 1971-74, and 1976-80—Con.

Mean Percentiles

Population diastolic blood Standard Proportion Proportion

Survey, race, sex, and age estimate pressure error 5th 50th 95th >90 mm/-/g >95 Mm/-/g

1976-80 (NHANES 11)—Con.

White adults—Con.

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . .

81ack adults

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands Millimeters mercury

64,296

11,919

14,494

10,584

10,369

9,601

7,329

14,740

3.406

3,499

2,527

2;259

1,760

1,288

6,592

1,533

1,546

1,112

1,044

801

555

8,148

1,873

1,953

1,415

1,215

959

733

78

71

74

79

83

84

84

82

74

79

85

90

90

87

84

76

82

88

88

91

86

81

73

76

83

91

88

87

0.51

0.46

0.57

0.61

0.79

0.63

0.69

0.55

0.74

0.66

1.33

1.39

0.96

0.77

0.77

1.38

1.41

1.91

2.22

1.27

0.80

0.60

1.18

0.91

1.58

1.70

1.35

1.17

60

58

60

60

65

65

62

60

58

60

64

70

70

66

64

60

62

65

70

70

66

60

56

58

60

70

70

68

78

70

72

78

80

82

82

80

74

78

88

90

90

88

82

74

80

90

86

90

88

80

70

76

84

90

90

86

100

88

90

100

102

104

108

110

92

100

106

116

116

110

110

94

106

110

112

124

110

108

90

95

105

118

110

110

21.2

4.4

9.5

20.5

34.1

35.2

36.2

33.9

11.8

20.1

45.8

52.2

54.2

46.7

36.0

13.9

26.8

52.8

42.9

56.4

46.2

32.2

10.1

14.8

40.3

60.2

52.3

47.2

10.2

1.7

3.0

9.1

18.4

16.8

19.6

17.5

3.7

9.2

23.5

32.0

28.9

24.4

20.4

4.7

13.4

33.2

25.6

35.4

25.7

15.3

2.8

5.8

15.9

37.6

23.4

23.4

‘Age adjusted by the direct method to the ovsrall U.S. population at tha midpoint of the 1976-80 survey.

53
Tabla 13. Propotiion of adult population with dafinite hypertension by race, sex, age, and survey: United States, 1960-62, 1971-74, and

1976-80

1960-62 (NHES ~ 1971-74 (NHANES /) 1976-80 (NIIANES 1/)

Definite Standard Definite Standard Definite Stendard

Race, sex, and age hypertension error hypertension error hypertension error

WHITE ADULTS

Both sexes

lB-74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . ,,, , . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLACK ADULTS

Both sexas

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years....,.........,,. . . . . . . . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18–74yearsl, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18.0

4.2

5.3

12.4

21.6

34.3

53.6

17.6

6.2

6.8

15.3

20.9

30.5

44.0

1B.3

2.5

3.9

9.6

22.2

37.8

61.5

33.6

6.1

17.8

32.1

43.5

53.8

77.2

30.8

*6.3

21.8

30.9

34.6

50.8

63.3

36.9

*5.9

15.2

33.2

52.3

56.9

8B.5

0.74

1,03

0,71

0.79

1.66

2.53

2.85

0.99

1.94

0.90

1.69

2.12

3.33

3.77

0,89

0.74

0.86

1.29

2.45

3.05

4.02

2.21

1.97

3.75

3.58

4.18

5.35

7.64

3.17

3.66

6.99

5.86

6.86

7.97

14.32

2.57

2.57

4.12

3.84

6.34

9.06

5.09

Percent of population

19.1

3.1

6.1

14.7

25.6

38.6

4B.O

20.2

4.9

8.4

18.1

28.2

38.1

41.3

17.9

1.4

4.0

11.5

23.2

39.2

53.1

33.9

3.8

16.0

36.6

50.8

59.3

64.2

32.8

*4.8

16.1

42.3

45,3

54.0

58.6

34.8

“3.0

16.0

32.3

55.4

63.6

68.5

0.53

0.58

0,72

1.08

1.52

1.71

1.40

0.84

1.16

1.37

1.93

2.02

2.54

1.62

0.61

0.31

0.54

1.06

1.89

2.25

1.85

1.48

0.99

2.72

4.43

5.69

4.63

3.44

2.46

1.54

5.52

6.66

7.88

6.42

3.97

1.76

1.07

2.39

4.72

6.04

6.67

4.60

21.0

4.5

8.7

14.7

30.0

38.4

49.2

22.3

6.9

12.9

17.2

32.4

38.0

43.6

19.8

2.1

4.6

12.3

27.8

38.8

53.4

28.6

4.5

11.3

29.0

48.7

58.1

63.0

26.0

*4.7

14.4

34.7

33.6

53.9

45.2

30.7

*4.2

8.8

24.6

61.7

61.7

76.5

0.82

0.66

0.82

1.28

1.47

1.30

1.42

0,97

1.08

1.47

2.08

1.85

1.82

1.91

0.82

0.57

0.77

1.21

2.01

1.76

1.86

1.53

1.38

2.21

3.44

5.00

3.33

3.87

1.84

2,32

3.76

6.82

8.BO

5.33

4.45

2.04

2.05

2.64

4.53

4.38

4.49

4.93

‘Age ad]usted by the direct method to the oversll U.S. population at the midpoint of the 1976-80 survey.

54
Table 14. Proportion of adult population with elevated blood pressure by sex, age. and rac- United Statea, 1960-62, 1971–74, and 1976–80

Totall White Black

Sex and age 1960-62 1971-74 1976-80 1960-62 1971-74 1976–80 1960-62 1971-74 1976-80

Both sexes

18-74 years2 . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . .

Men

18-74 yesrs2 . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . .

Women

18–74years2 . . . . . . . . . . . . . . .

18–24 years . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . .

35–44yaars . . . . . . . . . . . . . . . .

45–54 years . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . .

34.3 35.6 35.4

10.6 12.3 14.7

15.6 19.6 20.8

29.8 32.2 33.0

44.4 46.9 47.1

62.3 59.4 56.7

73.8 70.3 63.1

38.2 40.2 41.1

18.8 18.9 22.8

23.3 27.5 31.2

37.4 38.1 39.5

47.2 52.8 52.1

59.3 59.3 58.6

65.9 65.4 62.0

30.8 31.4 30.2

3.5 6.3 7.1

8.6 12.3 11.0

22.7 26.7 27.0

41.8 41.5 42.3

65.0 59.5 55.0

80.3 74.1 63.9

Percent of population

33.2 34.6 34.7

10.4 12.6 14.6

14.7 18.8 20.7

28.1 29.6 30.8

42.4 45.8 45.9

60.9 58.4 55.2

73.1 69.3 61.9

37.4 39.7 40.9

18.7 19.7 23.6

22.3 27.2 31.5

37.0 36.0 37.6

46.0 53.0 52.0

58.3 58.9 57.6

65.0 64.0 60.6

29.3 29.8 29.1

3.1 6.1 6.0

7.6 10.8 10.4

19.8 23.6 24.6

39.1 39.1 40.1

63.3 57.9 53.1

79.8 73.4 63.0

44.9 45.6

13.5 11.3

22.4 28.2

43.5 54.5

60.6 57.4

78.8 71.8

85.2 80.0

46.5 47.4

20.9 15.9

31.9 33.6

44.2 60.5

56.3 53.3

74.8 67.5

76.8 79.3

44.3 44.3

7.9 7.5

16.1 24.2

43.0 49.9

64.8 61.0

82.8 75.3

92.1 80.6

40.8

15.5

22.4

47.9

58.9

70.5

71.7

43.7

20.2

31.5

53.8

50.9

71.7

68.7

38.4

11.5

15.1

43.4

65.8

69.4

74.0

1includes sII other races not shown separately.

2Ageadjusted bythedirect method totheoverall U.S. population atthemidpoint of the1976-80suwey.

NOTE Elevated blood pressure includes resdings ofeithersystolic blood preasure ofatleast 140mmHg ordiastolic blood pressure ofatleast 90mmHg or both.

55
Table 15, Propotiion ofadukpopulation with undiagnosed hypatienaion klyraca, aex, aga, andsuNeY United States, 1960-62, 197’l-74,

and 1976-80

1960-62 (NHES /) 1977 -74( NHANES 1) 1976-80 (NHANES //)

Undiagnosed Standard Undiagnosed Standard Undiagnosed Standard

Race, sax, andaga hypertension error hypertension error hypertension arror

WHITE ADULTS

Both sexes

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8LACK ADULTS

Both saxas

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . ...<. . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

I

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years ., . . . . . . . . . . . . . . ...8 . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-i’ 4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.2

3.2

2.7

7.5

12.8

14.9

24.1

10.7

5.5

4.6

9.6

13.6

16.0

24.6

7.7

1.1

0.9

5.6

12.0

13.8

23.6

16.7

*3.2

11.6

20.0

23.9

25.8

24.0

21.1

*6.3

20.8

26.6

22.5

33.1

22.7

13.2

“0.8

*5.7

14.3

25.3

*18.6

25.0

0.53

0.97

0.55

0.70

1.32

1.69

2.16

0.73

1.92

1.04

1.32

1.71

2.09

3.48

0.65

0.62

0.40

0.84

1.48

2.19

2.41

1.72

1.58

3.32

3.62

4.14

4.68

5.78

2.96

3.66

6.57

6<33

7.22

5.69

8.96

1.85

0.77

2.40

2.89

4.36

6.94

7.84

Percent of population

11.2

2.7

4.9

10.4

15.8

20.3

23.0

13,4

4,4

6,5

14.1

18.6

22.2

24.1

9.3

1.1

3.4

7.0

13.1

18.6

22.2

17.1

3.5

10.5

18.4

26.2

22.9

32.6

18.7

*4.8

“12.7

19.3

29.0

24.9

32.7

15.8

*2.5

9.0

17.7

23.9

21.3

32.4

0.47

0.52

0.60

0.92

1.27

1.49

1.09

0.70

1.08

1.12

1.50

1.69

2.22

1.32

0.60

0.27

0.51

0.96

1.63

2.19

1.58

1.35

0.98

2.23

3.85

5.34

4,11

3.06

2.26

1.54

5.11

6.04

7.53

6.87

3.97

1,52

1.01

1.79

4.05

5.48

4.96

3.58

7.6

3.2

4.5

7.7

10.1

11.4

13.0

9.8

5.2

7.2

10.5

12.2

13.4

15.0

5.6

*1.3

1,9

5.1

8.0

9.5

11.6

6.9

2.4

4.3

8.0

10.3

11.2

11.6

9.9

“3.3

“6.2

14.5

11,0

17.2

16.8

4.5

*1.7

*2.9

“3.0

9.7

6.2

7.7

0.56

0.51

0.51

0.96

1.25

1,20

0.79

0.68

0.86

0.92

1.50

1.57

1.38

1.58

0.54

0.44

0.53

0.75

1.60

1.43

0.83

0.65

0.83

1.30

2.33

2.17

1.87

1.83

1.18

1.99

2.59

4.66

4.31

3.52

2.20

0.83

1.15

1.70

1.37

2.72

1.99

2.10

lAgeadjusted bythedirect method totheoverall U.S. population at the midpoint of the 1976 -80 survey.

56
Table 16. Proportion of adult population taking antihypertensive medication by race, sex, age, and survey United States, 1960-62, 1971-74,

and 1976-60

1960-62 (NHES O 1971-74 (NHANES /) 1976-80 (NHANES lo

Standard Standard Standard

Race, sex, and age Medicated error Madicated error Medicated error

WHITE ADULTS

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lB-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLACK ADULTS

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

1B-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years...............,.. . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.5

‘0.8

1.3

1.9

5.0

12.8

19.8

3.8

“0.5

*0.6

*1.5

3.5

9.1

13.5

7.0

*1.O

2.0

2.3

6.5

16.1

25.0

11.3

“2.0

6.3

7.9

13.6

14.9

37.4

6.0

*1.3

*2.8

%.7

*8.6

29.9

15.9

*3.5

9.6

12.2

2i.4

21.2

43.5

0.39

0.29

0.33

0.34

0.70

1.59

1.82

0.44

0.33

0.38

0.52

0.99

1.95

2.65

0.56

0.46

0.59

0.65

1.07

2.27

2.38

0.99

1.18

1.94

2.10

3.45

2.99

5.93

0.91

1.35

1.79

3.84

3.13

7.32

1.71

2.09

3.03

2.76

5.02

5.59

8.66

Percent of population

6.1

“0.0

“0.5

2.7

6.9

15.6

20.9

5.1

*O. 1

“0.6

*2,2

5.9

14.4

14.7

6.9

“0.4

3.2

7.8

16.6

25.7

11.5

“0.2

*3.9

9.1

17.1

25.7

25.2

8.1

“0.9

*8.6

“13.0

*14.5

22.2

14.2

“0.3

*6.2

9.5

20.6

34.8

27.6

0.24

0.05

0.20

0.46

0.81

1.24

0.97

0.43

0.10

0.39

0.76

1.11

2.15

1.14

0.38

0.14

0.50

1.32

1.67

1.40

1.10

0.09

1.37

2.30

4.10

4.94

2.38

1.50

0.88

4.54

5.69

5.5B

2.73

1,47

0.17

2.20

2.35

5.51

6.86

3.70

9.4

“0.3

1.9

3.9

13.3

20.4

29.5

7.6

‘0.3

2.0

3.4

11.6

16.9

22.4

11.1

“0.2

1.7

4.3

15.0

23.6

34.9

14.8

*1.1

3.7

11.9

26.1

32.0

43.5

9.2

‘0.8

“3.1

*1O.7

*1O.5

23.5

23.5

19.3

*1.4

*4.1

12.8

39.5

39.1

58.6

0.30

0.14

0.37

0.51

1.08

1.09

0.93

0.29

0.23

0.50

0.59

0.99

1.42

1.32

0.47

0.17

0.54

0.85

1.68

1.50

1.26

1.02

0,90

1.12

2.34

3.46

2.50

4.00

1.10

0.83

1.38

3.62

5.38

3.33

3.76

1.60

1.45

1.68

3.41

4.51

4.74

5.13

‘Age adjusted by the direct method to the overall US. population at the midpoint of the 1976-80 survey.

57
Table 17. Proportion of adult population with controlled hypertension by race, sex, age, and survey: United States, 1960-62, 1971-74,

and 1976-80

1960-62 (NHES /) 7971-74 (NHANES 1) 1976–80 (NHANES //]

Controlled Standard Controlled Standard Controlled Standard

Race, sex, and age hypertensicm error hypertension error hypertension error

WHITE ADULTS

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74years1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8LACK ADULTS

Both sexes

18–74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74 years] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 vears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2

“0.8

1.1

1.0

2.4

4.2

6.7

1.5

“0.5

“0.6

“0.4

*1.3

3.0

5.4

2.9

“1.0

‘1.6

1.5

3.4

5.2

7.7

3.6

“2.0

*3.8

*3.4

“4.0

*3.7

*5.2

‘0.6

*2.8

*1.1

6.0

*3.5

*6.4

“4.0

*8.O

*6.4

*9.5

0.32

0.29

0.34

0.21

0.51

1,31

1.35

0.39

0.33

0.38

0.27

0.70

1.79

1,59

0.44

0.46

0.54

0.46

0.71

1.23

2.26

0.87

1.18

1.69

1.44

1.76

1.74

3.79

0.43

1.79

1.15

1.41

2.09

2.76

1.52

3.04

3.33

6.91

Percent of population

2.7

“0.0

0.1

1.3

3.4

7.0

8.4

2.2

*o. 1

*O. 1

“0.9

2.4

6.9

6.2

3.1

“0.2

1.6

4.4

7.2

10.2

4.6

‘0,0

“3,1

‘4. 7

“7.0

7.2

8.5

“3.7

*5.4

*8.3

*4.5

8.2

5.1

*O. 1

*5.3

*4. 1

“6.0

*9.5

8.7

0.21

0.05

0.03

0.28

0.56

1.03

0.68

0.28

0.10

0.09

0.43

0.60

1.58

0.70

0.33

0.11

0.38

1.05

1.30

1.00

0.67

0.05

1.35

2.01

2.82

2.44

1.61

1.26

3.72

5.48

3.51

2.46

0.78

0.09

2.19

1.85

2.19

3.56

1.80

4.9

*O. 1

1.1

2.2

5.8

11.5

15,2

3.4

‘0.7

2.0

3.8

8.2

10.9

6.3

“0.2

1.4

2.4

7.7

14.4

18.5

7.9

‘0.8

“2.1

4.7

12.1

18.7

26.4

3.3

“1.0

*1.5

*4.3

8.2

13.1

11.6

“1.4

‘3.0

*7.2

18.8

27.5

36.5

0.26

0.08

0.27

0.37

0.72

0.95

0.97

0.25

0.29

0.45

0.81

0.96

1.08

0.39

0.17

0.46

0.69

1.22

1.21

1.18

0.96

0.79

0.75

1.79

2,79

2.22

4.68

0.71

0.69

1.45

2<40

1.68

3.69

1.44

1.45

1.27

2.83

4.65

3.79

6.75

‘Age adjusted by the direct method to the oversll U.S. population at the midpoint of the 1976-80 survey.

58
Table 18. Number and proportion of hypertensive disgnosed, medicsted, and controlled, by survey and age: United States, 1960-62,

1971-74, 1976-80

1960-62 (NHES /) 7977 -74( NHANES /) 7976-80 (NHANES //)

18-74 78-44 45–74 18-74 18-44 45-74 18-74

Status

18-44

years

45-74

years years years years years years years years

Population estimate . . . . . . . . . . . . . . . . . . . . . . .

Definite hypartensives . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . .

Definite hypertenaives whoweredisgnosed . . .

Definite hypertensives who were diagnosed . . .

Definite hypertensives who were medicated . . .

Definite hypertensives who were medicated . . .

Medicsted hypertensive who were controlled. . .

Medicated hypertensives who were controlled. . .

106,852

21,972

20.6

10,549

48.0

6,654

30.3

2,616

39.3

60,258

5,649

9.2

2,098

37.8

1,162

20.9

757

65.2

46,594

16,423

35.2

8,451

51.5

5,492

33.4

1,859

33.8

Number in thousands

128,147 73.404 54,743

26,766 6,447 20,318

Percent

20.9 8.8 37.1

Number in thousands

10,826 1,800 9,026

Percent

40.4 27.9 44.4

Number in thousands

8,610 996 7,614

Percent

32.2 15.4 37.5

Number in thousands

3,737 487 3,250

Percent

43.4 48.9 42.7

141,728

30,762

21.7

21,786

70.8

13,975

45.4

7,232

51.7

83,851

8,014

9.6

4,738

59.1

1,867

23.3

1,029

55.1

57,877

22,747

39.3

17,049

74.9

12,109

53.2

6,203

51.2

59
Table 19. PropoRions ofhypeRensives diagnosed, medicated, andcdtirolled, byeexor race, suwey, andage: United States, 1960-62,

1971-74, 1976-80

7960-62 (NHES /) 1977 -74( AVfAfdE.S /) 7976-80 (NHANES //)

18– 74 18-44 45-74 18-74 18-44 45-74 18-74 18-44 45-74

Sex, rata, andstatus years years years yaars yaars yaars years years years

Men

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension . . . . . . .

Definite hypertensives who were diagnosed . . . . . . . .

Definite hypertensives who were medicated. . . . . . . .

Medicated hyperteneives who were controlled. . . . .

Women

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . .

Definite hypertensives who were diagnoaed. . . . . . . .

Definita hypertensive who were medicated. . . . . . . .

Medicated hypertensives who were controlled. . . . . .

Whita adults

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . .

Definite hypertenaives who were diagnoaed. . . . . . . .

Definite hypertenaives who were medicated. . . . . . . .

Medicated hypertensives who were controlled. . . . . .

Black adults

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . .

Definite hypertensives who were diagnosed. . . . . . . .

Definite hypertensives who were medicated. . . . . . . .

Medicated hypertensive who were controlled. . . .

10,050

19.B

37.3

20.3

35.6

11,!323

21.3

57.1

38.7

41.0

18,015

19.2

48.6

29.9

40.4

3,768

33.9

46.5

32.5

32.7

3,184

11.1

27.0

8.8

57.8

2,365

7.5

52.4

37.2

67.5

4,074

7.8

39.5

18.3

68.5

1,331

20.4

33.9

28.5

55.1

6,865

30.8

42.0

25.7

32.0

9,558

39.3

58.2

39.0

34.7

13,941

33.5

51.3

33.3

35.9

2,438

63.0

53.5

34.7

22.6

Number in thousanda

13,037 3,886 9,151

Percent

21.4 11.0 35.B

32.8 23.8 36.6

24.8 9.9 31.1

43.9 41.5 44.3

Number in thousands

13,729 2,562 11,168

Percent

20.4 6.7 38.3

47.7 34.2 50.9

39.2 23.9 42.7

43.1 53.5 41.7

Number in thousanda

22,440 4,983 17,457

Percent

19.7 7.7 35.3

38.9 23.4 43.3

31.9 13.1 37.3

44.4 44.7 44.3

Number in thouaends

4,182 1,398 2,784

Percent

32.5 17.7 56.5

47.8 41.4 51.1

33.2 23.1 38.3

40.4 60.4 34.3

5,201

22.5

61.5

34.3

42,8

5,561

21.0

80.0

56.3

57.1

25,922

21.0

69.9

44.8

51.7

4,216

28.6

78.6

51.7

53.3

5,066

12.5

49.1

16.8

41.1

2,948

6.8

76.3

34.74

66.9

6,496

9.0

58.0

21.2

57.1

1,280

13.6

73.1

36.5

47.7

0,135

37.5

67.6

43.0

43.1

2,612

40.9

80.8

61.4

55.8

19,426

37.8

73.9

52.7

51.0

2,936

55.3

80.9

58.3

55.0

60
Table 20. proportions of hypertensive diagnosad, medicatad, and controlled. by race, se% suweyt and a9a United State.% 1960-62,

1971-74, 1976-80

1960-62 (NHES ~ 197? -74( NHANES ~ 1976-80 (NHANES //)

18-74 18-44 45-74 18-74 78-44 45-74 78-74 18-44

Race, sex, and status

45– 74

years yaars years years years years years years years

WHITE ADULTS

Men

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . . .

Definite hypertensives who ware diagnosed . . . . . . . .

Definite hypertensives who were medicated . . . . . . . .

Medicated hypertensives who were controlled . . . . . .

Women

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertenaion. . . . . . . . .

Definite hypertensives whowera diagnosed . . . . . . . .

Definite hypertensive who were medicated . . . . . . . .

Medicated hypertensives who were controlled . . . . . .

BLACK ADULTS

Men

,Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with dafinite hypertension. . . . . . . . .

Definite hypertensives who were diagnosed . . . . . . . .

Definite hypertensive who were madicated . . . . . . . .

Medicated hypertensive who were controlled . . . . . .

Women

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . . .

Definite hypertensives who were diagnosed . . . . . . . .

Definite hypertensive who ware medicated . . . . . . . .

Medicated hypertensive who were controlled . . . . . .

8,322

18.6

39.2

21.1

39.0

9,693

19.8

56.6

37.5

41.1

1,617

31.9

29.6

17.8

14.6

2,152

35.6

59.2

43.6

38,3

2,496

10.0

32.2

9.4

54.8

1,578

5.8

51.1

32.2

74.9

609

21.6

9.2

7.5

73.5

721

19.5

54.7

46.3

52.6

5,826

29.4

42.3

26.1

36.6

8,115

37.3

57.7

38.5

35.6

1,007

44.8

42.0

24.0

3.4

1,430

60.9

61.5

42.2

30.3

Number in thousands

11,161 3,179 7,982

Percent

20.5 10.2 34.4

31.2 19.5 35.8

24.9 8.9 31.3

43.4 36.7 44.2

Number in thousands

11,280 1,805 9,475

Percent

18.9 5.4 36.0

46.5 30.2 49.6

38.8 20.4 42.3

45.0 50.8 44.4

Number in thousands

1,809 674 1,135

Parcent

31.8 19.5 50.9

41.3 40.1 42.0

24.4 14.3 30.3

48.2 56.8 45.8

Number in thousands

2,373 725 1,649

Percent

33.1 16.2 61.0

52.8 42.6 57.3

40.0 31.3 43.8

36.7 61.9 28.8

13,177

22.3

61.1

34.1

44.2

12,745

19.8

79.1

56.8

56.5

1,715

26.0

66.0

35.4

35.6

2,501

30.7

87.2

62.9

60.2

4,270

12.2

47.5

15.2

45.2

2,226

6.0

78.3

32.7

67.6

681

16.2

64.3

26.3

18.1

599

11.4

83.1

48.1

65.0

8,907

37.0

67.7

43.2

44.0

10,519

38.5

79.2

60.7

55.3

1,034

43.1

67.1

41.4

42.9

1,901

65.4

88.5

67.5

59.1

61
Appendixes 

Contents 

I. Survey design and estimation procedures. .................................................................. 62 

Surveydesign ........................................................................................ 62 

Estimationprocedures ................................................................................. 6: 

Nonresponsebias ..................................................................................... 6: 

II. Statisticalmethodology .................................................................................. 

Measuresofvariability ................................................................................ 

Datareiiability ....................................................................................... 

III. Demographic and socioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

IV. Limitationsofdata...................................................................................... 

Appendix figure 

I. Smoothed weighted frequency distribution of the first diastolic blood pressure for white men ages 18-24 years by survey: 

United States, NHES I (1960-62), NHANES I (197 l--74), and NHANES II (1976-80) . . , . . , . . . . . . . . . . . . . . . . . . 

List of appendix tables 

I. Sample sizes and response rates for NHES I ( 1960-62), NHANES I (197 l-74), and NHANES II ( 1976-80), by age. . . . 

II. Percent of persons with blood pressure reading ending in zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65 

6~ 

6f 
Appendix I

Survey design and estimation

procedures

Survey design

The sampling plans for the first National Health Examination Survey (NHES I) and the first and second National Health

and Nutrition Examination Surveys (NHANES I and II) have

been described at length in earlier publications.s-]o Each of the

surveys utilized a stratified multistage probability design in

which a sample of the civilian noninstitutionalized population

of the United States was selected. Excluded from the selection

for all three surveys were persons residing on reservation lands

of American Indians, and excluded from selection for NHES I

and NHANE S I were persons residing in Alaska or Hawaii.

Successive stages in the sampling process dealt with primary sampling units (PSU’s-a standard metropolitan statistical

area, a county, or a small group of contiguous counties), census

enumeration districts (ED’s), segments (clusters of households),

households, eligible persons, and sample persons. In the first

stage of sample selection for each survey, the approximately

1,900 PSU’S into which the United States is subdivided were

grouped into superstrata. There were 42 such superstrata for

NHES I, 40 for NHANES I, and 64 for NHANES II. A

modified Goodman-Kish controlled selection technique was

used to select ftom each superstrata one or more PSU’S (also

called stands) to be included in the sample.61Forty-two PSU’S

were selected for inclusion in NHES I, 65 for inclusion in

NHANES I, and 64 for inclusion in NHANES II.

EDs (within-PSU geographic areas with similar numbers

of households) were then selected for subsequent sampling.

For NHANES I and NHANES II, the EDs within each PSU

were further grouped into “poverty” and “nonpoverty” strata

to allow oversampling among the “poverty stratum” ED’s. A

systematic sample of segments (clusters of households) was

selected from within the ED’s,

At the third stage of sampling, lists of all eligible sample

persons within each segment were made. From these lists systematic random samples in each age-sex group were selected to

be examined, using the following sampling rates:

Suwey and age/sex group Sampling rate

NHES I

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/2

NOTE A list of references follows the text.

Sampling

Survey and age/sex group—Con. rate—Con,

NHANES I

18-19 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

20-44 years

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/2

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/7

NHANES II

18-59 yeara . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

60-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 3/4

Of the 7,710 persons included in the NHES I sample, 6,672

(86.5 percent) were interviewed and examined. Comparable

figures for NHANES I and II, ages 18–74 years, were 13,645

of 19,572 and 12,504 of 18,209 (69.7 and 68.7 percent, respectively).

Estimation procedures

All data presented in this report are based on” weighted”

observations. That is, data recorded for each sample person

are inflated to characterize the subuniverse from which that

sample person was drawn. The weight for each examined person

is a product of the reciprocal of the probability of selecting the

person, an adjustment for nonresponse cases (that is, persons

not examined), and a poststratified ratio adjustment. The latter

increases precision by making the final sample estimates of the

population agree approximately with independent controls prepared by the U.S. Bureau of the Census for the noninstitutionalized population of the United States as of the approximate

survey midpoint by age, sex, and race.

Nonresponse bias

In any health examination survey there exists the potential

for three levels of nonresponse: Household interview nonresponse, examination nonresponse, and item nonresponse.

Household interview nonresponse is defined as the proportion

of those sample persons who do not complete the household

medical histo~ questionnaire. Examination nonresponse is the

proportion of those sample persons who initially respond to the

household demographic questions and some or all of the medical

history questionnaire, but who subsequently do not come to the

examination center for an examination. Item nonresponse re63
suits from sample persons who do not complete some portion

of either the household interview questionnaires or the examination protocol.

The response rates for all three surveys are presented in

table I. The summary response rates varied from a high of 86.8

percent for NHES I down to 68.7 percent for NHANES II. In

each of the surveys an inverse relationship between age and

response rate was observed. That is, as age increased, the response rate decreased. The magnitude of the difference was

similar among the surveys, with an approximate 10 percent

decline in response rates between the youngest and oldest age

groups observed for each of the three surveys.

Intense efforts were undertaken during each survey to

develop and implement procedures and inducements that would

reduce all types of nonresponse and thereby reduce the potential for bias in the survey estimates. Several studies have been

conducted to evaluate the effectiveness of these procedures and

to quanti~ any systematic bias that may have occurred. For

instance, a comparison of the 1976 National Health Interview

Survey (NHIS)62 and NHANES 1163suggests that there is not

a large nonresponse bias in some health-related variables be

cause of the close agreement on selected interview items in

NHANES II data with comparable items in the 1976 NHIS

data, for which there was a nonresponse rate of only 4 percent.

An earlier analysis comparing examined and nonexamined

(but interviewed) persons from the first 35 stands of NHANES I

found the two groups quite similar with respect to health characteristics being compared.64 A third study found no difference

between examined and nonexamined persons selected for participation in NHANE S I with respect to health-related variables,cs A study of factors relating to response in NHES I

found that 36 and31 percent of the nonexamined and examined

persons viewed themselves as being in excellent health, while 5

and 6 percent of the nonexamined and examined persons reported being in poor health.66 Finally, a study of NHES I

examinees involving comparisons between two extreme groups,

NOTE A list of references follows the text.

Table 1. Sample sizas and response rates for NHES I (1960-62),

NHANES I (1971-74), and NHANES II (1976-80), by age

Total

sample Number Percent

Survey and age size examined examined

NHES I

18-74 years . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . .

4.5-54 years . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . .

NHANES I

18-74 years . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . .

45-54 years....,.........,,.

55-64 years..............,..

65-74 years . . . . . . . . . . . . . . . . .

NHANES II

18-74 yeare . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . .

55-64 years.............,,..

65-74 years . . . . . . . . . . . . . . . . .

6,955

960

1,453

1,553

1,343

997

649

19,572

3,131

3,682

3,184

2,292

1,891

5,392

18,209

2,713

3,031

2,236

2,149

3,868

4,212

6,039

866

1,300

1,378

1,164

809

522

13,645

2,297

2,694

2,327

1,599

1,262

3,466

12,504

2,054

2,237

1,589

1,453

2,556

2,615

86.8

90.2

89.5

88.7

86.7

81.1

80.5

69.7

73.4

73.2

73.1

69.8

66.7

64.3

68.7

75.7

73.8

71.1

67.6

66.1

62.1

those who participated in the survey with no persuasive effort

and those who participated only after a great deal of persuasive

effort, found that differences between the two groups generally

had little effect on estimates, based on numerous selected examination and questionnaire items.G7

These findings have been interpreted as evidence that no

large bias exists between the two groups for the items investigated and provide support for the belief that there is little bias

introduced to the findings because of differences in health

characteristics between examined and nonexamined persons.

64
Appendix II

Statistical methodology

Measures of variability

Because the statistics presented in this report are based on

a sample, they may differ from the figures that would have been

obtained if a complete census had been taken using the same

survey instruments, instructions, interview and examination

personnel, and procedures. The probability design of the sample

permits the estimation of standard errors and standard deviations

that are appropriate for the design and weighted estimates

shown in this report.

The standard error is primarily a measure of the variation

inherent in the process of estimating a population mean from a

sample mean. As calculated for this report, the standard error

also reflects part of the variation that arises in the measurement

process. It does not include estimates of any bias that might be

contained in the data,

The estimation of sampling errors for a sample of the type

of the National Health and Nutrition Examination Survey is

difficult for at least two reasons (a) measurement error and

“pure” sampling error are confounded in the data because it is

difticult to find a procedure that will either completely include

both or treat one or the other separately, and (b) the survey

design and estimation procedure are complex and, accordingly,

require computationally involved techniques for the calculation

of variances. The estimates of standard errors are themselves

subject to errors that may be large if the number of cases or the

number of primary sampling units involved in the calculation of

variances is small.

Estimates of the standard errors for selected statistics used

in this report are presented in most of the tables in this report.

These estimates have been calculated by a replication technique

that yields overall variability through observation of variability

among random subsamples of the total sample. 15,16These estiNOTE A list of referencesfollowsthe text.

mated sampling errors do not reflect any residual bias that

might still be present after attempted correction for nonresponse.

The standard deviation is a measure of the dispersion of

the observations in a sample, and is useful in describing how an

individual observation compares with the mean of the sample.

As calculated for this report it also reflects part of the variation

that arises in the measurement process. The estimates of

standard deviations presented in the detailed tables were calculated using the pseudoreplication method. 15,]6

Data reliability

The criteria for reliability of estimates shown in this report

consisted of the following (a) that the sample size on which the

estimate is based be at least 25 persons, and (b) that the estimated coefficient of variation (that is, the standard error of the

mean divided by the mean) be less than 30 percent. Thus, if the

sample size was too small or if the variation regarding the mean

was too large, an asterisk was placed next to the value on the

table. This estimate is considered neither precise nor stable

enough to meet reliability standards. However, the va’lues are

shown to give an impression of the observed distribution and to

permit users to combine data into useful categories.

The following sample sizes were required for the presentation of percentile estimators given in this repom

Percentile Sample size

both . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

25th and 75th . . . . . . . . . . . . . . . . . . . . . . . . . 20

10th and 90th . . . . . . . . . . . . . . . . . . . . . . . . . 50

5thand 95th............,.,.,.. . . . . . . . 100

If these minimum sample sizes were not me; there is an asterisk

in the cell.

65
Appendix 11I

Demographic and

socioeconomic terms

.4ge-In the first National Health Examination Survey,

age at last birthday prior to the census interview was used as

the criterion for inclusion in the sample. Data in the detailed

tables and text of the report are shown by age at the time of the

census interview, regardless of age at examination.

In the first and second National Health and Nutrition Examination Surveys, two ages were recorded for each examinee: The age at last birthday at the time of examination and

at the time of the census interview. The age criterion for inclusion in the sample used in these two surveys was defined as

age at the time of the census interview. The adjustment and

weighting procedures used to produce national estimates were

based on the age at interview. Data in the detailed tables and

text of the report are shown by age at the time of the examination, except that those few who became 75 years of age by the

time of the examination are included in the 65–74 year age

group.

Race—For allthree surveys, race was recorded as “white:’

“Negro,” or “other.” “ Other” included Japanese, Chinese,

Aemerican Indian, Korean, Eskimo, and all races other than

white and black. Mexicans were included with “white” unless

definitely known to be American Indian or other nonwhite

race. Black persons and those of mixed black and other parentage were recorded as “Negro.” When a person of mixed racial

background was uncertain about his race, the race of his father

vvasrecorded.

Education—In all three surveys each person was classified

by education according to the highest grade of school completed.

The only grades counted were those attended in a regular graded

public or private school where persons were given formal education, whether during the day or at night, on a full-time or

pan-time attendance basis. A “regular” school is one that advances a person toward an elementary or high school diploma,

or a college, university, or professional degree. Education received in vocational, trade, or business schools outside the

regular school system was not counted in determining the highest grade of school completed. If a person attended school in a

foreign country, at an ungraded school, with a tutor, or under

other special circumstances, the nearest equivalent of his highest grade attended was given.

66
Appendix IV

Limitationsof data

The comparabfity of the blood pressure measurement procedures of the first National Health Examination Survey and

the first and second National Health and Nutrition Examination

Surveys may be indirectly evaluated by measuring shifls in the

frequency distributions of systolic and diastolic blood pressure

measurements (SBP’Sand DBP’s, respectively) in an age-racesex group in which no shifts would be expected. White males

ages 18–24 years are an example of such a group. This demographic subgroup has little hypertension and is, therefore, not a

target group for any significant blood pressure control measures.

Also, males would not have taken any contraceptive medication. Such contraceptive medication may result in a rise of as

much as 5–6 mmHg SBP.6S

As can be seen from figure 8 in the text, the curves for

SBP’S for the three surveys practically coincide, as expected.

The curves for the DBP’s (see figure I), however, are separated,

with succeeding surveys reflecting sequentially higher DBP’s.

Of considerable interest is the wide separation between the

NOTE A list of references followsthe text.

later surveys and the initial 1960–62 survey, a difference that

is more marked in the lower part of the distribution.

The consistency of the rightward shift throughout the distribution between the diastolic curves of 1960–62 and 1976–

80 maybe due to a deficiency in the training of the physicians

taking the readings. Extra attention was paid to blood pressure

measurement in the 1960–62 survey. For example, “the nurse

raised the manometer to the physician’s eye leveL”6During the

blood pressure determination, the physician obtained separate

readings for both the fourth and fifth phases. Both numbers

were recorded on the form in addition to the systolic level. It is

highly likely tha~ because of the necessity of recording numbers

for both the fourth and fti phases, the physician was forced to

concentrate his attention on the diastolic determinations. However, in the 1971–80 surveys physicians received no instructions on takhg blood pressures. The physicians were instructed

to read the manual for an overall description of how to conduct

the examination. Additional evidence supporting the contention

that more attention was paid to taking the blood pressures in

1960–62 than in 1971–80 is provided by the data for end-digit

preference. The percent of persons with an end digit of O is

40

_ 1960-62

..=.. = 1971-74

_ - 1976-80

30

zmo 20

k

L

10

0 J

o 40 50 60 70 80 90 100 110

First diastolic blood pressure in millimeters mercury

Figure 1. Smoothed weighted frequency distribution of the first diastolic blood pressure for white men ages 18-24 years by survey: United States,

NHES I (1 960-62), NHANES I (1971 –74), and NHANES II (1 976-80)

67
shown in table II. As can be seen, preference for the zero end

digit is markedly greater in the two later surveys than in the

1960–62 survey. Suppression of the end-digit preference is

commonly regarded as an indication that more conscious attention is being paid in taking blood pressure readings. It is possible

that the bias in DBPs might be somewhat less of a factor when

taking the blood pressures of persons in the older age groups

because the observer would be more attentive to the possibility

of elevated blood pressures. However, differential analysis of

these groups would be difficult because of the admixture of

high numbers of medicated people in these groups.

Another possible explanation for the shift in DBP distributions is a possible reduction in hearing acuity among the physicians of the 1976–80 survey. All of the physicians involved

in the 1960–62 survey were young (internal medicine residents),

as were most of the physicians used in the 1971 –74 survey.

However, nearly all the physicians used in the 1976-80 survey

were retired practitioners. An approximate 40-year examiner’s

age differential existed between the 1960-62 and 1976–80

surveys. No hearing tests were taken on any of the physicians

involved. Assuming their hearing approximated that of the U.S.

male population, and that the fundamental frequency of a

“typical” heartbeat is 500 hertz or lower, one would expect the

percent of persons responding to a 500-hertz tone at a threshold

level of 20 decibels or better to fall from 96.7 percent at ages

25–34 years, and 80.5 percent at ages 55–64 years, to 77.7

percent at ages 65–74 years.G9 It should be noted that the blood

pressure determinations did not take place in a soundproof

NOTE: A list of referencesfollowsthe text.

Table Il. Percent of persons with blood pressure reeding ending

in zero

systolic Diastolic

blood blood

Swvey pressure pressure

NHES I . . . . . . . . . . . . . . . . . . . . . . . . . . 32.4 34.7

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . 47.3 42.9

NHANES II . . . . . . . . . . . . . . . . . . . . . . . . 51.3 51.5

NOTE Ages 18-74 years.

room, so the hearing thresholds could be considerably higher.

A deterioration in average hearing levels for the physicians

employed in the 1976–80 survey may be postulated, but it is

not possible to quantify this effect with these data.

The increased lability of the DBP compared with the SBP

reflects the more difficult task presented to the auditory system

(peripheral and central) by the diastolic end point. This is

caused by the following

1.

:2.

The amplitude of the Korotkoff sounds following the onset

of the first phase increases rapidly in volume, whereas

sounds following the commencement of the muffling associated with the fourth phase take a relatively longer time

to die out.TQT1

The fourth phase involving muffling abruptly changes the

quality of the sound to a soft blowing nature. This results

from a marked diminution or disappearance of sound frequencies above 60 hertz.70’72 The curtailing of the frequency spectrum above 60 hertz results in a loss of audibility because hearing sensitivity is greater at higher

frequencies. The American Heart Association committee

report on recommendations for human blood pressure

determination notes that the determination of the fifth phase

(diastolic pressure) depends on the position of the steth~

scope over the artery, the efilciency of the stethoscope in

transmitting sounds of low intensity, and the sensitivity of

the observer’s hearing.72 An effect of hearing acuity on the

fifth sound level was noted in a Scandinavian study with

the remark that observerL seemed to have very high readings for the dktstolic fifth sound, which may have been

associated with her slightly deficient hearing.73

Thus, a deficiency in the training of the observer would

probably result in diastolic readings biased upward, because

tihe observer might not attempt to find the difllcult end point of

tlhe fifth phase but instead cut it off at a somewhat higher level.

This would be especially notable for a low diastolic reading

(below 70 in the case of white men average age 18-24 years)

as it makes no clinical difference whether a person has diastolic

pressure of 65 or 55 mmHg. The upward bias due to inattention

would be expected to be less frequent at higher diastolic readings, which might appear more unusual for a particular age-sex

glroup and consequently might assume more clinical significance.

* u.S. GOVERNMENT PRINTING_OFF~~E: 1986- 491- 33 5/ 4 (j I) 17

68
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the deta collection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research—Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collectad data, and contributions to

statistical theory. Studies also include comparison of

U.S. methodology with those of other countries.

Analytical and Epidemiological Studies—Reports presenting analytical or interpretive studias based on vital

and health statistics, carrying the analysis further than

the expository typas of reports in the other series.

Documents and Committee Reports-Final reports of

major committees concerned with vital and health statistic and documents such as recommended model vital

registration laws and revised birth and death certificates.

Comparative International Vital and Health Statistics

Reports-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected ]n the

continuing national household interview sutvey.

Data From tha National Health Examination Survey and

the National Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population

with respact to physical, physiological, and psychological characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit finite universe of persons.

Data From the Institutionalized Population Suweys— Discontinued in 1975. Repons from thesa surveys are included in Saries 13.

Data on Health Resources Utilization—Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

Data on Health Resourcas: Manpower and Facilities—

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys-Statistics on health and

health-related topics collected in special surveys that

are not a parl of the continuing data systems of the

National Center for Health Statistics.

Data on Mortality-Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marriage, and Divorce—Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records baaed on sample surveys of those records.

Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectively.

Data From the National Survey of Family Growth—

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 15-44 years

of age.

For answers to questions about this report or for a list of titlas of

reports published in these series, contact:

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782

301-436-8500
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

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