NCHS Data Brief ■ No. 263 ■ November 2016

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Age Differences in Visits to Office-based Physicians by 

Adults With Hypertension: United States, 2013

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

Key findings 

Data from the National 

Ambulatory Medical Care 

Survey

● The percentage of all

adult visits to office-based

physicians made by adults with

hypertension increased with

age, from 9% for those aged

18–44 to 58% for those aged 75

and over.

● Hypertensive medications

were provided, prescribed, or

continued at 62% of visits made

by adults with hypertension.

● Eighty-two percent of visits

by adults with hypertension

were made by those with

multiple chronic conditions,

and the number of chronic

conditions increased with age.

● Diseases of the circulatory

system increased as age

increased, from 23% for those

aged 18–44 to 29% for those

aged 75 and over.

Hypertension is a chronic condition that affects 31% of adults in the United 

States (1). The prevalence of hypertension increases with age, from 7% among 

those aged 18–39 to 65% among those aged 60 and over (2). This report 

describes age differences for chronic conditions mentioned, hypertensive 

medications prescribed, doctor visits in the past year, and selected primary 

diagnoses for office-based physician visits made by adults with hypertension. 

Adults with hypertension were defined as those aged 18 and over who have been 

diagnosed with hypertension, regardless of the diagnosis for the current visit. In 

2013, there were 258.5 million visits made by such patients, representing 34% of 

all office-based physician visits by adults (3).

Keyword: National Ambulatory Medical Care Survey

The percentage of all adult visits to office-based physicians 

made by adults with hypertension increased with age.

Figure 1. Percentage of visits to office-based physicians for adults with hypertension, by age and 

sex: United States, 2013

1

Percentage for women is significantly different from men (p < 0.05). 2

Percentage for those aged 45–64, 65–74, and 75 and over is significantly different from those aged 18–44 (p < 0.05). 3

Percentage for those aged 65–74 and 75 and over is significantly different from those aged 45–64 (p < 0.05). 4

Percentage for those aged 75 and over is significantly different from those aged 65–74 (p < 0.05).

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db263_table.pdf#1.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013. 
NCHS Data Brief ■ No. 263 ■ November 2016

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● The percentage of all adult visits to office-based physicians that were made by adults with 

hypertension increased with age, from 9% for those aged 18–44 to 58% for those aged 75 

and over (Figure 1). 

● Visits by men with hypertension (37%) accounted for a higher percentage of overall visits to 

office-based physicians compared with visits made by women with hypertension (31%). 

● The percentage of all visits made by women with hypertension increased with age, ranging 

from 7% for those aged 18–44 to 60% for those aged 75 and over. 

● The percentage of all visits made by men with hypertension also increased with age. But 

unlike women, visits made by men aged 75 and over (55%) were not significantly higher 

than visits made by men aged 65–74 (53%).

In 2013, the frequency of office-based physician visits made by adults with 

hypertension increased with age. 

● About 80% of visits by adults with hypertension were made by those making multiple trips 

to a sampled doctor (Figure 2). 

Figure 2. Percent distribution of number of office-based physician visits in the past 12 months for adults with hypertension, 

by age: United States, 2013

1

Linear decrease across all age groups (p < 0.05). 2

Linear increase across all age groups (p < 0.05).

NOTES: Estimates may not add to 100 due to rounding. Visits made in the past 12 months include the current visit. Access data table for Figure 2 at: 

http://www.cdc.gov/nchs/data/databriefs/db263_table.pdf#2.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013. 
NCHS Data Brief ■ No. 263 ■ November 2016

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● The percentage of visits by adults with hypertension who made only one visit to a sampled 

doctor declined as age increased, from 26% for those aged 18–44 to 17% for those aged 75 

and over.

● Almost one-half of all visits by adults with hypertension (47%) were made by those who 

had an office visit to a sampled doctor four or more times in the past 12 months. This 

percentage increased with age, ranging from 43% for those aged 18–44 to 53% for those 

aged 75 and over.

In 2013, hypertensive medications were provided, prescribed, or continued 

at 62% of office-based physician visits made by adults with hypertension, 

and the percentage of visits that included hypertensive medications 

increased with age.

● Hypertensive medications were provided, prescribed, or continued at 50% of all visits 

made by adults aged 18–44 with hypertension (Figure 3). This percentage increased 

with age, reaching 64% for those aged 75 and over.

● Visits by adults aged 18–44 with hypertension were more likely to have no or one 

hypertensive medication provided, prescribed, or continued compared with all other 

age groups.

● The percentage of visits made by adults with hypertension receiving three or more 

hypertensive medications increased with age, from 5% for those aged 18–44 to 18% 

for those aged 75 and over. 

Figure 3. Percent distribution of number of hypertensive medications provided, prescribed, or continued at office-based 

physician visits for adults with hypertension, by age: United States, 2013

1

Linear decrease across all age groups (p < 0.05). 2

Linear increase across all age groups (p < 0.05).

NOTES: Estimates may not add to 100 due to rounding. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db263_table.pdf#3.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013. 
NCHS Data Brief ■ No. 263 ■ November 2016

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In 2013, adults with hypertension who visited office-based physicians were 

likely to have multiple chronic conditions, and the percentage of visits 

made by adults with multiple chronic conditions increased with age.

● Hypertension was the only diagnosed chronic condition for 18% of all visits made by adults 

with hypertension (Figure 4). This percentage decreased as age increased, with hypertension 

being the only diagnosed chronic condition for 39% of visits made by adults aged 18–44, 

19% for those aged 45–64, and 14% each for the two oldest age groups.

● Eighteen percent of visits by adults aged 18–44 with hypertension were made by adults with 

three chronic conditions. This number increased to 26% for adults aged 45–64, 28% for 

those aged 65–74, and 29% for those aged 75 and over. 

● Only 10% of visits by adults aged 18–44 with hypertension were made by those with four or 

more chronic conditions. This number more than doubled to 23% for those aged 45–64 and 

almost tripled to 28% each for the two oldest age groups.

Figure 4. Percent distribution of number of diagnosed chronic conditions at office-based physician visits for adults with 

hypertension, by age: United States, 2013

1

Percentage for those aged 45–64, 65–74, and 75 and over is significantly different from those aged 18–44 (p < 0.05). 2

Percentage for those aged 65–74 and 75 and over is significantly different from those aged 45–64 (p < 0.05).

NOTES: Estimates may not add to 100 due to rounding. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db263_table.pdf#4.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013. 
NCHS Data Brief ■ No. 263 ■ November 2016

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For one-quarter of all office-based physician visits made by adults with 

hypertension, the primary diagnosis was a circulatory system disease, and 

the percentage of visits with this diagnosis increased with age in 2013.

● The primary diagnosis for 23% of visits made by adults aged 18–44 with hypertension was a 

disease of the circulatory system. This percentage increased as age increased, reaching 29% 

for those aged 75 and over (Figure 5). 

● Essential hypertension was the primary diagnosis for 20% of visits made by adults aged 

18–44 with hypertension. This percentage dropped to 15% for all other age groups.

● Heart disease was the primary diagnosis for 7% of all visits made by adults with 

hypertension. This percentage increased with age, ranging from 6% for those aged 45–64 to 

10% for those aged 75 and over.

Figure 5. Percentage of visits to office-based physicians for adults with hypertension having a primary diagnosis of diseases

of the circulatory system, by age: United States, 2013

* Estimate does not meet standards of reliability or precision. 1

Linear increase across all age groups (p < 0.05). 2

Percentage for those aged 18–44 is significantly different from those aged 75 and over (p < 0.05).

NOTES: Diagnosis definitions are based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) for the first-listed visit 

diagnosis. Visits for diseases of the circulatory system are defined as codes 390–459; visits for essential hypertension are defined as code 401; and visits for

heart disease are defined as codes 391–392.0, 393–398, 402, 410–416, and 420–429. Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/

databriefs/db263_table.pdf#5.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013. 
NCHS Data Brief ■ No. 263 ■ November 2016

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Summary

Hypertension is not the only health concern for the majority of adults with this condition. In 

2013, 82% of visits to office-based physicians by adults with hypertension were made by those 

who had additional chronic conditions. Visits by older adults were more likely to be made by 

those with multiple chronic conditions compared with visits by younger adults. Regardless of 

age, adults with hypertension used extensive health resources, which was evidenced by their 

frequent visits to physicians (47% having visited the same doctor four or more times in the past 

year) and extensive use of hypertensive medications. A total of 62% of all such visits included the 

provision, prescription, or continuation of one or more hypertensive medications. Visits by older 

adults were more likely than visits by younger adults to include three or more hypertensive drugs. 

Diseases of the circulatory system, including essential hypertension and heart disease, were listed 

as the primary diagnosis at 25% of all visits made by adults with hypertension, thus providing 

further evidence of the complex health care needs of this population. 

Definitions

Diagnosed hypertension and other chronic conditions: Since 2005, the National Ambulatory 

Medical Care Survey (NAMCS) has asked, “Regardless of the diagnosis for the current visit, does 

the patient now have (mark all that apply): hypertension, arthritis, asthma, cancer, cerebrovascular 

disease, chronic obstructive pulmonary disease, chronic renal failure, congestive heart failure, 

depression, diabetes, hyperlipidemia, ischemic heart disease, obesity, and osteoporosis.” 

Diagnosis codes for the visit were not used to define hypertension. Instead, this report includes 

all visits by adults whose medical record included a diagnosis of hypertension. Managing 

hypertension is the reason for some of these visits, but many other reasons, such as a respiratory 

infection or an injury, are also included. 

Diseases of the circulatory system: Based on the following International Classification of 

Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) (4) codes: 390–459.

Essential hypertension: Based on the ICD–9–CM (4) code: 401.

Heart disease: Based on the following ICD–9–CM (4) codes: 391–392.0, 393–398, 402, 

410–416, and 420–429.

Hypertensive medications: A comprehensive list of 102 hypertensive medications was compiled 

by a pharmacist at the National Center for Health Statistics (NCHS). Any hypertensive 

medication included on the patient record as having been provided, prescribed, or continued at a 

visit was included. Up to 10 drug mentions were collected per visit in 2013. For a complete list of 

the 102 medications, please contact the Ambulatory and Hospital Care Statistics Branch at

(301) 458–4600.

Visits in the past 12 months: All visits to the sampled doctor over the past 12 months are 

counted, including the sampled visit. New adult patients (13% of visits made by patients with 

hypertension) are included in the one-visit category. 
NCHS Data Brief ■ No. 263 ■ November 2016

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Data source and methods

All estimates are from the 2013 NAMCS, a nationally representative survey of visits to nonfederal, office-based physicians. The survey is conducted annually by NCHS, Division of Health 

Care Statistics. NAMCS uses a stratified two-stage sample, with physicians selected in the first 

stage and visits in the second stage. The survey data are inflated or weighted to produce national 

annual estimates of office visits. The unweighted visit response rate for the 2013 survey was 

41.1% (40.4% weighted) (5). 

Percentage estimates in Figure 1 are based on a sample of 44,739 office-based physician visits 

made by adults aged 18 and over, representing a weighted total of 771.6 million visits. Percentage 

estimates in Figures 2–5 are based on a sample of 14,146 office-based physician visits made by 

adults aged 18 and over with diagnosed hypertension, representing a weighted total of 258.5 

million visits (34% of all visits).

Differences among subgroups were evaluated using two-tailed t tests (p < 0.05). The Joinpoint 

Program (6) was used to test for linear trends. Data analyses were performed using the 

statistical packages SAS version 9.4 (SAS Institute, Cary, N.C.) and SUDAAN version 9.0 (RTI 

International, Research Triangle Park, N.C.).

About the authors

Jill J. Ashman and Susan M. Schappert are with the National Center for Health Statistics, 

Division of Health Care Statistics. Pinyao Rui is with Global Evaluation & Applied Research 

Solutions (GEARS), Inc.

References

1. National Center for Health Statistics. Health, United States, 2015: With special feature on 

racial and ethnic health disparities. Table 53. Hyattsville, MD. 2016.

2. Yoon SS, Fryar CD, Carroll MD. Hypertension prevalence and control among adults: United 

States, 2011–2014. NCHS data brief, no 220. Hyattsville, MD: National Center for Health 

Statistics. 2015. 

3. Hing E, Rui P, Palso K. National Ambulatory Medical Care Survey: 2013 state and national 

summary tables. Available from: http://www.cdc.gov/nchs/ahcd/ahcd_products.htm.

4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 

Centers for Medicare and Medicaid Services. Official version: International Classification of 

Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No.(PHS) 06–1260).

5. National Center for Health Statistics. 2013 NAMCS microdata file documentation. 

Hyattsville, MD. 2016.

6. National Cancer Institute. Joinpoint Regression Program (Version 4.3.1.0) [computer 

software]. 2016.
NCHS Data Brief ■ No. 263 ■ November 2016

Suggested citation

Ashman JJ, Rui P, Schappert SM. Age 

differences in visits to office-based 

physicians by adults with hypertension: 

United States, 2013. NCHS data brief, no 

263. Hyattsville, MD: National Center for 

Health Statistics. 2016.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

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

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

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

Alexander Strashny, Ph.D., Associate 

Director for Science

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