From VNal and Health Statistics of the National Center for Health Statwtlcs Number 84 � October 8, 1982 

. 

Blood Pressure	 Levels and Hypertension in Persons Ages 6–74 

Years: United States, 1976–80 

By Michael Rowland and Jean Roberts, Division of Health Examination Statistics 

Hypertension or substantially elevated blood pressure is one of the more prevalent chronic conditions 

lmownto increase the risk ofdevelopingcirculatory diseases, particularly heart disease and stroke. 1-4 Circulaory diseases are the leading cause of death and of hose	 pitalization in the United States. This report presents 

national estimates for blood pressure levels, the prevalence of known and previously undiagnosed hypertension, and the extent of use of antihypertensive medication in the general U.S. population during the period 

1976–80. The data are from the second National 

Health and Nutrition Examination Survey, which used 

a probability cross-sectional sample of the civilian noninstitutionalized population ages 6–74 years in the 

United States, including Alaska and Hawaii.s Trends 

since 1960 in the extent of treatment awareness, and 

control among those with hypertension are also shown. 

Methods 

The National Health and Nutrition Examination 

Survey of 1976–80 (NHANES II) is the fti in a 

series of programs of the National Center for Health 

Statistics carried out over the past 20 years that were 

designed to collect a broad range of morbidity data and 

related health information through direct standardized 

examinations, histories, tests, and procedures used in 

clinical practice as previously descriied.G-10 

In this latest survey, three blood pressure measurements were obtained on each person examined atthe 64

sample locations throughout-tie country. The examining physicians used standardized methods based on 

re~o-&&endations of the American HeartAssociation.1 1 

�

Of the 22.732 sanmle persons selected for the 

NHANES II k represen~the ~86.7 million persons ages 

6–74 years in the U.S. population as of the midpoint of 

the survey (March 1, 1978), 16Z04persons or71.3 percent were examined. 

Examination surveys lose information not only 

through the failure to exsmine all sample persons, but 

also through the failure to obtain and record all items of 

information for those examined. In this survey, 1 percent of the values for systolic or diastolic or both 

measurements were missing for each of the three blood 

pressure determinations. When data were missing, imputation was used to minimize the effect on population 

estimates by considering the person’s age, sex, race, arm 

@@ weight, height and any other systolic or diastolic 

measurements recorded. 

Additional information regarding the sample design, estimation procedure, tests of significance, 

sources of variation in blood pressure measures, and 

sampling variability of the national estimates is included in the “Technical notes.” 

For trend analyses, the national estimates from 

NHANES II blood pressure and medical history data 

are compared with those fi-omthe National Health Examination Surveys (NHES I, II, andIIl) andNHANES 

I, each based on findings for national probability samples of the designated civilian noninstitutionalized 

target population. NHES I of 1960–62 used a sample 

of adults 18–74 years of agq NHES II of 1963–65, 

children 6–1 1 years of age; andNHES IIIof 1966–70, 

youths 12–17 years. Jn NHANES I of 1971–74 the 

sample was for persons 6–24 years of agq NHANES I 

of 197 1–75 and NHANES IA of 1974–75 for adults 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service 
2 ackmcdm 

25–74 years of age. Comparisons involving the use of 

antihypertensive medication are limited findings from 

NHANES II, NHANE S IA, and NHES I because the 

question on medication use was identical only for these 

surveys. The survey data included in the trend analyses 

are summarized in table 1. 

Findings ‘ ‘ ,,; ;: 

Systolic pressures “ 

Age. —Mean systolic blood pressure estimates for 

the U.S. population in 1976–80 were higher in succeeding age groups ranging from 101.3 mm Hg among 

children ages 6– 11 years to 144.3 mm Hg among the 

oldest adults in the study, those ages 65–74 years 

(table 2). 

Sex.—At 12 through 54 years of age the mean 

levels of systolic pressure among males significantly 

exceeded those for females, but at 65 through 74 years, 

the mean levels for women were higher. 

Race.—At 18–24 years of age, systolic mean 

pressures for white men exceeded those for black men, 

but at 35–44 and 55–64 years, the mean systolic levels 

of black men were higher. Mean systolic blood pressures of white females 12– 17 years of age exceeded 

those for black females, but at 35–74 years of age, 

systolic levels of black women were higher. 

Diastolic pressures 

Age. —Mean diastolic pressure values were generally higher in succeeding age groups and ranged from 

64.3 mm Hg among children ages 6-11 years to 83.5 

mm Hg at ages 55–64 years (table 3). 

Sex.—Mean levels for men significantly exceeded 

levels for women at ages 18 through 64 years. 

Race.—At ages 35–74 years, mean diastolic pressures for black men and women exceeded those for 

white men and women, respectively. 

Elevated blood pressure levels 

The findings for elevated blood pressure are summarized for the variables age, sex, and race in this 

section. In addition, data are presented regarding the 

treatment (diagnosis and medication) for elevated 

blood pressure andtheprevalence of hypertension. Elevated blood pressure level, for the purpose of this 

report, is defined differently for people under 25 years 

of age than for people 25–74 years of age. The 

deffitions of all terms used in this section of the report 

(as well as in the section entitled “Secular trends”) are 

presented in table 4 with a summary of the prevalence 

estimates discussed in this section. 

Age.—In 1976–80, 0.4 percent of U.S. children 

ages 6– 11 years and 3.6 percent of U.S. youths ages 

12–17 years, or 0.9 million children and youths in the 

general population, were found to have elevated bl 

pressure levels as defined in table 4 (systolic pressure 

at least 140 mm Hg or diastolic pressure of at leasta9 

mm Hg or both). Among young adults ages 18–24 

years, 8.9 percent or 2.5 million had elevated blood 

pressure of this level. 

At ages 25–74 years, 14.5 percent or 16.5 million 

had elevated levels—systolic pressure of at least 160 

mm Hg and/or diastolic pressure of at least 95 mm Hg. 

Among adults the prevalence rates for this condition 

were higher in each succeeding age group ranging from 

5.5 percent at ages 25–34 years to 26.6 percent at ages 

65-74 years (table 5). 

S’ex.-Arnong young adults ages 18–24 years, 

prevalence of elevated blood pressure was signiilcantly higher among men (15.0 percent) than women 

(3.2 percent). At ages 25-64 years the prevalence (as 

defined in table 4) was higher among men than women, 

although the differences in rates in the 10-year age 

groups within this age range were not consistently large 

enough to be significant at the 5-percent probability 

level. 

Race.—Among white adults ages 18–24 years, the 

rates were higher for men than women but rates were 

similar for black men and women. At ages 25–74 years, 

elevated levels were signiilcantly more prevalent 

among black than white adults (22. 8 per 100 compare 

with 13.5). Among white, but not black, adults the rat 

were significantly higher for men than women at 25–7P 

years of age. 

Treatment.—The percent of those with elevated 

blood pressure who were reported as never having been 

diagnosed by a doctor was higher among youths ages 

12–1 7 years (90 percent) and young adults ages 18–24 

years (78 percent) than among the adults ages 25–74 

years (40 percent). However, an estimated 27 percent 

of the adults ages 25–74 years who were in the high risk 

group (diastolic pressure of at least 105 mm Hg) had 

never been told by a doctor that they had high blood 

pressure. 

About one-third of the adults 25–74 years of age 

with elevated blood pressure reported they were currently taking prescribed antihypertensive medication 

(table 6). This would include persons for whom such 

treatment had been prescribed so recently that the 

medication had not yet taken full effect as well as those 

for whom the medication did not reduce their blocxl 

pressure below the level defined as elevated. Forty percent of the adults with diastolic pressures that placed 

them in the high risk group were on antihypertensive 

medication. 

Hypertension 

Assuming that those adults whose blood pressure 

was not elevated but who reported current use of antihypertensive medication were keeping their blood pressure below the critical level (systolic of 160 mm Hg 
and/or diastolic of 95 mm Hg) through medication, that 

Ycontrolling their hypertension, there would have 

a en 25.1 million U.S. adults ages 25–74 years in 

1976–80 with hypertension, a rate of 22.0 per 100. 

This rate includes the 14.5 per 100 whose pressure was 

still elevated at the time of the survey and the 7.5 per 

100 taking medication whose pressure was not then 

elevated. 

Secular trends 

Mean blood~resszwe.—Both mean systolic and diastolic blood pressure levels of U.S. children and 

youths in 1976–80 were similar to the levels found in 

197 1–74, but were lower than the levels for children 

and youths in 1963–65 and 1966–70, respectively. 

Mean systolic blood pressure levels of adults in


1976–80 were significantly lower than mean levels at


the time of the previous national surveys in 1960-62


and 197 1–75. 12 The decrease in systolic pressure


levels fi-omthose found among adults in 1971–75 was


significant across the age range 25–74 years and from


1960-62 across ages 35–74 years (figure 1). The


difference in mean levels reflects a change primarily in


the systolic blood pressure of the older age groups. In


1960-62 the difference in systolic pressure between


ople ages 18–24 and those ages 65–74 was 38.4 mm 

g. In 1976–80 the difference was only 27.2 mm Hg. m Mean diastolic levels among adults in 1976-80


were signitlcantly lower than the mean levels in 197 l–


160 r 

u 

: Diastolic . ..8.9= . 

m 80 ,m*, *s 

t--’——~*4 

- _ 1960-62


60 . . . . . . 1971-75


_ 1976–80 

t 

Y 

+/ ‘ I I I I


o 30 40 50 60 70


Age in yeare 

Figure 1. Mean blood pressure in adults ages 25-74 years: United States, 

1960-62, 1971-75, and 1976-80


ackmcwt3 

75 but were essentially unchanged fkomthe mean levels 

in 1960-62. In other words, the 197 1–75 estimates 

were higher than estimates for the earlier and later time 

periods. 

Mean systolic and diastolic blood pressure levels


were significantly lower for both white and black adults


ages 25–74 years in 1976–80 than in 1971–75. This


difference was generally consistent across age groups


for both men and women. Mean systolic blood pressure


levels for each of the four race-sex groups of adults were


also generally lower in 1976-1980 than in 1960-62,


but the diastolic blood pressure levels in 1976–80 were


essentially similar to the levels in 1960–1 962 for each


of the four race-sex groups.


Elevated bloodpressure.—The prevalence of elevated bkmcl pressure in children 6–11 years and youths 

12–17 years in 1976–80 (0.4 and 3.6 per 100, respectively) was Iowerthan in 1971–74 (0.6 for children and 

6.4 for youths). 13 However, the difference was statistically significant only for youths. 

For adults ages 25–74, the prevalence rate of 14.5 

per 100 in 1976–80 was significantly less than the ageadjusted rates of 16.7 and 17.7 per 100 in 1960–62 and 

1971–75,12 respectively. Among the individual age 

groups the decrease was large enough to be statistically 

significant only at ages 55–74 years (figure 2). The 

downward trend occurred for three of the four race-sex 

groups. The differences in the age-adjusted prevalence 

of elevated blood pressure between the 1976–80 survey 

and the two earlier surveys were statistically significant 

for white and black women and black men. 

High Risk.—Blood pressure high enough to put 

adults into the high risk category was slightly but not 

significantly less prevalent in 1976–80 than in 1960– 

62 (age-adjusted rate of 2.8 versus 3.5 per 100); 

however, it was significantly less than in 1971–75 (a~e­ ,“ 

adjusted-rate of 4.5 per 1~). 

40


30


20


10 - _ 1960-62


... W.. 1971-75
 . .


I _ 1976-80


+/‘ I I I I


o 30 40 50 60 70


Age in yeara 

Figure 2. Prevalence rates for elevated blood pressure among adults ages 

25–74 years, by age: United States, 1960–62, 1971-75, and 1976-80

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75 80 � NOTE: The total hypertensive group includes those with elevated blood prassuf re on examination and othara currently taking antihypertensive medication. 

Figure 3. Percent of total adults ages 25-74 years with hypertension by previous diagnosis and medication status United States, 1960-62, 

1974–75, and 1976–80 
adwmdaa5 

@ 

a 

T..eatment.-Among those adults 25–74 years 

th elevated blood pressure, a higher percent reported 

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

blood pressure in 1976–80 (60 percent) than in 197 l– 

75 (51 percent) or in 1960–62 (45 percent). For the 

high risk group, the percent previously diagnosed was 

also higher in 1976–80 (73 percent) than in 1971–75 

(64 percent) and in 1960-62 (59 percent). The increase in awareness of their condition among those with 

elevated blood pressure was large enough to be statistically significant. The percent of adults 25–74 years 

with elevated blood pressure who were currently taking 

prescribed antihypertensive medication in 1976–80 

(33.5 wrcent) was higher than in 1974-75 (25.7 percent) and 1960–62 (23.0 percent). 

Hy~ertenszbn.-The prevalence of hypertension 

(as defined in table 4) among adults 25-74 years has 

not changed significantly since 1960–62 except for the 

increase among white men (table 7). However, among 

those with hypertension, the percent never diagnosed 

by a physician as having hypertension or high blood 

pressure has dropped significantly from 51 percent in 

1960–62 (age-adjusted) to 27 percent in 1976–80 

(figure 3). The decrease is consistent among white and 

black men and women. This decrease in unawareness 

or, conversely, increase in awareness since 1960–62 

s been accompanied by an increase in the proportion 

hypertensives who reported they were currently 

taking antihypertensive medication and an increase in 

the proportion taking such medication whose blood 

pressure at the time of the survey was below the 

elevated level. More than half the increase in awareness occurred prior to 1974–75; however, nearly 80 

percent of the increase in the use of antihypertensive 

medication has occurred since the 1974–75 period. 

Discussion 

The findings indicate that there has been increased 

awareness, treatment, and control of hypertension 

during the 1970’s. This has occurred at a time of decline in mortality from circulatory diseases and their 

two major components-coronary heart disease and 

stroke. Although many factors may be responsible for 

this decline, the improved control of blood pressure is 

considered a major contributor. 14 Kannel 1s has recently estimated that effective use of antihypert.ensive 

agents between 1968 and 1978 could be responsible for 

perhaps a third of the reduction in cardiovascular mortality during the same decade. Even prior to the era of 

decreased mortality from cardiovascular disease, 

Moriyama, Krueger, and StamlerlG noted that diiYerential trends in coronary heart disease among men and 

women, both black and white, in the 1940’s and 1950’s 

might be associated with the differential effects of 

hypertension on coronary heart disease risk and mortality. 
6 achtancedata 

References 

10. Paul (cd.): A survey of the epidemiology of hypertension 

1964–1974. Mod. Cone. Cardiov. Dis. 43(7):99–102, July 1974. 

2W. B. Kannel Role of blood pressure in cardiovascular morbidiw 

and mortality. Progr. Cardiov. Dis. 17:5–24, 1974. 

3W. B. K~el, p. A. Wolf, J. Verter, and p. M@Jamara: Epidemiologic assessment of the role of blood pressure in stroke: The 

Frarningham study. .L4JW4 214301-310, 1970. 

4Build and Blood Pressure Study, 1959, Vol. 1. Chicago. Society 

of Actuaries, 1959. 

5National Center for Health Statistics, A. McDowell, A. Engel, 

J. T. Massey, and K. Maurec Plan and operation of the Second 

National Health and Nutrition Examination Survey, 1976–80. 

Vital and Health Statistics. Series l–No. 15. DHHS Pub. No. 

(PHS) 81-1317. Public Health Service. Washington. U.S. Government Printing Otlice, July 1981. 

6National Center for Health Statistics: Plan and initial program of 

the Health Examination Survey. Vital and Health Statistics. 

(PHS) Pub. No. 1000-Series l-No. 4. Public Health Service. 

Washington. U.S. Government Printing Office, July 1965. 

7National Center for Health Statistics: Plan, operation and response results of a program of children’s examinations. Vital and 

Health Statistics. PHS Pub. No. 1000–Series l-No. 5. Public , 

Health Service. Washington, U.S. Government Printing Office, 

Oct. 1967. 

8National Center for Heak.h Statistics: Plan, operation of a Health 

Examination Survey of U.S. youths 12–17 years of age. Vital and 

Health Statistics. PHS Pub. No. 1000–Series 1–No. 8. Public 

Health Service. Washington. U.S. Government Printing Office. 

Sept. 1969. 

9National center for He~~ $Jtatistics+ H. W. Miller plan and 

operation of the Health and Nutrition Examination Survey, United 

States, 1971–73. Vital and Health Statistics. Series I–Nos. 10a 

and 10b. DHEW Pub. No. (HSM) 73–13 10. Public Health 

Service. Washington. U.S. Government Printing OffIce, Feb. 

1973. 

locational Center for Health Statistics, A. Engel, R. S. Murphy, 

K. Maurer, and E. Collins: Plan and operation of the NHANES-I 

Awzmentation Survev of adults 25-74 vears. United States. 1974-

19;5. Vital and He;lth Statistics. Sefies l~No. 14. DHE-W Pub. 

No. (PHS) 78-1314. Public Health Service. Washington. U.S. 

Government Printing Office, June 1978. 

1lco~ttee to Revise s~dardization of Hi@ Blood pressure 

Readings:. Recommendations for human bloodpressure determinations by sphygmomanometers. New York. American Heart 

Association, Oct. 1951. 

12Nation~ center for He~fi Statistics, J. Roberts and M. 

Rowland Hypertension in adults 25–74 years of age, United States 

1971-1975. Vital and Health Statistics. Series 1l–No. 221. 

DHHS Pub. No. (PHS) 81–1671. Public Health Service. Washington. U.S. Government Printing Office, Apr. 1981. 

13Nation~ center for Health Statistics, J. Roberts and K. Maurer: 

Blood Pressure Levels of Person 6-74 Years, United States, 1971-

1974. Vital and Health Statistics. Series 1l-No. 203. DHEW 

Pub. No. (HRA) 78–1 648. Health Resources Administration. 

Washington. U.S. Government Printing Office, Sept. 1977. 

14R. I. Levy and J. Moskowitz: cardiovascular research Decades 

of progress, a decade of promise. Science 217: 121–129, July 9, 

1982. 

15W. B. Kannel: Meaning of fie downward trend in cardiovascular ‘ 

mortal@. .L4MA 247(6):877–880, Feb. 1982. 

161. Moriyama, D. E. Kmeger, and J. Stamler: Cardiovascular 

diseases in the US. Cambridge. Harvard University Press, 197 

17Nat,iond Center for Health Statistics, P. J. McCarthY Replic 9 

tiom An approach to the analyses of data from complex surveys. 

Vital and Health Statistics. PHS Pub. No. 1000-Series 2-No. 14. 

Public Heal@ Service. Washington. U.S. Government Printing 

Ollice, Apr. 1966. 

18M0 spiege~m In@o&&on to Demography, 2d ed. Cambridge. Harvard Universi& Press, 1968. 

19R. G. Millet Simultaneous Statistical Inference. New York. 

McGraw-Hill Book Co., Inc., 1966. 
a&mdata7 

Table 1. Survey data used in study 

Survey program 

i{iiANES Al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

NHANES IA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

NH ES I II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

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

Number of Current use of 

7ime period Age of examinees blood pressure antihypertensive 

measurements medication 

1978-80 12-74 years 3 Yes 

1978-80 8-11 years 3 No 

1971-75 25-74 years 3 No 

1974-75 25-74 years 3 Yes 

1971-74 6-24 yeara 1 No 

1968-70 12-17 years 2 No 

1963-65 8-11 years 2 No 

1960-62 18-74 years 3 Yes 

Teble 2. Mean systolic blood pressure levels of persona 6-74 yeara by race, age, and sex, with standard errore of the means: United States, 1976-80 

Race and age 

All racesl �-11 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

White 

6-n yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65-74 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Biaclc 

6-n yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

18-24 years., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34 years . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65-74 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1,ncludea other ~cial grOupsin addition to white and black. 

NOTE All blood pressures are the average of 3 measurements. 

Both sexes Male Female 

Standard Standard Standard 

Mean error of Mean error of Mean error of 

mean mean mean 

Blood pressure in mm Hg 

101.3 0.73 101.2 0.74 101.4 0.89 

112.8 0.71 114.8 0.81 110.8 0.79 

117.1 0.62 123.7 0.82 110.9 0.64 

118.2 0.66 124.6 0.80 112.2 0.67 

122.6 0.78 126.1 0.99 119.4 0.85 

129.9 0.66 131.3 0.84 128.6 0.96 

137.4 0.83 137.3 0.89 137.4 1.03 

144.3 0.83 142.3 0.85 145.8 0.95 

101.4 0.70 107.5 0.70 101.4 0.88 

113.4 0.74 115.3 0.90 111.5 0.80 

117.4 0.63 124.3 0.84 110.9 0.64 

118.4 0.69 125.0 0.82 112.1 0.70 

122.1 0.81 125.8 1.08 118.6 0.82 

129.1 0.71 130.9 0.83 127.4 1.06 

136.7 0.83 136.9 0.89 136.6 1.02 

143.9 0.89 142.2 0.90 145.3 1.06 

101.7 1.16 100.8 1.35 102.6 1.41 

110.9 0.93 112.9 1.40 108.8 0.97 

115.9 1.00 120.6 1.41 112.1 1.19 

118.5 1.10 124.1 1.63 114.0 1.46 

128.2 1.37 131.2 2.30 125.8 1.82 

137.0 1.55 135.6 2.40 138.2 2.10 

144.9 2.20 143.8 2.63 145.8 2.77 

147.5 1.45 142.4 1.10 151.4 2.30 
� 

8 admncedata 

Table 3. Mean diastolic blood pressure levels of persons 6-74 years by race, age, and sex, with standard errora of the means: United States, 1976-80 

Race and age 

All racesl 

6-1 

12-

18-


25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

White 

6–ll yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Black 

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1 ,nclu,j~~ other ~acisl ~roups in addition to white and black. 

NOTE All blood pressuresare the average of 3 measurements. 

Both sexes Male 

Standard Standard 

Mean error of Mean error of 

mean mean 

Blood pressure in mm Hg 

64.3 0.46 64.3 0.56 

69.8 0.44 70.1 0.40 

72.8 0.36 75.6 0.44 

75.9 0.51 79.2 0.64 

80.0 0.59 82.4 0.70 

83.4 0.58 85.3 0.63 

83.5 0.51 85.0 0.57 

82.2 0.49 82.5 0.53 

. 

64.3 0.45 64.3 0.52 

69.8 0.46 70.0 0.42 

72.6 0.40 75.7 0.48 

75.8 0.54 79.2 0.65 

79.5 0.58 82.0 0.72 

82.9 0.59 85.0 0.64 

83.0 0.55 84.4 0.61 

81.8 0.54 82.2 0.56 

64.3 0.99 64.8 1.37 

70.3 0.56 70.9 0.94 

72.8 0.63 74.9 0.96 

.77.2 0.74 80.2 1.46 

83.9 1.24 86.1 1.84 

88.5 1..20 88.0 1.89 

88.5 0.79 90.4 1.23 

85.5 0.79 85.5 0.72 

Female 

Standard 

Mean error of 

mean 

64.1 0.46 

69.5 0.57 

70.2 0.45 

72.8 0.53 

77.8 0.61 

81.6 0.71 

82.3 0.53 

81.9 0.58 

64.2 0.48 

69.6 0.62 

70.0 0.45 

72.5 0.56 

77.1. 0.59 

80.9 0.73 

81.7 0.58 

81.5 0.62 

63.7 1.16 

69.7 0.56 

71.0 0.96 

74.7 0.98 

82.1 1.48 0 

89.0 1.51 

86.8 1.00 

85.5 1.22 

Table 4. Definition of terms basad on age, blood pressure measurement or questionnaire responses or both, and prevalanca estimates for groups 

Term 

Normotension . . . . . . . . . . . . . . . . . . . . . . . 

Elevatad blood prassure . . . . . . . . . . . . . . . 

High riak . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

On medication . . . . . . . . . . . . . . . . . . . 

Never diagnosed . . . . . . . . . . . . . . . . . . . . . . 

corresponding to these terms United States, 1976-80 

Age Measure 

25–74 years Svstolic below 140 mm Hg and diastolic below 90 mm Hg


6-24 yeara Systolic 140 mm Hg or greater and/or diaatolic 90 mm Hg or greatar


25-74 years Systolic 160 mm Hg or greater and/or diastolic 95 mm Hg or greatar


25-74 years Oiastolic at least 105 mm Hg


25–74 years Systolic 160 mm Hg or greater and/or diastolic 95 mm Hg or graater, plus


those with pressures below these levels at the time of examination 

who reportad on medical history that they were currently taking antihypertensive medication 

25–74 years Persons who reported on medical history that they were currently taking 

antihypertensive medication regardless of blood pressure Iavel on 

examination 

12,-74 years Persons with elevated blood pressure among those who reported on 

medicsl history that they had never bean told by a medical doctor that 

they had ever had hypertension (or high blood pressure) 

Prevalence estimate 

Percent 

69.3 

0.4 (6-1 1 yeare) 

3.6 (1 2-17 years) 

8.9 (1 8-24 years) 

14.5 

2.8 

22.0 

12.3 

90.0 (1 2-17 yeara) 

77.7 (1 8-24 yeara) 

40.4 (25-74 years) 
� 

aknceMa9 

prevalence rates of elevated blood pressure levels’ for persons	 25-74 years by race, age, and sex with standard e~ors of the mte$ United States, 

1976-80 

Both sexes MaIe . Female 

Rate Rate Rate 

Race and age per Standard per Standard per Standard 

100 error of 700 error of 700 error of 

popu- rare popu- rate popu- rate 

Iation Iation Iation 

a’ 

Allracesz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5 0.84 16.4 1.04 12.8 0.81 

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 0.78 8.7 1.31 2.6 0.56 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.9 7.07 11.8 1.67 8.2 0.98 

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.8 1.24 20.9 ‘1.73 ‘14.9 1.77 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.7 1.47 23.7 1.92 20.0 1.43 

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.6 7.34 24.9 1.54 27.9 1.76 

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 0.86 15.9 1.12 11.4 0.79 

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 0.87 8.4 1.43 2.3 0.57 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 1.04 10.6 1.75 6.5 0.75 

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.5 1.19 21.2 1.79 12.1 1.62 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2 1.57 22.3 2.07 18.3 1.58 

65–74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.5 ‘f.43 24.5 1.60 26.3 1.77 

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.8 1.62 22.4 1.87 23.2 2.29 

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6 1.14 11.7 2.30 4.3 1.46 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.6 2.74 22.3 5.01 17.6 4.18 

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.7 4.61 23.0 5.37 37.3 5.50 

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.6 3.97 39.2 3.89 36.4 6.06 

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.5 3.26 27.5 3.01 43.4 5.62 

1~v~tofic bloOd ~re~~ure of at least 160 mm Ha and/or diastolic blood Dressure of at least 95 mm Ha. 

Iricludes other “mcial groups in addition to wh;te and black. 

TE All blood pressures are the average of 3 measurements. 

Table 6. Number and percent of persons ages 25-74 yeara by responsas to selected medical history items and specified blood pressure levels,’ with 

standard error of the percent United States, 1976-80 

Systolic 160mm Hg orgreaterand/or 

diastolic 95 mm Hg or greater At least 105 mm Hg diastolic 

Medical history items 

Population in Percent Standard error 

thousands of percent 

Population in 

thousands 

Percent Standard error 

of percent 

Tota125-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,541 100.0 . . . 3,253 100.0 . . . 

Have you ever been told by a doctor that you had high blood 

pressure or hypertension? 

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,863 59.6 1.50 2,363 72.6 3.19 

During the past 12 months, about how many times have you seen 

or talked to a doctor about your high blood pressure or hypertension? 

Oneor more times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,144 43.1 1.21 1,657 50.9 3.71 

Are you now taking any medicine prescribed by a doctor for your 

high blood pressure or hypertension? 

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,535 33.5 1.46 1,294 39.8 3.88 

NOTE All blood pressures are the average of 3 measurements. 
Tabla 7. Prevalence rates of hypertension 

Race and sex 

Allpeople 25-74 years5, . . . . . . . . . . . . . . 

White men . . . . . . . . . . . . . . . . . . . . . . . . . . . 

White women . . . . . . . . . . . . . . . . . . . . . . . . 

Black man . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Black women . . . . . . . . . . . . . . . . . . . . . . . . . 

Allpeopie 25-74 years5 . . . . . . . . . . . . . . . 

White men . . . . . . . . . . . . . . . . . . . . . . . . . . . 

White women . . . . . . . . . . . . . . . . . . . . . . . . 

Black en . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Black women . . . . . . . . . . . . . . . . . . . . . . . . . 

for persona 25–74 years of age by treatment history, race, and sex, with standard errors of the percenfi United States, 1960-62,1974-75, and 1976-60 

On medication and Hypertensive 1 Never diagnosed On medication controlled 

1960–62 1974-75 1976-80 1960-62 1974-75 1976-80 1960–62 1974–76 1976-80 1960–62 1974–75 1976–80 

Percent of p0pulation4 

20.3 22.1 22.0 

16.3 21.4 21.2 

20.4 19.6 20.0 

31.6 37.1 28.3 

39.8 35.5 39.8 

0.83 1.26 0.68 

0.95 2.19 1.04 

1.07 1.14 0.66 

3.37 5.94 1.86 

3.73 3.60 1.96 

Percent of total with hypertension,4 

51.1 36.4 26.6 31.3 34.2 56.2 16.0 19.6 34.1 

57.6 42.3 40.6 22.4 25.9 38.3 11.8 15.1 20,9 

43.9 29.7 25.2 38.2 48.5 58.6 21.9 28.1 40.3 

70.5 41.0 35.7 18.5 “24.0 40.9 5.0 *1 2.7 16.1 

35.1 28,9 14.5 48,1 36.4 60.6 20.2 *22.3 38.3 

Standard error of percent 

1.66 1.70 1.53 1.62 2.21 1.99 1.65 1.49 2.02 

3.75 2.63 1.BO 3.07 3.22 2.47 2’.59 2.56 2.01 

2.77 2.OB 1.97 2.24 3.61 2.40 2.24 2.93 2.99 

7.07 10.38 4.27 5.53 10.79 4.52 2.18 6.69 3.72 

3.72 7.42 2.73 3.87 8.30 3.22 3.21 7.93 4.35 

1Elevated blood ~re~~ure (that is, ~ ay~tolic ~ea~urement of at [east 160 mm Hg or ~ d’ia~tOlicmeaa”rement Of at Iaast 95 mm Hg) or taking antihypertensive medication. 

2ffePo*ed never told by physician that he or she had high blood pressure or h~pefiensiOn.


3~ubset of -on ~edication<. group; those tafing a“tihypemen~ive medicatiO” whO~e blood pressure was not elevated at the time of the examination.


4*ge ~dju.-ted by direct method to the population at midpOint of the 1976-80 NatiOnal Health a“d Nutrition Examination survey.


slncl”de~ aII other races nOt shown sePa~tely. 
11’


a 

@ 

ethnical notes 

Sample design 

The itiorrnation presented in this report is based on 

data from the direct standardized physical examinations, tests, measurements, and questionnaires collected in the second National Health and Nutrition 

Examination Survey (NHANES II) during 1976-80. 

The target population of NH.ANES II was the civilian 

noninstitutionalized population of the United States, 

including Alaska and Hawaii, ages 6 months through 

74 years. 

NHANES II used a multistage probability design 

that involved selection of primary sampling units 

(PSU’S); households; eligible persons; and, finally, 

sample persons. The sample design provided for oversarnpling among persons 6 months-5 years of age, 

persons 60–74 years of age, and persons living in 

poverty areas. Under contract to the National Center 

for Health Statistics and according to rigorous agreed 

specitlcations, the U.S. Bureau of the Census selected 

the NHANES II sample of 27,801 persons. Of this 

total sample, 20,322 (73. 1 percent) were examined. 

The data in this report are presented as population 

subdomain estimates. Examination findings for each 

ple person have been inflated by the reciprocal of 

the probability of selecting a person, adjusted for 

persons who were not examined, and poststratiled so 

that final population estimates closely approximate the 

independent U.S. Bureau of the Census estimates for 

the civilian noninstitutionalized population of the 

United States by race, sex, and age as of the midpoint of 

the study, March 1, 1978. 

Sampling errors 

The estimates presented in this report are based on 

a sample of the target population rather than on the 

entire population. Thus the estimated values may &Her 

from the values that would be obtained from examining 

the entire target population. Assuming that an estimate 

is unbiased, the expected magnitude of the sampling 

error is measured by a statistic called the standard 

error. A variant of the pseudoreplication method was 

used to produce the estimates of standard errors for this 

report. 17 

Standardized values 

Means and rates have been adjusted for age to the 

.S. civilian noninstitutionrdized population in 1976– 

Notct A list of references foHows the text. 

80, where indicated, using the direct method of standardization. 1s Standardization removes the effect that 

differences in the age distributions may have on the 

comparison of subgroup rates. 

Tests of significance 

The procedure used in this report for testing the 

significance of the difference between two means 

consisted of dividing this difference by the standard 

error of the difference (Z-statistic). An approximation 

of the standard error of a difference d = x —y between 

the two statistics x and y is given by the formula S~ = 

(S; -1-S~)fi where S. and SY are estimates, respectively, of the actual standard errors. When the two 

groups or measures are positively or negatively correlated, this equation yields an overestimate or underestimate, respectively, of the actual standard error of 

the difference. 

If more than one comparison is implied, the Bonferroni test Ig was used to test for signiilcance. In the 

Bonfemoni test the Z-statistic is computed for each 

component in the multiple compariso~ but each individual signi.ilcance level is adjusted to account for the 

increased likelihood of a significant result from multiple 

tests. 

The 5-percent probability level has been used for 

the determination of statistical significance in this 

report. 

Order of measurements 

The exarninee’s first blood pressure determination 

in the NHANES II of 1976-80 was made before the 

physical examination with the examinee sitting, the 

second at the end of the examination with the examinee 

supine, and the third immediately after the second with 

the exarninee sitting on the edge of the exti.ation 

table. This examination protocol was also used in the 

NHANES I of 1971-75. In the NHES of 1960-

62, the order of the measurements in relation to the 

examination was similar to that in the present study, but 

all three were taken in a sitting position. 

Initial blood pressure values for examinees on 

whom more than one reading was obtained in the 

National Health Examination Survey during the 1960’s 

were generally higher than the subsequent ones. In contras~ blood pressure levels from all three measurements 

in the 197 1–75 NHANES I were similar as are the three 

measurements in the 1976–80 NHANES II. 
12 adwncedata 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 83. Deliveries in Short-Stay Hospitals: United States, 1980 

(Issued: October 8, 1982) 

No. 82. Contraceptive Use Patterns, Prior Source, and Pregnancy 

History of Female Family Planning Patients: United States, 1980 

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No. 81. Drug Utilization in Office Practice by Age and Sex of the 

Patienti National Ambulatory Medical Care Survey, United 

States, 1980 (Issued July 26, 1982) 

SUGGESTED CITATION 

National Center for Health Statistics, Michael Rowland 

and Jean Robe= Blood Pressure Levela and 

Hypertension in Persons Ages 6–74 Years: United 

States, 1976-BO. Advance Data From Wtal and Health 

Statistics, No. 84. DHHS Pub. No. (PHS) 82-1250. 

Public Health Service. Hyattsville, Md.


October 8, 1982


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No. 80. Medication Therapy in Office Visits for Hypertension: 

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United States, 1976-80 (Issued: May 12, 1982) 

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