Trends in Awareness, Antihypertensive Medication Use and Blood Pressure Control by Race and Ethnicity Among Adults with Hypertension in the United States: A National Health and Nutrition Examination Analysis from 2011 to 2018
Authors: Lu Yuan , Liu Yuntian , Dhingra Lovedeep Singh , Massey Daisy , Caraballo César , Mahajan Shiwani , Spatz Erica S. , Onuma Oyere , Herrin Jeph , Krumholz Harlan M. 
Published: August 2021

Objective

To examine United States (US) trends in racial/ethnic differences in hypertension awareness and antihypertensive medication use, and whether these differences help explain racial/ethnic differences in hypertension control among adults from 2011 to 2018.

Design

Population-based study.

Setting

National Health and Nutrition Examination Survey (NHANES), 2011-2018.

Participants

A nationally representative sample of US adults aged 18 years or older.

Main outcome measures

Hypertension awareness was defined as self-reported physician diagnosis of hypertension. Antihypertensive treatment was based on self-reported use of antihypertensive agents. Blood pressure (BP) control was measured systolic BP <140 mmHg and diastolic BP <90 mmHg.

Results

This study included 8,095 adults with hypertension from NHANES 2011-2018. During the study period, age-adjusted hypertension awareness declined from 84.0% (95% confidence interval 79.5 to 86.2) to 77.5% (74.0 to 80.5), hypertension treatment declined from 77.3% (73.4 to 81.1) to 71.4% (69.0 to 73.8) and control rates declined from 51.9% (47.1 to 56.7) to 43.1% (39.7 to 46.5). These declines were consistent for Black, Hispanic, and White individuals, but the three outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals did not have a significantly different awareness (odds ratio:1.20 [0.96 to 1.45]) and overall treatment rate (1.04 [0.84 to 1.25]), but received more antihypertensive medications if treated (1.41 [1.27 to 1.56]), and had a lower BP control rate (0.72 [0.61 to 0.83]); Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52 to 0.85] and 0.74 [0.59 to 0.89], respectively), overall treatment rates (0.72 [0.57 to 0.88] and 0.69 [0.55 to 0.82]), received fewer medications if treated (0.60 [0.50 to 0.72] and 0.86 [0.75 to 0.96]), and had lower BP control rates (0.66 [0.54 to 0.79] and 0.69 [0.57 to 0.81]). The racial/ethnic differences in awareness, treatment, and BP control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were associated with lower BP control in Asian and Hispanic individuals, but not in Black individuals.

Conclusions

Hypertension awareness, treatment, and control declined from 2011-2018, and this decline was consistent for Black, Hispanic, and White individuals. BP control was worse for Asian, Black, and Hispanic individuals than for White individuals over the entire study period; this was explained partly by differences in awareness and treatment for Asian and Hispanic individuals, but not for Black individuals.

What this Paper Adds

Section 1: What is already known on this subject?

Hypertension control rate has declined in the United States (US) since 2013, and this decline is more pronounced in Black and Hispanic communities.

Section 2: What this study adds

Our study shows that hypertension awareness, treatment, and control in the US have worsened from 2011 to 2018, and this trend was consistent for Black, Hispanic, and White individuals. Compared with White individuals, Black individuals had similar awareness and overall treatment rates, received more antihypertensive medications if treated, but had a lower control rate; Asian and Hispanic individuals had significantly lower awareness rates, overall treatment rates, received fewer medications if treated, and had lower control rates. Lower awareness and treatment were associated with lower BP control in Asian and Hispanic individuals, but not in Black individuals. These findings highlight the need for interventions to improve awareness and treatment among Asian and Hispanic individuals, and more investigation into the downstream factors that may contribute to the poor hypertension control among Black individuals.