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Racial/Ethnic Disparities in the Awareness, Treatment, and Control of Hypertension — United States, 2003–2010

Hypertension is a leading cause of cardiovascular disease and affects nearly one third of U.S. adults (1,2). Because the risk for cardiovascular disease mortality increases as blood pressure increases, clinical recommendations for persons with stage 2 hypertension (systolic blood pressure [SBP] ≥160 mmHg or diastolic blood pressure [DBP] ≥100 mmHg) include a more extensive treatment and follow-up regime than for those with stage 1 hypertension (SBP 140–159 mmHg or DBP 90–99 mmHg) (3). Although racial/ethnic disparities in the prevalence of hypertension have been well documented (4); ethnic disparities in the awareness, treatment, and control within blood pressure stages have not. To examine racial/ethnic disparities in awareness, treatment, and control of high blood pressure by hypertension stages, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the period 2003–2010. This report describes the results of that analysis, which indicated that the proportion of Mexican-Americans and blacks with stage 1 and stage 2 hypertension was greater than for whites.* Among those with stage 1 hypertension, treatment with medication was significantly lower for Mexican-Americans compared with their non-Hispanic counterparts. Although treatment among persons with stage 2 hypertension did not differ by race/ethnicity, less than 60% of those with stage 2 hypertension were treated with medication. More efforts are needed to reduce barriers to accessing health care and low-cost medication, as well as increasing clinicians' hypertension treatment knowledge and adherence to clinical guidelines.

NHANES is an ongoing, stratified, multistage probability sample of the noninstitutionalized U.S. civilian population. Interviews and detailed physical examinations are performed. To obtain statistically stable estimates within racial/ethnic groups, CDC analyzed data from four 2-year cycles (2003–2010). Examination response rates ranged from 75% to 77% during this period, resulting in a total of 22,992 adult (aged ≥18 years) participants. The analysis excluded women who were pregnant (n = 732), participants without a blood pressure measurement (n = 1,339), other Hispanics and persons of other race or of multiple race (n = 2,693), and persons without hypertension (n = 14,313). Some participants were excluded based on more than one criterion, yielding a final study sample of 6,632 participants. Hypertension was defined as an average SBP ≥140 mmHg or DBP ≥90 mmHg, based on the average of up to three blood pressure measurements,§ or self-report of currently using blood pressure–lowering medication. Hypertension treatment was identified as the use of blood pressure–lowering medication and did not include lifestyle or dietary approaches. Hypertension stages were classified as stage 1 hypertension (SBP 140–159 mmHg or DBP 90–99 mmHg) and stage 2 hypertension (SBP ≥160 mmHg or DBP ≥100 mmHg) (3). Blood pressure control was defined as an SBP <140 mmHg and DBP <90 mmHg among those with hypertension. Hypertension awareness was determined based on whether a participant was ever told they had high blood pressure by a health-care provider. Health-care coverage was categorized into three groups: 1) Medicare, 2) private insurance, or 3) public insurance, which included Medicaid, a military health plan, or a state-sponsored plan.

All analyses were performed using statistical software to account for sampling weights and adjust variance estimates for the complex sampling design. A univariate chi-square test of independence was used to determine statistically significant (p<0.05) differences across racial/ethnic groups. Because multiple NHANES cycles were combined, trends over time could not be examined, and prevalence estimates could not be age adjusted. Population counts were estimated using the Current Population Surveys provided from NHANES by averaging the population during the period coinciding with the four NHANES cycles.

Among those with hypertension, the proportion of persons who were aged <65 years was greater for blacks (74.1%) and Mexican-Americans (71.9%) compared with whites (57.4%) (Table 1). Hypertension awareness, treatment, and control were lowest among Mexican-Americans (68.7%, 58.7%, and 35.5%, respectively) compared with whites (aware: 79.1%, treated: 71.2%, and controlled: 48.6%) and blacks (aware: 80.8%, treated: 71.9%, and controlled: 43.0%).

Among those with uncontrolled hypertension, awareness and treatment was greater for blacks (66.3% and 50.7%, respectively) compared with whites (aware: 59.4%, treated: 44.0%) and Mexican-Americans (aware: 51.4%, treated: 35.9%) (Table 2). Blacks with stage 1 hypertension had greater awareness (61.3%) and treatment (47.4%) compared with whites (awareness: 57.4%, treatment: 42.1%) and Mexican-Americans (awareness: 45.2%, treatment: 30.0%). Among those with stage 2 hypertension, blacks had greater awareness (77.6%) compared with whites (65.7%) and Mexican-Americans (66.0%); however, no difference was observed in hypertension treatment by race/ethnicity. Health-care coverage for those with uncontrolled hypertension was lowest for Mexican-Americans (59.3%) compared with blacks (77.7%) and whites (89.4%). However, among all persons with uncontrolled hypertension who were treated, the proportion who had health-care coverage was lower for Mexican-Americans (75.0%) compared with blacks (86.9%) and whites (94.4%). Awareness and treatment increased from stage 1 to stage 2 hypertension across all racial/ethnic groups.

Reported by

Amy L. Valderrama, PhD, Cathleen Gillespie, MS, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion; Carla Mercado, PhD, EIS Officer, CDC. Corresponding contributor: Carla Mercado, cmercado@cdc.gov, 770-488-8075.

Editorial Note

The results presented in this report indicate that during 2003–2010, racial/ethnic disparities existed among U.S. adults with hypertension and within hypertension stages for age, awareness, treatment, and health-care coverage. Mexican-Americans and blacks with hypertension were significantly younger than whites. This might reflect earlier onset of hypertension among these racial/ethnic groups (5). Awareness and treatment was highest among blacks. This association is consistent with previous studies (6,7) and might be a result of efforts to reduce the persistent high prevalence of hypertension among blacks. Although no significant difference was observed in hypertension treatment by race/ethnicity among those with stage 2 hypertension, treatment was low overall (50%–58%) in this high-risk group, for whom clinical guidelines recommend a two-drug combination (3). Data on the number or type of medication used by participants, including two-drug combinations, were not examined in this report. A greater proportion of blood pressure control among those treated for hypertension has been observed among Mexican-Americans (74%) and whites (75%) compared with blacks (62%) (6). To improve treatment and achieve the Healthy People 2020 goal of blood pressure control in 61.2% of persons with hypertension (8) across all race/ethnic groups, targeted implementation of demonstrated, evidence-based community and clinical strategies is necessary (1).

In this study, the proportion of persons with health-care coverage was lowest among Mexican-Americans. Lack of health-care coverage has been associated with lower rates of hypertension awareness, treatment, and control (9). This might partially explain the observed lower treatment and awareness of hypertension among Mexican-Americans in this report.

The findings in this report are subject to at least five limitations. First, although the focus of the study was to investigate racial/ethnic disparities within blood pressure stages, CDC did not consider other racial/ethnic groups or respondents who were multiracial because sample sizes were too small for meaningful analysis. Similarly, the study could not consider other Hispanic subpopulations or Hispanics as a whole because of differences in NHANES sample design between the 2003–2006 and 2007–2010 cycles. Second, hypertension awareness and treatment as well as other covariates were self-reported and subject to recall bias. Third, hypertension treatment was based only on medication use, not accounting for participants who were using lifestyle or dietary approaches to reduce blood pressure, which might have resulted in an underestimation of proportion of adults with hypertension who received "treatment." Fourth, because of a limited number of participants with stage 2 hypertension within each cycle of NHANES, changes over time in the estimates were not evaluated. Finally, NHANES examination response rates ranged from 75% to 77%.

Racial/ethnic disparities exist in blood pressure, awareness, treatment, and control, with Mexican-Americans having a lower awareness and treatment of hypertension, as well as less health-care coverage, compared with blacks and whites. Multiple national efforts target improvements in high blood pressure prevention, treatment, and control (3). The Million Hearts initiative, co-led by CDC and the Centers for Medicare and Medicaid Services, is focusing efforts on preventing 1 million heart attacks and strokes by 2017, partially achieved by increasing blood pressure control for 10 million persons in the United States (10).** Million Hearts is working to reduce cardiovascular disease risk factors through parallel efforts aimed at clinical settings and communities with a focus on the "ABCS" (i.e., appropriate aspirin use for those at risk, blood pressure control, cholesterol management, and smoking cessation). The initiative aims to improve prescription and patient adherence to appropriate medications for the ABCS, promote a heart-healthy lifestyle, and refine access to effective care, while bringing clinicians' attention to cardiovascular disease prevention, including appropriate drug regimens. Million Hearts also provides communities and clinical settings with resources and materials that are tailored for different racial/ethnic populations.

References

  1. CDC. Vital signs: awareness and treatment of uncontrolled hypertension among adults—United States, 2003–2010. MMWR 2012;61:703–9.
  2. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 2013;127:e6–e245.
  3. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206–52.
  4. Yoon SS, Burt V, Louis T, Carroll MD. Hypertension among adults in the United States, 2009–2010. NCHS data brief, no. 107. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2012. Available at http://www.cdc.gov/nchs/data/databriefs/db107.htm.
  5. Carson AP, Howard G, Burke GL, Shea S, Levitan EB, Muntner P. Ethnic differences in hypertension incidence among middle-aged and older adults: the multi-ethnic study of atherosclerosis. Hypertension 2011;57:1101–7.
  6. CDC. Control of hypertension among adults—National Health and Nutrition Examination Survey, United States, 2005–2008. MMWR 2012:61(Suppl 2):19–25.
  7. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health and Nutrition Examination Survey, 2001 to 2010. Circulation 2012;126:2105–14.
  8. US Department of Health and Human Services. Healthy people 2020: heart disease and stroke. Washington, DC: US Department of Health and Human Services; 2013. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21.
  9. Angell SY, Garg RK, Gwynn RC, Bash L, Thorpe LE, Frieden TR. Prevalence, awareness, treatment, and predictors of control of hypertension in New York City. Circ Cardiovasc Qual Outcomes 2008;1:46–53.
  10. Frieden TR, Berwick DM. The "Million Hearts" initiative—preventing heart attacks and strokes. N Engl J Med 2011;365:e27.

* For this report, all persons of black or white race are non-Hispanic. Mexican-Americans might be of any race.

Additional information available at http://www.cdc.gov/nchs/nhanes.htm.

§ Additional information available at http://www.cdc.gov/nchs/nhanes.htm.

Additional information available at http://www.cdc.gov/nchs/nhanes/response_rates_cps.htm.

** Additional information available at http://millionhearts.hhs.gov/index.html.


What is already known on this topic?

It has been previously reported that one in three U.S. adults had high blood pressure during 2009–2010, and approximately half (53.3%) had their condition under control. The prevalence of high blood pressure differs by race/ethnicity, with the condition being more common among blacks (40.4%) compared with whites (27.4%) and Mexican-Americans (26.1%).

What is added by this report?

Based on data from the National Health and Nutrition Examination Survey for the period 2003–2010, high blood pressure control differed for whites (48.6%), blacks (43.0%), and Mexican-Americans (35.5%). Among those with hypertension, the proportion with stage 2 hypertension was greater for Mexican-Americans (19.2%) and blacks (17.7%) compared with whites (12.3%).

What are the implications for public health practice?

To reduce the prevalence of uncontrolled high blood pressure and the associated racial/ethnic disparities, efforts are needed to increase hypertension awareness and hypertension treatment and adherence, especially in the Mexican-American population. The Million Hearts initiative focuses on addressing these issues by presenting a multifactorial approach focusing on reducing cardiovascular risk factors, such as high blood pressure, and tailoring this approach to effectively reach different racial/ethnic populations.


TABLE 1. Prevalence of selected characteristics among adults aged ≥18 years with hypertension,* by race/ethnicity — National Health and Nutrition Examination Survey, United States, 2003–2010

Characteristic

Mexican-American

White, non-Hispanic

Black, non-Hispanic

p-value§

N = 1,062

N = 3,766

N = 1,804

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sex

Male

505

52.4

(49.4–55.4)

1.6

1,945

49.2

(47.6–50.7)

22.4

855

42.8

(40.4–45.2)

3.7

<0.001

Female

557

47.6

(44.6–50.6)

1.4

1,821

50.8

(49.3–52.4)

23.1

949

57.2

(54.8–59.6)

5.0

Age group (yrs)

18–44

121

25.0

(20.7–29.4)

0.8

370

13.4

(11.6–15.2)

6.1

284

21.4

(19.2–23.6)

1.9

<0.001

45–64

488

46.9

(43.3–50.6)

1.4

1,207

44.0

(42.1–46.0)

20.0

869

52.7

(50.4–55.0)

4.6

≥65

453

28.0

(25.3–30.7)

0.8

2,189

42.6

(40.4–44.8)

19.4

651

25.9

(23.2–28.7)

2.2

Education (respondents aged ≥25 yrs)

Less than high school diploma

677

57.7

(52.7–62.8)

1.7

869

17.9

(15.2–20.6)

8.1

618

31.6

(28.5–34.7)

2.7

<0.001

High school diploma

170

19.3

(16.2–22.4)

0.6

1,116

29.9

(27.8–32.0)

13.5

431

24.8

(22.4–27.2)

2.1

Some college

141

15.2

(11.4–19.0)

0.4

1,014

29.2

(27.2–31.2)

13.2

489

29.7

(27.5–31.9)

2.5

College degree or higher

58

7.8

( 5.3–10.3)

0.2

737

23.1

(20.4–25.7)

10.4

235

13.9

(12.0–15.9)

1.2

Poverty-to-income ratio

<100%

298

27.0

(21.6–32.4)

0.8

403

7.2

( 5.9– 8.6)

3.3

336

18.5

(16.1–20.8)

1.6

<0.001

100%–299%

474

43.1

(38.6–47.6)

1.3

1,642

36.8

(34.2–39.4)

16.8

795

43.7

(40.9–46.4)

3.8

300%–499%

126

13.9

(10.6–17.2)

0.4

782

25.3

(23.0–27.6)

11.5

320

18.0

(15.7–20.4)

1.6

≥500%

164

16.0

(11.9–20.1)

0.5

939

30.6

(27.6–33.6)

13.9

353

19.8

(17.6–22.0)

1.7

Hypertension awareness**

Aware

768

68.7

(64.9–72.4)

2.1

2,996

79.1

(77.3–80.9)

36.0

1,486

80.8

(78.2–83.4)

7.0

<0.001

Unaware

294

31.3

(27.6–35.1)

0.9

770

20.9

(19.1–22.7)

9.5

318

19.2

(16.6–21.8)

1.7

Hypertension treatment††

Treated

674

58.7

(53.7–63.6)

1.8

2,725

71.2

(68.9–73.4)

32.4

1,335

71.9

(68.9–74.9)

6.2

<0.001

Untreated

386

41.3

(36.4–46.3)

1.2

1,035

28.8

(26.6–31.1)

13.1

469

28.1

(25.1–31.1)

2.4

Hypertension controlled§§

Yes

402

35.5

(32.7–38.3)

1.1

1,795

48.6

(46.3–50.8)

22.1

786

43.0

(40.3–45.7)

3.7

<0.001

No

660

64.5

(61.7–67.3)

1.9

1,971

51.4

(49.2–53.7)

23.4

1,018

57.0

(54.3–59.7)

4.9

Blood pressure stages¶¶

Normal

127

12.0

(10.1–14.0)

0.4

660

17.8

(16.5–19.1)

8.1

286

16.5

(14.8–18.1)

1.4

<0.001

Pre-hypertension

275

23.5

(21.0–26.0)

0.7

1,135

30.8

(28.9–32.6)

14.0

500

26.5

(24.3–28.7)

2.3

Stage 1 hypertension

435

45.3

(41.3–49.2)

1.4

1,429

39.2

(36.9–41.4)

17.8

699

39.3

(36.9–41.8)

3.4

Stage 2 hypertension

225

19.2

(16.1–22.2)

0.6

542

12.3

(11.1–13.4)

5.6

319

17.7

(15.6–19.8)

1.5

Health-care coverage***

No

302

35.0

(31.1–38.9)

1.1

289

8.1

( 6.8– 9.3)

3.7

254

16.8

(14.5–19.0)

1.5

<0.001

Yes

760

65.0

(61.1–68.9)

2.0

3,477

91.9

(90.7–93.2)

41.8

1,550

83.2

(81.0–85.5)

7.2

Health-care coverage type†††

Medicare

204

19.6

(14.9–24.3)

0.4

645

13.0

(11.5–14.5)

5.4

280

14.3

(12.7–16.0)

1.0

<0.001

Private

344

53.3

(47.3–59.4)

1.0

2,215

72.1

(69.9–74.3)

30.2

874

59.3

(56.5–62.2)

4.3

Public

212

27.0

(22.2–31.9)

0.5

617

14.9

(13.3–16.6)

6.2

396

26.4

(23.3–29.4)

1.9

Routine place for health care§§§

Yes

909

81.1

(78.1–84.0)

2.4

3,592

94.8

(93.9–95.7)

43.1

1,721

94.7

(93.4–95.9)

8.2

<0.001

No

153

18.9

(16.0–21.9)

0.6

174

5.2

(4.3– 6.1)

2.4

83

5.3

( 4.1– 6.6)

0.5

No. of times received health care in past year¶¶¶

0

151

18.0

(14.8–21.2)

0.5

190

5.5

( 4.4– 6.7)

2.5

132

8.5

( 7.1–10.0)

0.7

<0.001

1

139

14.8

(11.7–17.8)

0.4

387

12.3

(10.9–13.6)

5.6

181

10.5

( 9.0–12.1)

0.9

≥2

772

67.2

(62.8–71.6)

2.0

3,187

82.2

(80.6–83.8)

37.4

1,487

80.9

(79.2–82.7)

7.0

Abbreviation: CI = confidence interval.

* Defined as systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg or currently using blood pressure–lowering medication.

Adult participants with no blood pressure measurement, self-reported race/ethnicity as "other/multiracial," and pregnant women were excluded.

§ Pearson chi-squared statistic, corrected for survey design.

Ratio of family income to poverty as defined by the U.S. Census Bureau. Information available at http://www.census.gov/hhes/www/poverty/methods/definitions.html#ratio of income to poverty.

** Based on responses to the following questions, "Have you ever been told by a doctor or other health-care professional that you had hypertension, also called high blood pressure?" and "Were you told on two or more different visits that you had hypertension or high blood pressure?"

†† Based on whether the participant answered "yes" to both of the following questions: "Because of your high blood pressure, have you ever been told to take prescribed medicine?" and "Are you now taking prescribed medicine for high blood pressure?"

§§ Based on blood pressure measurements for those with hypertension: controlled (SBP <140 and DBP <90) and uncontrolled (SBP ≥140 or DBP ≥90).

¶¶ Classified as normal (SBP <120 and DBP <80), pre-hypertension (SBP 120–139 or DBP 80–89), stage 1 hypertension (SBP 140–159 or DBP 90–99), and stage 2 hypertension (SBP ≥160 or DBP ≥100).

*** Participants were asked, "Are you covered by health insurance or some other health-care plan?"

††† Health-care coverage types reported were Medicare, private insurance, and/or public health insurance (Medicaid, Children's Health Insurance Program [CHIP], state or other government sponsored health plan, or military health plan).

§§§ Based on response to the question, "Is there a place that you usually go when sick or need advice about health?"

¶¶¶ Based on response to the question, "During the past 12 months, how many times have you seen a doctor or other health-care professional about your health, not including being hospitalized overnight?"


TABLE 2. Prevalence of selected characteristics among adults aged ≥18 years with uncontrolled hypertension,* by stage of hypertension — National Health and Nutrition Examination Survey, United States, 2003–2010

Characteristic

All uncontrolled hypertension

Mexican-American (n = 660)

White, non-Hispanic (n = 1,971)

Black, non-Hispanic (n = 1,018)

p-value§

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sex

Male

321

53.9

(49.7–58.2)

1.0

1,009

49.9

(47.9–51.8)

11.7

523

48.0

(44.9–51.2)

2.4

0.139

Female

339

46.1

(41.8–50.3)

0.9

962

50.1

(48.2–52.1)

11.7

495

52.0

(48.8–55.1)

2.6

Age group (yrs)

18–44

97

31.8

(27.1–36.5)

0.6

218

14.9

(12.5–17.3)

3.5

197

25.4

(22.3–28.4)

1.3

<0.001

45–64

271

39.6

(34.8–44.5)

0.8

587

42.0

(39.4–44.7)

9.8

477

50.4

(47.6–53.1)

2.5

≥65

292

28.6

(24.8–32.3)

0.6

1,166

43.0

(40.3–45.8)

10.1

344

24.3

(21.0–27.5)

1.2

Hypertension awareness

Aware

366

51.4

(46.8–56.0)

1.0

1,201

59.4

(56.7–62.0)

13.9

700

66.3

(62.6–70.1)

3.3

<0.001

Unaware

294

48.6

(44.0–53.2)

0.9

770

40.6

(38.0–43.3)

9.5

318

33.7

(29.9–37.4)

1.7

Hypertension treatment**

Treated

274

35.9

(30.1–41.7)

0.7

936

44.0

(41.3–46.7)

10.3

549

50.7

(46.6–54.8)

2.5

0.001

Untreated

386

64.1

(58.3–69.9)

1.2

1,035

56.0

(53.3–58.7)

13.1

469

49.3

(45.2–53.4)

2.4

Health-care coverage††

Yes

441

59.3

(55.1–63.5)

1.2

1,783

89.4

(87.6–91.1)

20.9

825

77.7

(74.7–80.7)

3.8

<0.001

No

219

40.7

(36.5–44.9)

0.8

188

10.6

(8.9–12.4)

2.5

193

22.3

(19.3–25.3)

1.1

Routine place for health care§§ 

Yes

524

73.5

(69.1–77.9)

1.4

1,824

91.4

(89.7–93.2)

21.4

946

91.9

(89.7–94.1)

4.5

<0.001

No

136

26.5

(22.1–30.9)

0.5

147

8.6

(6.8–10.3)

2.0

72

8.1

(5.9–10.3)

0.4

No. of times received health care in past year¶¶

0

136

25.5

(21.6–29.4)

0.5

175

10.0

(7.9–12.0)

2.3

125

14.2

(11.7–16.7)

0.7

<0.001

1

109

18.6

(14.5–22.7)

0.4

253

15.8

(14.1–17.6)

3.7

135

13.7

(11.1–16.3)

0.7

≥2

415

55.9

(51.0–60.8)

1.1

1,542

74.2

(71.9–76.5)

17.4

757

72.1

(69.0–75.2)

3.6

Characteristic

Stage 1 hypertension

Mexican-American (n = 435)

White, non-Hispanic (n = 1,429)

Black, non-Hispanic (n = 699)

p-value§

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sex

Male

227

57.1

(50.7–63.4)

0.8

779

52.9

(50.5–55.3)

9.4

381

50.4

(46.5–54.2)

1.7

0.212

Female

208

42.9

(36.6–49.3)

0.6

650

47.1

(44.7–49.5)

8.4

318

49.6

(45.8–53.5)

1.7

Age group (yrs)

18–44

81

37.4

(31.3–43.5)

0.5

190

17.3

(14.5–20.2)

3.1

157

28.3

(24.5–32.2)

1.0

<0.001

45–64

184

38.7

(32.8–44.6)

0.5

478

45.0

(41.9–48.0)

8.0

333

50.8

(47.0–54.5)

1.7

≥65

170

23.9

(19.7–28.1)

0.3

761

37.7

(35.0–40.4)

6.7

209

20.9

(16.8–25.0)

0.7

Hypertension awareness

Aware

212

45.2

(40.5–50.0)

0.6

839

57.4

(54.3–60.5)

10.2

450

61.3

(57.4–65.2)

2.1

<0.001

Unaware

223

54.8

(50.0–59.5)

0.7

590

42.6

(39.5–45.7)

7.6

249

38.7

(34.8–42.6)

1.3

Hypertension treatment**

Treated

153

30.0

(24.6–35.4)

0.4

644

42.1

(39.1–45.2)

7.5

358

47.4

(43.5–51.4)

1.6

<0.001

Untreated

282

70.0

(64.6–75.4)

1.0

785

57.9

(54.8–60.9)

10.3

341

52.6

(48.6–56.5)

1.8

Health-care coverage††

Yes

287

58.4

(53.5–63.4)

0.8

1,279

88.9

(86.9–90.8)

15.8

576

79.4

(76.1–82.6)

2.7

<0.001

No

148

41.6

(36.6–46.5)

0.6

150

11.1

(9.2–13.1)

2.0

123

20.6

(17.4–23.9)

0.7

Routine place for health care§§

Yes

342

72.7

(66.9–78.5)

1.0

1,314

91.0

(88.9–93.0)

16.2

650

92.1

(89.7–94.4)

3.1

<0.001

No

93

27.3

(21.5–33.1)

0.4

115

9.0

(7.0–11.1)

1.6

49

7.9

(5.6–10.3)

0.3

No. of times received health care in past year¶¶

0

95

26.9

(22.3–31.4)

0.4

128

10.0

(7.8–12.1)

1.8

80

13.7

(11.0–16.4)

0.5

<0.001

1

75

18.9

(14.2–23.6)

0.3

194

16.4

(14.3–18.4)

2.9

96

14.3

(11.3–17.3)

0.5

≥2

265

54.2

(48.2–60.2)

0.7

1,106

73.6

(71.1–76.2)

13.1

522

72.0

(68.7–75.3)

2.5


TABLE 2. (Continued) Prevalence of selected characteristics among adults aged ≥18 years with uncontrolled hypertension,* by stage of hypertension — National Health and Nutrition Examination Survey, United States, 2003–2010

Characteristic

Stage 2 hypertension

Mexican-American (n = 225)

White, non-Hispanic (n = 542)

Black, non-Hispanic (n = 319)

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

Sample size

%

(95% CI)

No. in population (in millions)

p-value§

Sex

Male

94

46.6

(39.9–53.2)

0.3

230

40.1

(36.3–44.0)

2.2

142

42.8

(37.0–48.5)

0.7

0.310

Female

131

53.4

(46.8–60.1)

0.3

312

59.9

(56.0–63.7)

3.3

177

57.2

(51.5–63.0)

0.9

Age group (yrs)

18–44

16

18.7

(11.4–26.1)

0.1

28

7.1

(4.0–10.3)

0.4

40

18.7

(13.4–24.1)

0.3

<0.001

45–64

87

41.8

(34.6–49.0)

0.2

109

32.7

(28.4–37.0)

1.8

144

49.5

(44.1–54.9)

0.8

≥65

122

39.5

(32.2–46.8)

0.2

405

60.2

(55.5–64.8)

3.4

135

31.8

(26.9–36.6)

0.5

Hypertension awareness

Aware

154

66.0

(55.7–76.2)

0.4

362

65.7

(61.6–69.7)

3.7

250

77.6

(71.8–83.4)

1.2

0.010

Unaware

71

34.0

(23.8–44.3)

0.2

180

34.3

(30.3–38.4)

1.9

69

22.4

(16.6–28.2)

0.3

Hypertension treatment**

Treated

121

49.9

(39.6–60.3)

0.3

292

49.9

(44.9–54.9)

2.8

191

58.0

(51.0–65.0)

0.9

0.163

Untreated

104

50.1

(39.7–60.4)

0.3

250

50.1

(45.1–55.1)

2.8

128

42.0

(35.0–49.0)

0.6

Health-care coverage††

Yes

154

61.3

(54.2–68.4)

0.4

504

90.9

(87.5–94.3)

5.1

249

74.1

(68.5–79.7)

1.1

<0.001

No

71

38.7

(31.6–45.8)

0.2

38

9.1

(5.7–12.5)

0.5

70

25.9

(20.3–31.5)

0.4

Routine place for health care§§

Yes

182

75.4

(68.3–82.5)

0.4

510

92.8

(90.3–95.2)

5.2

296

91.6

(87.2–96.0)

1.4

<0.001

No

43

24.6

(17.5–31.7)

0.1

32

7.2

(4.8–9.7)

0.4

23

8.4

(4.0–12.8)

0.1

No. of times received health care in past year¶¶

0

41

22.3

(16.7–27.9)

0.1

47

10.0

(7.0–13.0)

0.6

45

15.3

(11.2–19.4)

0.2

0.005

1

34

17.9

(10.8–24.9)

0.1

59

14.0

(9.6–18.3)

0.8

39

12.5

(8.8–16.1)

0.2

≥2

150

59.8

(53.9–65.8)

0.3

436

76.0

(71.1–80.9)

4.2

235

72.3

(66.7–77.9)

1.1

Abbreviation: CI = confidence interval.

* Defined as an average systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg.

Stages of hypertension were stage 1 hypertension (SBP 140–159 or DBP 90–99) and stage 2 hypertension (SBP ≥160 or DBP ≥100).

§ Pearson chi-squared statistic, corrected for survey design.

Based on responses to the following questions, "Have you ever been told by a doctor or other health-care professional that you had hypertension, also called high blood pressure?" and "Were you told on two or more different visits that you had hypertension or high blood pressure?"

** Based on whether the participant answered "yes" to both of the following questions: "Because of your high blood pressure, have you ever been told to take prescribed medicine?" and "Are you now taking prescribed medicine for high blood pressure?"

†† Participants were asked, "Are you covered by health insurance or some other health-care plan?"

§§ Based on response to the question, "Is there a place that you usually go when sick or need advice about health?"

¶¶ Based on response to the question, "During the past 12 months, how many times have you seen a doctor or other health-care professional about your health, not including being hospitalized overnight?"


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