How many people in the United States have high blood pressure?

According to the 2017 ACC/AHA Hypertension Guidelines, the threshold for diagnosing hypertension is now defined as ≥ 130/80 mm Hg.¹ The previous threshold from the 2003 JNC7 guidelines was ≥140/90.^2,3 Overall prevalence of hypertension in the United States for adults changed from 32% with the 2003 threshold to 46% with the 2017 threshold.¹

An analysis on the impact of the 2017 guidelines on the US population found that there is a significant rise in the prevalence of hypertension due to the revised hypertension definitions.⁴ However, it found only a small increase in the number of US adults who will need antihypertensive medication based on the new guidelines’ pharmacological treatment recommendations. This analysis was performed on the data of 9,623 participants (≥20 years of age) in the National Health and Nutrition Examination Survey, 2011–2014. It found the overall crude prevalence of hypertension in US adults over age 20 was 45.6% (95% confidence interval [CI] [43.6% – 47.6%]) based on the 2017 ACC/AHA guidelines and 31.9% (95% CI [30.1% – 3.7%]) based on the 2003 JNC7 guidelines. Based on these guidelines, respectively, antihypertensive medication would be recommended for 36.2% (95% CI [34.2% – 38.2%]) and 34.3% (95% CI [32.5% – 36.2%]) of US adults over age 20. In the US according to the 2017 guidelines, 103.3 (95% CI [92.7 – 114.0]) million adults have hypertension. About 81.9 (95% CI [73.8 – 90.1]) million should be recommended antihypertensive medication according to the guideline.

^References

1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.
2. 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 (6): 1206-1252.
3. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA 2014; 311 (5): 507-520.
4. Muntner P, Carey RM, Gidding S, et al. Potential U.S. population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol 2018; 71 (2): 109-118.