Self-reported Hypertension and Use of Antihypertensive Medication Among Adults

United States, 2005-2009

Jing Fang, MD; Carma Ayala, PhD; Fleetwood Loustalot, PhD; Shifan Dai, MD, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2013;62(13):237-244. 

In This Article

Introduction

Hypertension affects one third of adults in the United States[1] and is a major risk factor for heart disease and stroke.[2] A previous report found differences in the prevalence of hypertension among racial/ethnic populations in the United States; blacks had a higher prevalence of hypertension, and Hispanics had the lowest use of antihypertensive medication.[3] Recent variations in geographic differences in hypertension prevalence in the United States are less well known.[4] To assess state-level trends in self-reported hypertension and treatment among U.S. adults, CDC analyzed 2005–2009 data from the Behavioral Risk Factor Surveillance System (BRFSS). The results indicated wide variation among states in the prevalence of self-reported diagnosed hypertension and use of antihypertensive medications. In 2009, the age-adjusted prevalence of self-reported hypertension ranged from 20.9% in Minnesota to 35.9% in Mississippi. The proportion reporting use of antihypertensive medications among those who reported hypertension ranged from 52.3% in California to 74.1% in Tennessee. From 2005 to 2009, nearly all states had an increased prevalence of self-reported hypertension, with percentage-point increases ranging from 0.2 for Virginia (from 26.9% to 27.1%) to 7.0 for Kentucky (from 27.5% to 34.5%). Overall, from 2005 to 2009, the prevalence of self-reported hypertension among U.S. adults increased from 25.8% to 28.3%. Among those reporting hypertension, the proportion using antihypertensive medications increased from 61.1% to 62.6%. Increased knowledge of the differences in self-reported prevalence of hypertension and use of antihypertensive medications by state can help in guiding programs to prevent heart disease, stroke, and other complications of uncontrolled hypertension, including those conducted by state and local public health agencies and health-care providers.

BRFSS is a state-based telephone survey of health behaviors among adults aged ≥18 years.* The survey has been conducted by state health departments, with assistance from CDC, since 1984. Questions on hypertension are asked in odd-numbered years. Since 2005, two questions about hypertension have been included in BRFSS. The first question is, "Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?" Respondents who answer "yes" to the first question are then asked, "Are you currently taking medicine for your high blood pressure?" These questions were used to assess prevalence of self-reported hypertension and proportion reporting antihypertensive medication use among those with reported hypertension in 2005, 2007, and 2009. Estimates were calculated for the United States overall and for the 50 states and the District of Columbia. In addition to analysis by state, estimates were analyzed by age group, sex, race/ethnicity, and level of education. Age-adjusted estimates were calculated using the 2000 U.S. standard population. Linear trends were assessed using orthogonal polynomial coefficients, and results were considered significant at p<0.05.

Median state response rates for BRFSS were 51.1% (range: 34.6%–67.4%) in 2005, 50.6% (range: 26.9%–65.4%) in 2007, and 52.5% (range: 37.9%–66.9%) in 2009. Total respondents were 356,112 in 2005, 430,912 in 2007, and 432,617 in 2009. State sample sizes ranged from 2,432 in 2009 (Alaska) to 39,549 in 2007 (Florida).

From 2005 to 2009, overall age-adjusted prevalence of self-reported hypertension in the United States increased from 25.8% to 28.3% ( Table 1 ). Self-reported hypertension ranged from 21.1% (Colorado) to 33.5% (Mississippi) in 2005, and from 20.9% (Minnesota) to 35.9% (Mississippi) in 2009. From 2005 to 2009, nearly all states had an increased prevalence of self-reported hypertension, with percentage-point increases ranging from 0.2 for Virginia (from 26.9% to 27.1%) to 7.0 for Kentucky (from 27.5% to 34.5%). In 2009, the prevalence of self-reported hypertension was, in general, higher in southern states and lower in western states (Figure).

Figure.

Age-adjusted prevalence of self-reported hypertension among adults and the proportion of those participants reporting use of antihypertensive medication, by state — Behavioral Risk Factor Surveillance System, United States, 2009

Among those with self-reported hypertension, the estimated number of participants reporting use of antihypertensive medications was 45,023,301 in 2005, 50,191,337 in 2007, and 53,602,447 in 2009; the proportion increased from 61.1% (2005) to 62.6% (2009). In 2009, among those with self-reported hypertension, the proportion reporting current use of antihypertensive medication was highest in Tennessee (74.1%) and lowest in California (52.3%); however, Tennessee showed no significant change in reported antihypertensive medication use from 2005 to 2009, whereas California had a significant increase, from 48.0% to 52.3%. As with self-reported hypertension, the proportion of participants reporting use of antihypertensive medication generally was higher in southern states and lower in western states (Figure). States that showed significant increases in use of antihypertensive medications included California, Iowa, and Michigan, whereas Kentucky, Nebraska, and Rhode Island had significant decreases.

By selected characteristics, self-reported hypertension prevalence in 2009 was significantly higher among persons aged ≥65 years (59.6%) compared with persons aged 18–44 years (13.3%) and 45–64 years (37.1%); among men (30.3%) compared with women (26.2%); among blacks (39.6%) compared with American Indian/Alaska Natives (32.0%), Hispanics (27.6%), whites (27.1%), and Asian/Pacific Islanders (24.0%); and among those with less than a high school education (33.6%) compared with those with a high school education (31.4%), those with some college (29.2%), and those with a college degree or higher (23.8%). From 2005 to 2009, the prevalence of self-reported hypertension increased for all sociodemographic subgroups, although the linear trends were not significant for Hispanics, Asian/Pacific Islanders, and American Indian/Alaska Natives ( Table 1 ).

Among persons reporting hypertension in 2009, the proportion reporting antihypertensive medication use was significantly higher among persons aged ≥65 years (94.1%) compared with those aged 18–44 years (45.1%) and 45–64 years (82.3%); among women (66.9%) compared with men (59.9%); and among blacks (71.6%) compared with Hispanics (55.2%) ( Table 2 ). From 2005 to 2009, significant increases in self-reported use of antihypertensive medication among those reporting hypertension were observed among blacks (from 67.0% to 71.6%) and Hispanics (from 51.2% to 55.2%).

* Details on BRFSS methodology, sampling procedures, design, and quality are available at http://www.cdc.gov/brfss.
In this report, persons identified as Hispanic might be of any race. Persons identified as black, white, Asian/Pacific Islander, or American Indian/Alaska Native are non-Hispanic. The five racial/ethnic categories are mutually exclusive.

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