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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.
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.
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.
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.
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.
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.
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.
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.
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.
** 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?"
