Trends in Blood Pressure Control among US Adults With Hypertension, 2013-2014 to 2021-2023

BACKGROUND: Prior studies have reported a decrease in the proportion of US adults with hypertension who had controlled blood pressure (BP). METHODS: We analyzed data from the National Health and Nutrition Examination Survey (n = 25,128, >= 18 years of age) to determine changes in BP control from 2013-2014 to 2021-2023. Hypertension was defined as systolic BP >= 140 mm Hg, diastolic BP >= 90 mm Hg, or antihypertensive medication use. BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. RESULTS: The age-adjusted prevalence of hypertension (95% CI) was 32.8% (31.2%-34.4%) in 2013-2014 and 32.0% (30.1%-33.9%) in 2021-2023. Among US adults with hypertension, the age-adjusted proportion (95% CI) with controlled BP was 54.1% (49.1%-59.2%), 48.6% (44.5%-52.7%), and 48.3% (45.8%-50.8%) in 2013-2014, 2015-2016, and 2017-2020, respectively, (P-trend = 0.058), and 51.1% (47.9%-54.3%) in 2021-2023 (P-value = 0.184 comparing 2021-2023 vs. 2017-2020). The proportion (95% CI) of US adults taking antihypertensive medication with controlled BP was 72.0% (68.5%-75.5%), 66.7% (62.9%-70.5%), and 67.8% (65.3%-70.3%) in 2013-2014, 2015-2016, and 2017-2020, respectively, (P-trend = 0.085), and 68.3% (64.8%-71.9%) in 2021-2023 (P-value = 0.654 comparing 2021-2023 vs. 2017-2020). Among non-Hispanic Black adults, BP control increased from 37.4% (95% CI 33.6%-41.1%) to 49.6% (95% CI 42.3%-56.9%) between 2017-2020 and 2021-2023 for those with hypertension (P-value = 0.005), and from 52.6% (95% CI 47.4%-57.8%) to 62.6% (95% CI 55.6%-69.7%) for those taking antihypertensive medication (P-value = 0.033). There was no difference in BP control across race/ethnicity groups in 2021-2023. CONCLUSIONS: The decline in BP control from 2013-2014 to 2017-2020 did not continue through 2021-2023. An increase in BP control occurred from 2017-2020 and 2021-2023 among non-Hispanic Black adults.