Table 4.
Odds of reclassification of blood pressure control status among hypertensive adults aged ≥18 years with application of the 2017 Hypertension Guideline compared to JNC‐7—National Health and Nutrition Examination Survey, 2011‐2014a
| JNC‐7b , c | 2017 Hypertension Guidelineb , d | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Ne | BP Controlled | Ne | BP controlled | Differenceg | |||||
| % (95% CI) | Nf | % (95% CI) | Nf | % | N | aORh (95% CI) | |||
| Total | 72.3 | 45.3 (42.0‐48.7) | 32.8 | 104.6 | 24.3 (21.9‐26.8) | 25.4 | −21.1 | −7.4 | |
| Men | 34.4 | 43.1 (39.6‐46.7) | 14.8 | 53.2 | 21.8 (19.7‐24.2) | 11.6 | −21.3 | −3.2 | 0.75 (0.55‐1.00) |
| Women | 37.9 | 47.4 (43.4‐51.5) | 18.0 | 51.3 | 26.9 (23.6‐30.6) | 13.8 | −20.5 | −4.2 | 1.00 |
| Age group (y) | |||||||||
| 18‐44 | 11.0 | 40.1 (33.8‐46.8) | 4.4 | 25.8 | 11.8 (9.3‐14.7) | 3.0 | −28.4 | −1.4 | 1.00 |
| 45‐64 | 33.0 | 51.4 (46.5‐56.3) | 17.0 | 46.1 | 28.1 (25.1‐31.4) | 12.9 | −23.3 | −4.0 | 1.61 (1.05‐2.46) |
| 45‐54 | 12.8 | 51.9 (46.2‐57.5) | 6.7 | 20.5 | 25.3 (21.3‐29.7) | 5.2 | −26.6 | −1.5 | 1.32 (0.81‐2.15) |
| 55‐64 | 20.0 | 51.1 (44.7‐57.6) | 10.2 | 25.5 | 30.3 (26.5‐34.4) | 7.7 | −20.8 | −2.5 | 1.84 (1.12‐3.03) |
| ≥65 | 28.1 | 40.0 (36.5‐43.5) | 11.2 | 32.5 | 28.7 (25.0‐32.6) | 9.3 | −11.3 | −1.9 | 1.04 (0.69‐1.58) |
| 65‐74 | 14.8 | 45.9 (41.2‐50.7) | 6.8 | 17.7 | 31.7 (26.8‐37.0) | 5.6 | −14.2 | −1.2 | 1.18 (0.70‐1.99) |
| ≥75 | 13.5 | 32.5 (27.1‐38.3) | 4.4 | 14.9 | 24.5 (20.1‐29.6) | 3.7 | −7.9 | −0.7 | 0.86 (0.57‐1.29) |
| Race ethnicity | |||||||||
| NH White | 50.3 | 48.3 (43.9‐52.8) | 24.3 | 71.9 | 26.7 (23.8‐29.8) | 19.2 | −21.6 | −5.1 | 1.00 |
| NH Black | 10.7 | 38.6 (34.3‐43.0) | 4.1 | 14.5 | 20.3 (17.0‐24.1) | 3.0 | −18.2 | −1.2 | 1.12 (0.84‐1.50) |
| NH Asian | 2.8 | 33.7 (28.4‐39.3) | 1.0 | 4.2 | 16.0 (12.2‐20.8) | 0.7 | −17.6 | −0.3 | 0.92 (0.63‐1.34) |
| Hispanic | 7.0 | 39.4 (35.0‐43.9) | 2.8 | 11.6 | 18.1 (15.1‐21.6) | 2.1 | −21.3 | −0.7 | 0.79 (0.60‐1.05) |
| Other | 1.5 | 39.5 (24.4‐56.8) | 0.6 | 2.3 | 18.7 (9.0‐34.9) | 0.4 | −20.7 | −0.1 | 0.97 (0.34‐2.72) |
| BMI categoryi | |||||||||
| Normal/Underweight | 13.6 | 32.9 (26.3‐40.3) | 4.5 | 21.3 | 16.8 (12.8‐21.7) | 3.6 | −16.1 | −0.9 | 1.00 |
| Overweight | 23.1 | 50.2 (45.7‐54.8) | 11.6 | 34.9 | 24.9 (21.8‐28.4) | 8.7 | −25.3 | −2.9 | 2.07 (1.31‐3.28) |
| Obese | 35.5 | 46.9 (43.3‐50.6) | 16.7 | 48.3 | 27.1 (24.5‐30.0) | 13.1 | −19.8 | −3.5 | 1.74 (1.24‐2.45) |
| Diabetes mellitusj | |||||||||
| Yes | 18.4 | 37.1 (32.1‐42.4) | 6.8 | 21.5 | 31.7 (27.3‐36.5) | 6.8 | −5.4 | 0.0 | – |
| No | 53.9 | 48.2 (44.3‐52.1) | 25.9 | 83.1 | 22.4 (19.8‐25.1) | 18.6 | −25.8 | −7.4 | |
| Chronic kidney diseasek | |||||||||
| Yes | 21.2 | 33.3 (30‐36.8) | 7.1 | 25.2 | 28.0 (25.0‐31.3) | 7.1 | −5.2 | 0.0 | – |
| No | 51.0 | 50.4 (46‐54.7) | 25.7 | 79.4 | 23.1 (20.2‐26.2) | 18.3 | −27.3 | −7.4 | |
| History of clinical CVDl | |||||||||
| Yes | 14.3 | 48.3 (42.0‐54.6) | 6.9 | 16.2 | 36.6 (31.5‐42.1) | 5.9 | −11.7 | −1.0 | 0.89 (0.53‐1.47) |
| No | 58.0 | 44.6 (40.9‐48.4) | 25.9 | 88.4 | 22.0 (19.7‐24.6) | 19.5 | −22.6 | −6.4 | 1.00 |
| ASCVD riskm | |||||||||
| ≥10% | 30.7 | 36.9 (33.3‐40.7) | 11.3 | 35.5 | 25.7 (22.7‐29.0) | 9.1 | −11.2 | −2.2 | 0.66 (0.42‐1.03) |
| <10% | 26.0 | 62.0 (57.1‐66.7) | 16.1 | 41.8 | 29.2 (26.0‐32.5) | 12.2 | −32.8 | −4.0 | 1.00 |
| Health care access and use | |||||||||
| Health insurancen | |||||||||
| Any | 64.8 | 46.5 (43.3‐49.8) | 30.1 | 89.7 | 26.5 (23.9‐29.2) | 23.7 | −20.1 | −6.4 | 1.07 (0.62‐1.84) |
| Private | 44.0 | 47.9 (43.8‐52.0) | 21.0 | 63.8 | 25.3 (22.4‐28.5) | 16.2 | −22.5 | −4.9 | 1.12 (0.64‐1.98) |
| Medicare | 13.3 | 39.7 (35.0‐44.7) | 5.3 | 15.1 | 29.9 (25.0‐35.2) | 4.5 | −9.9 | −0.7 | 0.77 (0.37‐1.62) |
| Other public | 7.5 | 50.7 (43.5‐57.8) | 3.8 | 10.7 | 28.5 (22.7‐35.0) | 3.0 | −22.2 | −0.8 | 0.99 (0.55‐1.78) |
| None | 7.5 | 35.1 (26.8‐44.4) | 2.6 | 14.9 | 11.2 (8.2‐15.1) | 1.7 | −23.9 | −1.0 | 1.00 |
| Usual source of care | |||||||||
| Yes | 67.8 | 47.4 (43.9‐51.0) | 32.1 | 93.7 | 26.5 (23.8‐29.4) | 24.9 | −20.9 | −7.3 | 11 . 29 (4.89‐26.07) |
| No | 4.5 | 13.9 (8.0‐23.0) | 0.6 | 10.9 | 5.0 (2.6‐9.2) | 0.5 | −8.9 | −0.1 | 1.00 |
| Health care visits past yearo | |||||||||
| 0 | 5.2 | 12.5 (6.6‐22.3) | 0.7 | 11.7 | 5.1 (2.5‐10.0) | 0.6 | −7.4 | −0.1 | 1.00 |
| 1 | 7.4 | 30.5 (24.4‐37.4) | 2.3 | 14.4 | 10.2 (7.4‐13.8) | 1.5 | −20.3 | −0.8 | 11 . 86 (1.82‐77.30) |
| ≥2 | 59.6 | 50.1 (46.7‐53.4) | 29.9 | 78.6 | 29.7 (26.7‐32.9) | 23.3 | −20.3 | −6.5 | 18 . 82 (3.16‐112.24) |
| Established linkages to carep | |||||||||
| Yes | 59.8 | 48.5 (45.0‐51.9) | 29.0 | 79.7 | 28.5 (25.7‐31.5) | 22.7 | −20.0 | −6.3 | 1.91 (1.18‐3.08) |
| No | 12.4 | 30.2 (24.1‐37.1) | 3.8 | 24.9 | 10.8 (8.3‐14.0) | 2.7 | −19.4 | −1.1 | 1.00 |
2017 Hypertension Guideline: 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure; aOR: adjusted odds ratio; ASCVD: atherosclerotic cardiovascular disease; BMI: body mass index; CI: confidence interval; CVD: cardiovascular disease; JNC‐7: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NH: non‐Hispanic.
Estimates in italics are unstable with relative standard errors >30%.
–, Odds ratios undefined.
Includes examined adults aged ≥18 years with ≥1 complete nonzero systolic and diastolic blood pressure (BP) measurement and complete data to establish hypertension and treatment eligibility status. Pregnant women were excluded.
Hypertension is defined as a high average blood pressure (BP) (based on up to 3 measurements) or self‐reported BP‐lowering medication use. BP‐lowering medication use is defined by answers to the questions: "Because of your high blood pressure/hypertension, have you ever been told to take prescribed medicine?" and "Are you now taking prescribed medicine?"
JCN‐7 defines hypertension as BP ≥140/90 mm Hg. BP control is defined as <130/80 mm Hg among those with diabetes or chronic kidney disease who had initiated pharmacologic treatment or <140/90 mm Hg among all other adults.
2017 Hypertension Guideline defines hypertension as BP ≥130/80 mm Hg. BP control is defined as BP <130/80 mm Hg.
Population with hypertension (N in millions), calculated by multiplying the estimated hypertension prevalence (as proportions) by the average 2011‐2012 and 2013‐2014 National Center for Health Statistics’ 2‐year national population counts, which are compiled from the US Census Bureau's American Community Survey (https://wwwn.cdc.gov/nchs/nhanes/ResponseRates.aspx ).
Population with controlled hypertension (N in millions), calculated by multiplying the estimated prevalence of controlled hypertension (as proportions) by the average 2011‐2012 and 2013‐2014 National Center for Health Statistics’ 2‐year national population counts, which are compiled from the US Census Bureau's American Community Survey (https://wwwn.cdc.gov/nchs/nhanes/ResponseRates.aspx ).
Difference in BP control prevalence under JNC‐7 and the 2017 Hypertension Guideline.
Odds for having controlled BP under JNC‐7 but not under the 2017 Hypertension Guideline ("newly" uncontrolled); adjusted for sex, age group, and race/ethnicity.
Defined based on BMI = weight (kg)/height (m)2. Among adults aged ≥20 years: normal/underweight defined as BMI <25.0; overweight defined as BMI 25.0‐29.9; and Obese defined as BMI ≥30.0. Among adults aged 18‐19 years: Normal/Underweight defined as BMI <85th sex‐ and height‐specific percentile; overweight defined as BMI 85th ‐<95th sex‐ and height‐specific percentile; and obese defined as BMI ≥95th sex‐ and height‐specific percentile. BMI percentiles based on: https://www.cdc.gov/growthcharts/html_charts/bmiagerev.htm.
Defined as fasting plasma glucose ≥126 mg/dL, glycohemoglobin (HbA1c) ≥6.5%, or self‐report (an answer of "yes" to the question "Have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?").
Defined as urinary albumin/creatinine ratio >30 mg/g or estimated glomerular filtration rate <60 mL/min per 1.73 m2.
Defined from self‐report: stable or unstable angina, congestive heart failure, acute myocardial infarction, or stroke.
ASCVD risk is calculated among adults aged 40‐79 years, based on the pooled cohort equations from the American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk.
Defined as an answer of "yes" to the question "Are you covered by health insurance or some other kind of health care plan?" Participants reporting only a single‐service plan were defined as not insured. Other public insurance includes Medigap, Medicaid, SCHIP, military health plan, Indian Health Service, state‐sponsored health plan, or other government insurance.
Defined as an answer of "yes" or "there is more than one place" to the question "Is there a place that you usually go when you are sick or you need advice about your health?"
Based on answers to the question "During the past 12 months, how many times have you seen a doctor or other health care professional about your health at a doctor's office, a clinic or some other place?"
Defined as having health insurance, having a usual source of health care, and ≥1 health care visit in the past year.