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Original Article

Trends in the Prevalence, Awareness, Treatment, and Control


of Hypertension Among Young Adults in the United
States, 1999 to 2014
Yiyi Zhang, Andrew E. Moran

Abstract—Overall hypertension prevalence has not changed in the United States in recent decades although awareness,
treatment, and control improved. However, hypertension epidemiology and its temporal trends may differ in younger adults
compared with older adults. Our study included 41 331 participants ≥18 years of age from 8 National Health and Nutrition
Examination Surveys (1999–2014) and estimated temporal trends of hypertension, awareness, treatment, and control
among young adults (age, 18–39 years) compared with middle-age (age, 40–59 years) and older adults (age, ≥60 years).
In 2013 to 2014, 7.3% of the US young adults had hypertension. During 1999 to 2014, young adults saw larger increases
in hypertension awareness, treatment, and control than did older adults. However, all of these components of hypertension
control were lower among young adults compared with middle-aged or older adults (74.7% younger versus 81.9% middle
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versus 88.4% older for awareness; 50.0% versus 70.3% versus 83.0% for treatment; and 40.2% versus 56.7% versus 54.4%
for control). Worse hypertension awareness, treatment, and control in young adults overall were mostly driven by worse
measures in young adult men compared with young adult women. More frequent healthcare visits by young adult women
explained ≈28% of the sex-related difference in awareness, 60% of the difference in treatment, and 52% of the difference in
control. These findings suggest that improved access to and engagement in medical care might improve hypertension control
in young adults, particularly young adult men, and reduce life-time cardiovascular risk.  (Hypertension. 2017;70:00-00.

DOI: 10.1161/HYPERTENSIONAHA.117.09801.) Online Data Supplement
Key Words: blood pressure ■ body mass index ■ cardiovascular diseases ■ hypertension ■ young adult

H ypertension is a major cardiovascular disease risk


factor, costing an estimated $51.2 billion in 2012 to
2013 in the United States.1,2 Prior studies demonstrated an
risk factor for stroke, and ≈10% of all strokes occur in indi-
viduals 18 to 50 years of age.13–15 In contrast to the decline
in overall age-adjusted rates of stroke mortality and hos-
increase in hypertension prevalence from 1988–1994 to pitalization in the past 2 decades, hospitalization for acute
1999–2000, followed by stable prevalence from 1999–2000 ischemic stroke increased significantly among young adults
to 2009–2010.3–6 Overall awareness, treatment, and con- <45 years of age.2,16,17 Increased prevalence of overweight
trol among adults with hypertension also improved during and obesity among adolescents in recent decades may be
the same time interval.3–7 Despite this progress, awareness, leading to a higher young adult hypertension prevalence that
treatment, and control appeared to be worse among young will continue into the future.18,19 Therefore, young adulthood
adults compared with middle-aged and older adults.3–6,8 represents an important age interval for early hypertension
However, previous studies mainly focused on the overall prevention and treatment, which has the potential to reduce
population and did not examine age-specific hypertension short-term and later life cardiovascular disease risk.
trends; and when they did, the young adult (18–39 years) Using data from 8 National Health and Nutrition
sample size was small, limiting precise estimates of trends Examination Surveys (NHANES), we examined the preva-
in this age group.6 lence and temporal trends in hypertension, awareness, treat-
Pathological changes to the vasculature and myocar- ment, and control among US young adults aged 18 to 39 years
dium are often caused by cumulative early life exposure to compared with other adult age groups during the years 1999 to
high blood pressure.9,10 High blood pressure in young adult- 2014. We also explored factors that may contribute to the age-
hood is associated with increased risks of cardiovascular related differences in hypertension epidemiology, including
disease and mortality decades later, independent of later life sex, race/ethnicity, body mass index (BMI), insurance cover-
blood pressure levels.11,12 High blood pressure is the leading age, and healthcare use.

Received May 30, 2017; first decision June 16, 2017; revision accepted July 12, 2017.
From the Division of General Medicine, Columbia University, New York, NY.
The online-only Data Supplement is available with this article at http://hyper.ahajournals.org/lookup/suppl/doi:10.1161/HYPERTENSIONAHA.
117.09801/-/DC1.
Correspondence to Andrew E. Moran, Division of General Medicine, Columbia University Medical Center, Presbyterian Hospital, 9th Floor E, Room
105, 622 W, 168th St, New York, NY 10032. E-mail aem35@cumc.columbia.edu
© 2017 American Heart Association, Inc.
Hypertension is available at http://hyper.ahajournals.org DOI: 10.1161/HYPERTENSIONAHA.117.09801

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Methods examined the prevalence of hypertension, awareness, treatment, and


control further stratified by sex and race/ethnicity. Relative SEs were
calculated for each estimate, and estimates with relative SE ≤ 30%
Study Design and Population were considered reliable estimates.
The NHANES, conducted by the National Center for Health Statistics/ We used multivariable logistic regression models to examine
Centers for Disease Control and Prevention, constitutes a series of whether differences in the distribution of sex, race/ethnicity, BMI,
cross-sectional, multistage probability surveys representative of the health insurance, and healthcare use may contribute to the differ-
civilian noninstitutionalized US population.20 The NHANES has con- ences in trends by age group. We first fit an unadjusted model with
tinuously collected data in 2-year cycles since 1999, and we used hypertension, pre-hypertension, awareness, treatment, and control,
data from 8 consecutive 2-year surveys from 1999 to 2014 to estimate respectively, as the outcome variable and age, survey period, and age-
recent trends in the prevalence of hypertension. Of the 47 356 par- by-survey interaction as covariates. We then fit an adjusted model by
ticipants ≥18 years of age who were both interviewed and examined, including sex, race/ethnicity, BMI, health insurance, and healthcare
we excluded 4651 participants with missing blood pressure measure- visits as covariates in the regression model. We computed the predict-
ments and 1374 women who were pregnant. The final analysis was ed prevalence for the unadjusted and adjusted models to determine
based on 41 331 participants (20 765 men and 20 566 women). All the extent to which sex, race/ethnicity, BMI, health insurance status,
participants provided written informed consent, and the survey proto- and healthcare visit frequency may explain the differences by age
cols were approved by the National Center for Health Statistics ethics groups. In addition, to calculate the total number of noninstitutional-
review board. ized US adults with hypertension in 2013 to 2014, we multiplied the
prevalence estimates from NHANES 2013 to 2014 (not age adjusted
Data Collection to the 2000 US Census) by the corresponding population totals from
NHANES included a standardized questionnaire administered in the the Current Population Surveys.21 All statistical analyses were per-
formed using STATA version 14 (StataCorp LP, College Station, TX).
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home by a trained interviewer and a detailed physical examination


at a mobile examination center.20 Race/ethnicity was self-reported
by participants during in-person interviews and categorized as non-
Hispanic white, non-Hispanic black, Mexican-American, and other Results
(including multiracial). Health insurance status (yes/no) and the total In 2013 to 2014, unadjusted hypertension prevalence was 31.6
number of healthcare visits to a doctor’s office, clinic, hospital emer- (29.6%–33.6%) in the overall adult population, 7.3% (95%
gency room, at home, or some other places in the prior year (none, confidence interval, 6.2%–8.5%) in those aged 18 to 39 years,
1–3 times, ≥4 times) were self-reported by the participants. BMI
was calculated as weight in kilograms divided by height in meters
32.7% (29.6%–35.7%) in those aged 40 to 59 years, and
squared. 65.6% (61.6%–69.6%) in those aged ≥60 years (Figure 1).
Blood pressures were measured in the mobile examination center This equates to an estimated 75.1 million adults ≥18 years
by trained physicians following a standard protocol.21 After resting of age with hypertension (6.7, 27.7, and 40.3 million among
quietly in a seated position for 5 minutes, 3 consecutive blood pres- those 18–39, 40–59, and ≥60 years of age, respectively). In
sure readings were obtained by the auscultatory method using a mer-
cury sphygmomanometer and appropriate cuff size determined from addition, 214 million (23.4%) adults aged 18 to 39 years, 229
an upper arm circumference measurement. If a blood pressure mea- million (27.1%) aged 40 to 59 years, and 125 million (20.3%)
surement was interrupted or incomplete, a fourth attempt was made. aged ≥60 years were pre-hypertensive.
All available readings were used to calculate the mean systolic blood Age-standardized prevalence of hypertension remained
pressure (SBP) and diastolic blood pressure (DBP) for each partici- unchanged from 1999 to 2014, whereas there was a decrease
pant. Hypertension was defined as an SBP ≥ 140 mm Hg, or a DBP
≥ 90 mm Hg, or current use of blood pressure–lowering medications. in pre-hypertension and increases in the awareness, treat-
Pre-hypertension was defined as an SBP 120 to 139 mm Hg or a DBP ment, and control of hypertension in all age groups (Figure 2;
80 to 89 mm Hg among those without hypertension.2 Awareness of Table S1 in the online-only Data Supplement). Young adults
hypertension was defined as an affirmative response to the question aged 18 to 39 years saw the largest reduction in pre-hyper-
“Have you ever been told by a doctor or health professional that you
tension, from 32.2% in 1999 to 2000 to 23.4% in 2013 to
had hypertension, also called high blood pressure?.”7 Treatment of
hypertension was defined as affirmative responses to both questions 2014. Awareness, treatment, and control of hypertension
“Because of your high blood pressure/hypertension, have you ever improved the most among young adults during the same
been told to take prescribed medicine?” and “Are you now taking pre- period, from 52.1% to 74.7% for awareness, from 27.7% to
scribed medicine for high blood pressure?.” Controlled hypertension 50.0% for treatment, and from 14.1% to 40.2% for control
was defined as an SBP < 140 mm Hg and DBP < 90 mm Hg among
those with hypertension.
of hypertension, respectively. Despite these improvements,
hypertension awareness and management remained signifi-
cantly lower among young adults compared with those ≥40
Statistical Analyses
years. These age-related differences were not explained by
We used mobile examination center survey sampling weights to
account for the complex survey design of NHANES and to produce the different distributions of sex, race/ethnicity, and BMI
estimates representative of the civilian noninstitutionalized US popu- (data not shown) but partly explained by health insurance
lation. Age-standardized weighted prevalence of hypertension and status and healthcare use (Figures S1 and S2). Lower like-
the percentage of awareness, treatment, and control of hypertension lihood of health insurance coverage and fewer healthcare
were calculated for each age group (18–39, 40–59, ≥60 years of age).
For hypertension and pre-hypertension, prevalence estimates were
visits in young adults explained ≈11% and 21% of the age-
age standardized to the 2000 US Census population using appropri- related difference in awareness, 8% and 11% of the differ-
ate weights to allow comparisons across different survey cycles. For ence in treatment, and 12% and 26% of the difference in
awareness, treatment, and control, estimates were age standardized to control, respectively, in 2013 to 2014. Of note, although
the age distribution of the subgroup of participants who had hyper- the overall control rate of hypertension was lower among
tension.7,22 We used logistic regression to examine the differences in
hypertension prevalence by age group. Tests for trends across sur- young adults, when treated, young adults were more likely
vey cycles were calculated by including the midpoint of each survey to achieve blood pressure control compared with older adults
period as a continuous variable in the logistic regression. We also (80.4% versus 65.5% in 2013–2014).
Zhang and Moran   Trends in Hypertension Among US Young Adults   3

Figure 1. Prevalence and total number (in


millions) of noninstitutionalized US adults
with hypertension in 2013 to 2014.

When further stratified by sex, temporal trends in hyper- young adult men (68.4% versus 86.0% for awareness; 43.7%
tension prevalence, awareness, treatment, and control in men versus 61.3% for treatment; and 33.7% versus 51.8% for
and women were similar to those observed in the overall pop- control, respectively, in 2013–2014). Young adult women
ulation (Figure 3). However, young adult men had a substan- reported on average more healthcare visits than men (Figure
tially higher prevalence of pre-hypertension compared with S3). More frequent healthcare visits in women explained
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young adult women (33.6% versus 12.8% in 2013–2014). ≈28% of the sex-related difference in awareness, 60% of the
Awareness, treatment, and control were also much lower in difference in treatment, and 52% of the difference in control in

Figure 2. Age-standardized weighted prevalence (95% confidence interval) of hypertension, pre-hypertension, awareness, treatment, and
control by age.
4  Hypertension  October 2017
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Figure 3. Age-standardized weighted prevalence (95% confidence interval) of hypertension, pre-hypertension, awareness, treatment, and
control by age and sex.

2013 to 2014 (Figure S4). In contrast, health insurance status obese among those with hypertension was 2.87 (95% confi-
explained little of the differences in hypertension awareness dence interval, 1.82–4.51) comparing young adults to those
(5%), treatment (8%), and control (8%) between young adult aged ≥40 years, adjusting for sex and race/ethnicity.
men and women.
When stratified by race/ethnicity, non-Hispanic blacks had Discussion
a higher prevalence of hypertension compared with non-His- In a representative sample of noninstitutionalized US adults,
panic whites or Mexican-Americans across the years (Figure hypertension prevalence remained unchanged from 1999 to
S5). Among adults ≥40 years of age, awareness and treatment 2014, whereas there was a decrease in pre-hypertension and
were higher in non-Hispanic blacks, but the prevalence of an increase in the awareness, treatment, and control of hyper-
controlled hypertension was lower compared with non-His- tension. Despite these improvements, awareness, treatment,
panic whites. Hypertension awareness, treatment, and control and control were worse among young adults 18 to 39 years
stratified by race/ethnicity could not be reliably compared for of age compared with those ≥40 years. Worse hypertension
participants aged 18 to 39 years because of small numbers. awareness, treatment, and control in young adults were mostly
Among those with hypertension, obesity prevalence driven by lower prevalence of awareness, treatment, and con-
increased over time and was particularly high among young trol in young adult men compared with young adult women
adults (Figure 4). The age-standardized prevalence of obesity and were partly explained by fewer healthcare visits in young
increased from 65% in 1999 to 2000 to 73% in 2013 to 2014 adult men. These findings suggest that public health and medi-
among those aged 18 to 39 years, from 51% to 57% among cal care outreach efforts on young adults, particularly young
those aged 40 to 59 years, and from 35% to 42% among those adult men, could prevent hypertension and, potentially, later
aged ≥60 years. In 2013 to 2014, the odds ratio for being life cardiovascular disease.
Zhang and Moran   Trends in Hypertension Among US Young Adults   5
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Figure 4. Age-standardized weighted prevalence of overweight and obesity among participants with hypertension.

Our study showed that the prevalence of hypertension control. We did observe that although the overall control
remained unchanged from 1999–2000 to 2013–2014 in all rate of hypertension was lower among young adults com-
age groups, consistent with previous findings.3,4 In addition, pared with middle-aged or older adults, when treated, young
we found that the prevalence of pre-hypertension decreased and middle-aged adults were more likely to achieve blood
from 31.1% to 24.0% in the same period, with the largest pressure control compared with older adults. This might be
reduction seen among young adults 18 to 39 years of age. explained by a higher proportion of stage 2 hypertension and
This decline in pre-hypertension was consistent with another higher prevalence of comorbidities limiting pharmacological
recent NHANES report.23 The exact reason for this decline is treatment among older adults.27,28
unclear; however, we observed a decrease in current smok- We also observed sex-related differences in pre-hyperten-
ing in our study with the largest reduction seen among young sion, awareness, and management among young adults, with
adults (data not shown), suggesting that decrease in smok- young adult men having substantially higher prevalence of
ing may partly explain the decrease in pre-hypertension.24 pre-hypertension and lower awareness, treatment, and control
Dietary patterns (eg, sodium and potassium intakes) may have compared with young adult women. Sex-related differences
changed as well during this period, but these changes were not were diminished in those ≥40 years of age. This awareness
reliably measurable in NHANES. Further research is needed and treatment gap between younger and older adult men is not
to better understand how changes in these factors or others a phenomenon unique to the United States: it has also been
may explain the decline in pre-hypertension in young adults. observed in China, South Korea, and Germany.29–31 Young
Hypertension awareness, treatment, and control increased women may be more likely to have their blood pressure
from 1999–2000 to 2013–2014, with the largest percentage checked than young men (eg, during regular gynecological
point improvements among young adults. Despite this prog- care or pregnancy).32 Accordingly, when we adjusted for num-
ress, only 53.9% of the hypertensive adults had their blood ber of healthcare visits in the past year as a surrogate marker
pressure controlled in 2013 to 2014, which was substantially of healthcare use, higher number of visits in women explained
lower than the Healthy People 2020 goal of 62.1%.25 some of the sex-related differences. These results were con-
Young adults 18 to 39 years have significantly lower sistent with previous NHANES reports,33,34 as well as with
awareness, treatment, and control of hypertension compared results from a cross-sectional study of young adults aged 24 to
with adults aged ≥40 years. Lower prevalence of treatment 32 years from the National Longitudinal Study of Adolescent
among young adults might be due, in part, to healthcare pro- Health, which found that hypertension awareness was ≈2-fold
viders’ uncertainty and concern about long-term benefits and higher in young adults who had seen a provider for routine
adverse effects of early pharmacological intervention in this healthcare in the past 2 years.35 Taken together, these findings
age group. As a case in point, the 2014 National Hypertension suggest that efforts to improve blood pressure control among
Guidelines strongly recommended treating raised DBP in young adults, particularly men, should focus on raising aware-
adults aged ≥30 years but only weakly recommended treat- ness, improving screening strategy, and advancing follow-up
ment in those aged 18 to 29 years.26 The best tolerated and and subsequent linkage to care.4,35 With implementation of the
safest approach to controlling blood pressure in young adults Affordable Care Act, the rate of insurance in US adults aged
may be lifestyle modifications, such as reduced sodium 19 to 25 years old increased by >10% since 2010, represent-
intake, weight loss, and physical activity. We were not able to ing an increase of ≈6.1 million young adults with access to
examine young adult uptake of these behaviors in the present a regular source of medical care, and potentially, prevention
analysis or how increased uptake might affect hypertension programs.36 In our analysis, health insurance coverage alone
6  Hypertension  October 2017

did not explain low hypertension awareness, treatment, or Disclosures


control in young adult men, suggesting that low preventive None.
services uptake may be more important than insurance status
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Novelty and Significance


What Is New? Summary
• Hypertension awareness, treatment, and control improved in US young There remain important quality gaps in today’s approach to blood
adults in the past 15 years but remained substantially lower compared
pressure control in young adults. Public health efforts to improve
with middle-aged and older adults.
blood pressure control among young adults, particularly men, should
• Young adult men had worse hypertension awareness, treatment, and focus on raising awareness and improving outreach in medical,
control compared with young adult women.
worksite, and community settings.
What Is Relevant?
• In 2013 to 2014, 6.7 million US young adults had hypertension, of whom
only 50% were treated and 40% controlled.
Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among
Young Adults in the United States, 1999 to 2014
Yiyi Zhang and Andrew E. Moran

Hypertension. published online August 28, 2017;


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Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension among

Young Adults in the United States, 1999-2014

Yiyi Zhang, PhD,1 Andrew E Moran, MD, MPH1

1 Division of General Medicine, Columbia University, New York, NY

Correspondence: Andrew E. Moran, MD, MPH, Columbia University Division of General

Medicine, Presbyterian Hospital, 9th Fl. East, Rm. 105, 622 West 168th St., New York, NY

10032, Tel: 212-305-2569, Email: aem35@cumc.columbia.edu

Brief title: Trends in hypertension among U.S. young adults

Word count (abstract): 232

Word count (text): 3,076

Total number of figures: 4

1
Table S1. Age-standardized weighted prevalence (standard error) of hypertension, and awareness, treatment, and control of
hypertension per 100 adults in the US general population
Overall By NHANES survey cycle
Age 1999- 2001- 2003- 2005- 2007- 2009- 2011- 2013-
groups Total 2000 2002 2004 2006 2008 2010 2012 2014
Cases P-trend
N (n = (n = (n = (n = (n = (n = (n = (n =
4,487) 4,945) 4,668) 4,693) 5,615) 5,988) 5,294) 5,641)
Hypertension
All 41,331 14,229 28.7 (1.4) 28.0 (0.9) 29.7 (1.1) 29.0 (1.0) 29.6 (0.7) 28.5 (0.9) 28.7 (0.7) 29.4 (0.9)
Age
(years)
18-39 15,669 1,053 7.6 (1.6) 6.4 (0.5) 6.8 (0.8) 7.2 (1.0) 7.8 (0.9) 6.8 (0.7) 7.3 (0.6) 7.3 (0.5) 0.80
40-59 12,490 4,174 30.2 (2.0) 29.3 (1.9) 33.1 (2.2) 31.2 (1.8) 32.2 (1.3) 30.4 (2.0) 31.8 (1.4) 32.7 (1.4) 0.61
≥60 13,172 9,002 66.1 (1.9) 66.9 (1.8) 67.2 (1.7) 66.5 (1.6) 66.5 (1.8) 66.7 (1.8) 64.4 (1.8) 65.6 (1.9) 0.64
P-value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Prehypertension
All 41,331 10,717 31.1 (1.0) 29.8 (0.9) 28.2 (0.9) 28.2 (1.2) 27.0 (1.0) 25.9 (1.0) 28.1 (1.1) 24.0 (0.7)
Age
(years)
18-39 15,669 4,286 32.2 (1.2) 30.6 (1.8) 27.0 (1.3) 29.0 (1.8) 27.1 (1.7) 27.6 (1.4) 27.6 (1.6) 23.4 (1.4) <0.001
40-59 12,490 3,894 34.7 (1.6) 34.0 (1.2) 34.9 (1.6) 33.7 (1.9) 30.9 (1.2) 29.2 (1.5) 33.9 (1.7) 27.1 (1.3) <0.001
≥60 13,172 2,537 23.1 (1.5) 21.2 (1.5) 19.9 (1.3) 17.7 (0.7) 20.4 (1.4) 17.5 (1.0) 19.9 (1.8) 20.3 (1.5) <0.001
P-value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Awareness (among participants with hypertension)
All 14,229 11,142 69.5 (2.0) 70.5 (1.5) 75.1 (1.7) 77.9 (1.5) 79.7 (1.1) 81.5 (1.5) 82.1 (1.8) 84.4 (1.3)
Age
(years)
18-39 1,053 602 52.1 (7.2) 48.6 (3.1) 53.7 (6.3) 51.8 (4.6) 64.7 (7.9) 58.7 (5.6) 61.5 (4.7) 74.7 (3.4) <0.001
40-59 4,174 3,274 73.0 (3.0) 72.1 (2.7) 75.1 (2.7) 79.2 (2.2) 79.1 (2.4) 84.1 (1.8) 82.5 (2.6) 81.9 (2.8) <0.001
≥60 9,002 7,266 70.0 (1.9) 73.4 (1.3) 79.3 (1.9) 81.9 (1.6) 83.2 (1.4) 84.0 (1.6) 85.8 (1.6) 88.4 (1.1) <0.001

2
P-value 0.03 <0.001 <0.001 <0.001 0.01 <0.001 <0.001 <0.001
Treatment (among participants with hypertension)
All 14,229 9,949 59.1 (2.7) 60.2 (1.7) 64.7 (2.2) 67.8 (1.6) 71.6 (1.2) 75.8 (1.7) 74.5 (1.9) 74.7 (2.2)
Age
(years)
18-39 1,053 418 27.7 (5.7) 35.9 (3.0) 39.3 (7.6) 29.3 (4.3) 49.1 (5.9) 46.0 (5.4) 44.0 (5.7) 50.0 (4.2) 0.001
40-59 4,174 2,784 62.1 (3.3) 58.8 (2.3) 61.4 (4.0) 66.1 (2.5) 67.7 (2.7) 77.0 (2.6) 72.9 (2.7) 70.3 (4.0) <0.001
≥60 9,002 6,747 62.8 (3.2) 66.1 (2.1) 72.2 (2.0) 76.6 (1.8) 79.1 (1.4) 80.6 (1.6) 81.7 (1.8) 83.0 (1.5) <0.001
P-value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Controlled (among participants treated for hypertension)
All 9,949 6,121 53.1 (2.5) 58.9 (1.2) 62.4 (2.3) 65.8 (1.8) 68.3 (1.4) 70.1 (1.2) 70.3 (1.9) 73.0 (1.5)
Age
(years)
50.9
18-39 418 301 80.0 (6.4) 77.3 (5.9) 81.5 (6.4) 82.7 (5.3) 71.2 (5.7) 78.1 (5.4) 80.4 (5.1) 0.13
(10.9)
40-59 2,784 1,942 65.6 (3.5) 63.0 (2.6) 66.9 (3.2) 71.6 (3.2) 73.8 (1.8) 72.4 (2.4) 79.1 (3.1) 80.7 (2.6) <0.001
≥60 6,747 3,878 43.5 (2.4) 51.6 (1.3) 55.9 (2.6) 58.2 (2.2) 61.3 (2.0) 68.1 (1.4) 61.9 (2.7) 65.5 (1.8) <0.001
P-value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Controlled (among all participants with hypertension)
All 14,229 6,121 31.4 (2.4) 34.8 (1.5) 39.7 (2.2) 43.7 (1.5) 48.3 (1.6) 53.1 (1.7) 51.8 (2.4) 53.9 (2.6)
Age
(years)
18-39 1,053 301 14.1 (2.9) 28.7 (3.9) 30.4 (7.3) 23.9 (4.3) 40.6 (6.0) 32.8 (5.0) 34.4 (5.5) 40.2 (3.9) <0.001
40-59 4,174 1,942 40.8 (3.4) 37.1 (2.6) 41.1 (3.7) 47.4 (2.4) 49.9 (2.4) 55.7 (2.4) 57.7 (3.9) 56.7 (4.7) <0.001
≥60 9,002 3,878 27.4 (2.3) 34.1 (1.4) 40.4 (1.9) 44.6 (2.3) 48.4 (2.0) 54.9 (2.0) 50.6 (2.5) 54.4 (1.9) <0.001
P-value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

3
Figure S1. Age-standardized weighted prevalence of health insurance and healthcare
visits among participants with hypertension, by age group.

4
Figure S2. Unadjusted and adjusted prevalence of hypertension, and awareness,
treatment, and control of hypertension by age.

5
Figure S3. Age-standardized weighted prevalence of health insurance and healthcare
visits among participants with hypertension, by age and sex.

6
Figure S4. Unadjusted and adjusted prevalence of hypertension awareness, treatment,
and control by sex among young adults 18-39 years of age.

7
Figure S5. Age-standardized weighted prevalence (95% CI) of hypertension,
prehypertension, awareness, treatment, and control by age and race.
Estimates with relative standard error > 30% were not shown in the plot.

8
Figure S6. Age-standardized weighted mean systolic and diastolic blood pressure
among the overall population and those treated for hypertension.

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