About Hypertension

Hypertension in the United States

According to the Department of Health and Human Services, nearly one in two adults have hypertension. Even more troubling, only one in four people with hypertension have it under control. As a nation, this alarming percentage indicates that millions of Americans are at risk for heart disease and stroke, which are the first and fifth leading causes of death in the United States.

Everybody knows somebody who has hypertension, which is why the roundtable supports making hypertension control efforts and addressing disparities in care and prevention a national priority.

In the United States, uncontrolled hypertension:

  • Resulted in the loss of more than 877,503 lives in 2019.
  • Impacts individuals of all ages; more than 18% of those individuals were younger than 65.
  • Can increase a person’s risk of developing other life-threatening conditions, such as heart failure, kidney disease, pregnancy complications, and cognitive decline later in life.

Health Equity and Hypertension

When addressing this complex condition, it is important to note that in the United States, certain groups of people have disproportionately high rates of hypertension and its related health consequences, however, we have an opportunity to prevent these health disparities with the use of evidence-based interventions and multi-sector engagement and support.

  • Prevalence is higher among older adults and also is notably higher among certain racial and ethnic groups, especially non-Hispanic Black people.
  • Psychosocial and socioeconomic stressors— such as low socioeconomic status, depression, job stress, financial stress, segregated neighborhoods, and neighborhood poverty level—also contribute to the risk of hypertension.
  • Social determinants of health, such as inequalities in the distribution of social, economic, and environmental conditions needed for health, have been associated with hypertension risk especially among non-Hispanic Black people and other historically oppressed communities of color

Burden of Hypertension

Uncontrolled hypertension affects us as individuals, families, communities, and as a society.

  • Based on the most recent blood pressure guidelines, about 47% of American adults (116 million) have hypertension, and most (92.1 million) do not have it in control1.
  • One in five adults with high blood pressure is unaware of it, which means that there are even more individuals battling it than we know1.
  • Hypertension is a major preventable risk factor for cardiovascular disease, which resulted in the loss of 516,955 lives in 20192.
  • Hypertension impacts individuals of all ages; more than 18% of those individuals were younger than 65.
  • High blood pressure costs the United States $131 billion to $198 billion annually in associated medical costs (2014 and 2016 dollars)3 4.
  • Annual medical costs for people with high blood pressure are up to $2,500 (2014 and 2016 dollars) higher than costs for people without high blood pressure.3 4
  • About 650 million prescriptions for blood pressure medicine are filled each year, which accounts for about $29 billion (2014 dollars) in total spending.5
  • In addition to direct costs, hypertension costs from annual lost productivity for both paid and unpaid work are projected to be more than $35 billion (2008 dollars) by 2025.6

Disparities in Hypertension

In the U.S., certain groups of people have disproportionately high rates of hypertension and its related health consequences. For example, prevalence is higher among older adults and is also notably higher among certain historically oppressed racial and ethnic groups, especially non-Hispanic Black people. Health inequities and disparities are present across all aspects of hypertension, from awareness to disease severity to treatment and control. Differences in these rates can be attributed to many factors, called the social determinants of health, and include healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and build environment.

Disparities By Age

  • Prevalence rates vary across age groups with approximately 25% of adults aged 18–44 years, 59% of adults aged 45–64 years and nearly 76% of adults aged ≥65 years having hypertension.
  • There are also differences in prevalence rates based on gender. Approximately 50% of men and 44% of women have hypertension, with more than 81% of men and nearly 77% of women having uncontrolled hypertension.2

Disparities by Race/Ethnicity

  • 56.2% of non-Hispanic Black people have hypertension compared to 48.0% non-Hispanic white people, 46.3% non-Hispanic Asian people, and 38.9% Hispanic people.
  • Among people with hypertension, 85.6% Hispanic people, and 86.4% non-Hispanic Asian people, 81.9% non-Hispanic Black people, and 77.8% non-Hispanic white people have uncontrolled hypertension.2

The Opportunity

The COVID-19 pandemic highlighted how certain communities are impacted by chronic disease more than others. Through collective action, we can support people in controlling their blood pressure wherever they live, learn, earn, play, and pray.

Now, we need to apply these tools and resources more widely. Learn more about targeted strategies that different sectors can take to collectively improve hypertension control across the U.S.

1 Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2015–2018. Atlanta, GA: US Department of Health and Human Services; 2019. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html, Accessed March 12, 2021.
2 Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999–2019 on CDC WONDER Online Database website. http://wonder.cdc.gov/mcd-icd10.html. Accessed February 1, 2021.
3 Kirkland EB, Heincelman M, Bishu KG, et. al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003-2014. J Am Heart Assoc. 2018;7:e008731.
4 Wang G, Zhou X, Zhuo X, Zhang P. Annual total medical expenditures associated with hypertension by diabetes status in US adults. Am J Prev Med. 2017;53(6 suppl 2):S182–S189.
5 Ritchey M, Tsipas S, Loustalot F, Wozniak G. Use of pharmacy sales data to assess changes in prescription- and payment-related factors that promote adherence to medications commonly used to treat hypertension, 2009 and 2014. PLoS One. 2016;11(7):e0159366.
6 Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933–944.