High Blood Pressure and Its Treatment Across U.S. States, 2017

Hypertension — high blood pressure — is a major risk factor for heart disease and stroke. It becomes more common with age, is more common in men than women and among non-Hispanic Black adults than other groups, and has long been highest in the Southeastern United States. CDC used the 2017 Behavioral Risk Factor Surveillance System (BRFSS), a phone survey of 450,016 adults, to update state-by-state estimates.

People were counted as having hypertension if a doctor, nurse or other health professional had ever told them they had high blood pressure (not counting borderline or pregnancy-related cases), and as taking medication if they said they currently took medicine for it.

How common

• 32.4% of adults in the 50 states and D.C. reported hypertension — an estimated 81.7 million people.
• After adjusting for age, the median state rate was 29.7%, ranging from 24.3% in Minnesota to 38.6% in Alabama and West Virginia. Rates were generally highest in Southeastern and Appalachian states.
• Age-adjusted rates were higher in men (32.9%) than women (27.0%), highest among Black adults (40.0%), rose with age, and fell as education and household income rose.

Age-standardized prevalence of self-reported hypertension and of medication use among those with hypertension, by state, 2017. CDC figure.

Taking medication

• About three-quarters of adults with hypertension reported taking blood pressure medicine — an estimated 61.9 million people.
• The age-adjusted median state rate was 59.4%, from 50.2% in Idaho to 71.2% in Mississippi, highest in the Southeast, Appalachia and the Dakotas — the Dakotas despite only middling hypertension rates.
• Use rose with age, was highest among Black adults (68.1%), was higher in women (64.0%) than men (56.7%), and didn't vary by education or income.

The overall age-adjusted rates of hypertension (29.9%) and medication use (59.6%) were similar to 2011–2015 survey results and, for hypertension, to measured blood pressure data from 2015–2016. Why women report taking medication more often is unclear: among Medicare Part D beneficiaries 65 and older, men (25.8%) and women (26.7%) fail to take their medicines as prescribed at similar rates.

Limitations: the data are self-reported; response rates were low (median 45.9%), which could bias estimates either way despite weighting; and people in nursing homes, prisons and other institutions weren't included.

What helps

Hypertension prevention and control is a priority of CDC's state and local heart disease and stroke funding and a key part of the Million Hearts initiative. CDC works with states on team-based care, in which two or more providers — doctors, nurses, pharmacists, dietitians, community health workers and others — work together with each patient to educate them, identify risk factors, provide treatment and keep the conversation going. This gives many chances to improve blood pressure control, with the goal of reducing disparities in hypertension awareness, treatment and control across the country.

Sources

• Samanic CM, Barbour KE, Liu Y, et al. "Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults — United States, 2017." Morbidity and Mortality Weekly Report 69(14), Centers for Disease Control and Prevention.
• The report gives slightly different shares of adults with hypertension taking medication in its results and its summary; this page says about three-quarters.