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HDS-12 Data Details

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HDS-12 Increase the proportion of adults with hypertension whose blood pressure is under control
LHI

Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
National Health and Nutrition Examination Survey (NHANES); Centers for Disease Control and Prevention, National Center for Health Statistics (CDC/NCHS)
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
percent (age adjusted—see Comments)
Baseline (Year): 
43.7 (2005–08)
Target: 
61.2
Target-Setting Method: 
Projection/trend analysis
Target-Setting Method Justification: 
The proportion of adults with hypertension whose blood pressure is controlled improved by 55 percent between 1999–2000 and 2007–08, from 30.5 percent to 47.4 percent. Using linear regression based on these trend data, the projected rate in 2017–18 is 66.2 percent (age adjusted), or a 40-percent improvement. Based on this percent improvement and the baseline value for 2005–2008, the proposed HP2020 target is 61.2 percent (age adjusted).
Numerator: 

Number of persons aged 18 years and over, excluding pregnant women, with hypertension whose mean systolic blood pressure is less than 140 mm Hg and mean diastolic blood pressure is less than 90 mm Hg

Denominator: 

Number of persons with high blood pressure/hypertension aged 18 years and over, excluding pregnant women

Comparable Healthy People 2010 Objective: 
Retained from HP2010 objective
Questions Used to Obtain the National Baseline Data: 

    From the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey:

    [NUMERATOR AND DENOMINATOR:]

    Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?

    1. Yes
    2. No
    3. Refused
    4. Don't know

    Because of your high blood pressure/hypertension, have you ever been told by a doctor or other health professional to take prescribed medication?

    1. Yes
    2. No
    3. Refused
    4. Don't know

    Are you now taking prescribed medication?

    1. Yes
    2. No
    3. Refused
    4. Don't know
Data Collection Frequency: 
Periodic
Leading Health Indicator:
Heart Disease and Stroke
Methodology Notes: 

    Adults are defined as having high blood pressure/hypertension if they either: (a) have a measurement of mean systolic blood pressure (SBP) ≥140 mm Hg or (b) mean diastolic blood pressure (DBP) ≥90 mm Hg or (c) report they are taking high blood pressure medicine.

    Blood pressure is measured by averaging up to 3 blood pressure readings taken during the physical examination in the NHANES mobile examination center

    Blood pressure has been measured with the mercury sphygmomanometer for many years but with new technologies available, alternative blood pressure devices have taken center stage. The rapid pace of the development of automated sphygmomanometers with improving accuracy and reliability combined with increasing affordability has meant that these devices have now replaced the mercury sphygmomanometer in many settings. A detailed description of the procedures for blood pressure measurement in the NHANES has been published elsewhere.

    Age Adjustment Notes: 

    This Indicator uses Age-Adjustment Groups for four-year data:

    • Total: 18-49, 50-59, 60-69, 70-79, 80+
    • Sex: 18-49, 50-59, 60-69, 70-79, 80+
    • Race/Ethnicity: 18-49, 50-59, 60-69, 70-79, 80+
    • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
    • Family Income: 18-49, 50-59, 60-69, 70-79, 80+
    • Country of Birth: 18-49, 50-59, 60-69, 70-79, 80+
    • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Health Insurance Status: 18-49, 50-59, 60-64
    • Diabetes Status: 18-49, 50-59, 60-69, 70-79, 80+
    • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Veteran Status: 18-49, 50-59, 60-69, 70-79, 80+
    • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+

    This Indicator uses Age-Adjustment Groups for two-year data:

    • Total: 18-39, 40-59, 60+
    • Sex: 18-39, 40-59, 60+
    • Race/Ethnicity: 18-39, 40-59, 60+
    • Educational Attainment: 25-39, 40-59, 60+
    • Family Income: 18-39, 40-59, 60+
    • Country of Birth: 18-39, 40-59, 60+
    • Disability Status: 20-39, 40-59, 60+
    • Health Insurance Status: 18-39, 40-59, 60-64
    • Diabetes Status: 18-39, 40-59, 60+
    • Marital Status: 20-39, 40-59, 60+
    • Veteran Status: 18-39, 40-59, 60+
    • Obesity Status: 20-39, 40-59, 60+
Trend Issues: 
Two-year data are used as a placeholder to provide the latest data available and will be replaced with four-year data when available. Two-year and four-year data are not comparable. Different age adjustment groups are used for the two year and four year data. Two-year estimates are generally less stable and reliable than four-year estimates.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
In 2014, the baseline data by obesity status and the confidence intervals were revised due to a change in the methodology. Obesity status was originally coded based on the calculated BMI variable (BMXBMI) and had an error in the 2007-08 dataset. Some records had a missing height or weight but not a missing BMXBMI. To be consistent with NHANES reports, instead of using the calculated BMI variable, BMI is now computed directly from the weight and height variables. In addition, the BMX 2007-2008 updated April 2011 file was used. The method for computing the confidence intervals was revised from the standard Wald method to the Wald method on the log scale.

References

Additional resources about the objective

  1. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2005-2006, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, November 2007.
  2. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2007-2008, Public Use Blood Pressure and Cholesterol Questionnaire Documentation. Hyattsville, MD: Centers for Disease Control and Prevention, September 2009.
  3. National Center for Health Statistics. National Health and Nutrition Examination Survey, 2009-2010, Health Tech/Blood Pressure Procedures Manual. Hyattsville, MD: Centers for Disease Control and Prevention, May 2009.