title: National surveillance definitions for hypertension prevalence and control among adults.
abstract: BACKGROUND
  Clear and consistent definitions of hypertension and hypertension control are crucial to guide diagnosis, treatment, and surveillance. A variety of surveillance definitions are in frequent use, resulting in variation of reported hypertension prevalence and control, even when based on the same data set.
  
  
  RESULTS
  To assess the variety of published surveillance definitions and rates, we performed a literature search for studies and reports that used National Health and Nutrition Examination Surveys (NHANES) data from at least as recent as the 2003 to 2004 survey cycle. We identified 19 studies that used various criteria for defining hypertension and hypertension control, as well as different parameters for age adjustment and inclusion of subpopulations. This resulted in variation of reported age-standardized hypertension prevalence from 28.9% to 32.1% and hypertension control from 35.1% to 64%. We then assessed the effects of varying the definitions of hypertension and hypertension control, parameters for age adjustment, and inclusion of subpopulations on NHANES data from both 2007 to 2008 (n=5645) and 2005 to 2008 (n=10 365). We propose standard surveillance definitions and age-adjustment parameters for hypertension and hypertension control. By using our recommended approach with NHANES 2007 to 2008 data, the age-standardized prevalence of hypertension in the United States was 29.8% (SE, 0.62%) and the rate of hypertension control was 45.8% (SE, 4.03%).
  
  
  CONCLUSIONS
  Surveillance definitions of hypertension and hypertension control vary in the literature. We present standard definitions of hypertension prevalence and control among adults and standard parameters for age-adjustment and population composition that will enable meaningful population comparisons and monitoring of trends.
authors.affiliation: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, Chamblee, GA 30341, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Crim
authors.forename: Sung Sug Sarah
authors.initials: SS
authors.lastname: Yoon
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Wall
authors.forename: Susan
authors.initials: S
authors.lastname: Schober
authors.forename: Cathleen
authors.initials: C
authors.lastname: Gillespie
authors.forename: Paul
authors.initials: P
authors.lastname: Sorlie
authors.forename: Nora
authors.initials: N
authors.lastname: Keenan
authors.forename: Darwin
authors.initials: D
authors.lastname: Labarthe
authors.forename: Yuling
authors.initials: Y
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011159:Population Surveillance; D015995:Prevalence; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents