Abstract
Introduction: The proportion of US adults with hypertension who had controlled blood pressure (BP) decreased from 2013-2018. The rising prevalence of obesity has been implicated as a reason for this decline. We investigated trends in BP control from 2013-2018 among US adults with hypertension, overall and among those taking antihypertensive medication, by body mass index (BMI) category. Methods: We used National Health and Nutrition Examination Survey data from 2013-2014, 2015-2016, and 2017-2018 for US adults aged ≥18 with hypertension (N=5,580). We examined the BMI distribution [normal (BMI <25 kg/m 2 ), overweight (BMI 25-<30 kg/m 2 ), class 1 obesity (BMI 30-<35 kg/m 2 ), class 2 or 3 obesity (BMI ≥35 kg/m 2 )] in each survey cycle. We calculated the age-adjusted prevalence of BP control (<140/90 mmHg) overall and among those taking antihypertensive medication in each survey cycle by BMI category. We examined trends in BP control within BMI category adjusted for age and other sociodemographic and clinical characteristics; we tested differences in trends by BMI category using interaction terms. Results: The prevalence of overweight and obesity among US adults with hypertension did not change from 2013-2018 ( Table ). The overall proportion of adults with hypertension who had controlled BP was higher among those with overweight or obesity than those with normal BMI. BP control among those taking antihypertensive medication was similar among those with overweight or obesity and those with normal BMI. BP control overall decreased over time with no evidence of a difference by BMI category. Among those taking antihypertensive medication, BP control decreased in those who were overweight or had class 1 obesity but not in those with normal BMI or class 2 or 3 obesity. Conclusions: Among US adults with hypertension, there was no increase in the prevalence of overweight and obesity from 2013-2018 and BP control decreased in all subgroups. These findings suggest the obesity epidemic is not driving the decrease in BP control in the US population.
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