Differences in Hypertension Prevalence and Hypertension Control by Urbanization Among Adults in the United States, 2013–2018

Abstract

Abstract Background To examine the associations between urbanization and hypertension, stage II hypertension, and hypertension control. Methods Data on 16,360 US adults aged 18 years or older from the 2013–2018 National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension (blood pressure (BP) ≥130/80 mm Hg or use of medication for hypertension), stage II hypertension (BP ≥140/90 mm Hg), and hypertension control (BP <130/80 mm Hg among hypertensives) by urbanization, classified by levels of metropolitan statistical areas as large MSAs (population ≥1,000,000), medium to small MSAs (population 50,000–999,999), and non-MSAs (population <50,000). Results All prevalence ratios (PRs) were compared with large MSAs and adjusted for demographics and risk factors. The PRs of hypertension were 1.07 (95% confidence interval (CI) = 0.99–1.14) for adults residing in medium to small MSAs and 1.06 (95% CI = 0.99–1.13) for adults residing in non-MSAs. For stage II hypertension, the PRs were higher for adults residing in medium to small MSAs 1.21 (95% CI = 1.06–1.36) but not for adults residing in non-MSAs 1.06 (95% CI = 0.88–1.29). For hypertension control, the PRs were 0.96 (95% CI = 0.91–1.01) for adults residing in medium to small MSAs and 1.00 (95% CI = 0.93–1.06) for adults residing in non-MSAs. Conclusions Among US adults, urbanization was associated with stage II hypertension.