Trends in Prevalence, Treatment, and Control of Cardiometabolic Risk Factors Among Adults With Hypertension in the United States, 1999-2023

Abstract

BACKGROUND Hypertension-related deaths in the United States have sharply increased over the past decade. Understanding factors behind this concerning trend is crucial to guide public health strategies. OBJECTIVES This study sought to examine changes in prevalence, treatment, and control of cardiometabolic risk factors among U.S. adults with hypertension. METHODS Using National Health and Nutrition Examination Survey, we identified 21,822 adults with hypertension from 1999 to 2023. Trends in age-adjusted prevalence of diabetes, hyperlipidemia, obesity, smoking, and high-risk drinking, as well as in age-adjusted treatment and control rates for hypertension, diabetes, and hyperlipidemia, were assessed. RESULTS In adults with hypertension, prevalence of diabetes increased from 17.2% (95% CI: 14.6%-20.2%) in 1999-2000 to 27.8% (95% CI: 25.2%-30.7%) in 2021-2023. Among patients with hypertension and diabetes, the proportion receiving treatment for both conditions rose until 2009-2010 but subsequently plateaued (71.6% in 2021-2023; 95% CI: 67.5%-75.4%). A similar trend was observed for the proportion achieving control of both conditions, which remained at 31.2% in 2021-2023 (95% CI: 26.5%-36.3%). Prevalence of hyperlipidemia decreased in adults with hypertension but was still high at 73.1% (95% CI: 70.6%-75.4%) in 2021-2023. Among patients with hypertension and hyperlipidemia, treatment and control rates for both conditions increased only until around 2007; the respective rates were 50.4% (95% CI: 47.2%-53.6%) and 32.3% (95% CI: 29.5%-35.2%) in 2021-2023. Prevalence of concurrent diabetes and hyperlipidemia in adults with hypertension nearly doubled from 12.5% (95% CI: 10.6%-14.7%) in 1999-2000 to 21.3% (95% CI: 19.0%-23.8%) in 2021-2023. Among patients with hypertension, diabetes, and hyperlipidemia, the treatment rate for all 3 conditions increased until 2007-2008 and plateaued afterward (62.1% in 2021-2023; 95% CI: 56.6%-67.2%). The control rate for all 3 conditions followed a similar trend but remained low at 26.3% (95% CI: 20.8%-32.6%) in 2021-2023. Prevalence of obesity and high-risk drinking increased over time, whereas prevalence of smoking held steady. CONCLUSIONS The burden of cardiometabolic risk factors among U.S. adults with hypertension has increased overall, with concurrent diabetes and hyperlipidemia now affecting more than 1 in 5. Only one-quarter of adults with hypertension, diabetes, and hyperlipidemia have all 3 conditions controlled-a proportion that has not improved in more than a decade. (JACC. 2025;86:2577-2593) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).