Background: Hypertension is a major risk factor for cardiovascular disease and all-cause mortality. Compared with prior guidelines, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommends lower blood pressure thresholds for defining hypertension, for initiating antihypertensive medication, and for antihypertensive medication treatment goals.

Methods and results: To better understand potential impacts of the 2017 guideline, we studied trends in mean systolic blood pressure and diastolic blood pressure, prevalence and burden of hypertension, and proportion of controlled hypertension in the US adult population aged ≥20 from 1999 through 2016. We used data from 38 276 adults from the National Health and Nutrition Examination Survey. Age-standardized prevalence of hypertension decreased from 48.4% in 1999-2000 to 45.4% in 2015-2016. However, absolute burden of hypertension consistently increased, from 87.0 million in 1999-2000 to 108.2 million in 2015-2016. The age-standardized proportion of controlled hypertension among adults receiving antihypertensive pharmacologic treatment increased from 1999-2000 (25.6%) to 2015-2016 (43.5%). There was not consistent improvement in control throughout the full period among non-Hispanic blacks, individuals aged ≥60, or those with diabetes mellitus, chronic kidney disease, or high cardiovascular disease risk.

Conclusions: Based on the 2017 guideline, from 1999 to 2016, the age-standardized prevalence of hypertension decreased and the proportion of control among those treated for hypertension improved. However, the absolute hypertension burden increased. Among those treated, the control rate did not consistently improve in all subgroups. These data emphasize the need for continuous efforts in the prevention and control of hypertension in the US general population.