Prevalence and Mortality Trends of Hypertension Subtypes Among US Adults: An Analysis of the National Health and Nutrition Examination Survey

BACKGROUND Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality.METHODS This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis.RESULTS Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A subcohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR = 1.18, 95% CI, 1.01-1.38; HR = 1.31, 95% CI, 1.07-1.60, respectively) and all-cause mortality (HR = 1.17, 95% CI, 1.06-1.28; HR = 1.21, 95% CI, 1.08-1.37, respectively).CONCLUSIONS Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.