10-Year community prevalence and trends of severe asymptomatic hypertension among patients with hypertension in the USA: 2007-2016

Background: Severe asymptomatic hypertension (SAH) is associated with significant health cost, morbidity and mortality. Aim: Establish the nationwide prevalence, trends and associated sociodemographic characteristics of SAH among patients with hypertension in the USA. Methods: We utilized the National Health and Nutrition Examination data collected over five survey cycles (2007-2016). Included were participants aged 20-80 years with self-reported diagnosis of hypertension. SAH was defined as having a mean systolic blood pressure (SBP) >= 180 mmHg and/or mean diastolic blood pressure (DBP) >= 120 mmHg at the time of examination. The Chi square test was used to compare prevalence across different categories. Associations between sociodemographic variables and SAH were assessed using multivariate binary logistic regression. Results: The prevalence of SAH among patients with hypertension is 2.15% (95% CI 1.80-2.56), mainly explained by isolated mean SBP >= 180 mmHg (86% of all cases), with no statistically significant change between 2007: 2.66% (95% CI 2.10-3.36) and 2016:2.61% [95% CI 1.73-3.94), p-trend = 0.17. Increasing age (OR 1.07, 95% CI 1.04-1.09), NH Blacks (OR 2.20, 95% CI 1.37-3.54), BMI< 25 (OR 2.52, 95% CI 1.48-4.28), lack of health insurance OR 4.92% (95% CI 2.53-9.54) and never married individuals (OR = 2.59%, 95% CI 1.20-5.60) were more likely to have SAH, comparatively. There was no significant association between duration of hypertension and SAH. Conclusion: The prevalence of SAH in the USA is 2.15% and has been stable over the past decade. Our study underscores the importance of identifying barriers to screening and treatment of hypertension which is a major treatable risk factor for cardiovascular disease.