Blood PressureLevels in Persons18-74 Years of Agein 1976–80, andTrends in BloodPressure From 1960to 1980 in theUnited States

This report presents blood pressure levels

and prevalence rates of hypertension

among U.S. adults in 1976–80 by age,

sex, race, and education. Secular trends

for blood pressure and hypertension in

the period from 1960 to 1980 are also

presented.

Data From the National Health SurveySeries 11, No. 234

DHHS Publication (PHS) 86-1684

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

July 1986

. ——

Copyright information:

All material appearing in this report is in the public domain snd may be

reproduced or copied without permiaaion; citation as to source,

however, is appreciated.

Suggested Citation

National Center for Health Statistics, T. Drizd, A. L. Dannenberg, and

A. Engel: Blood pressure levels in persons 18–74 yeara of age in

1976-80, and trenda in blood pressure from 1960 to 1980 in the

United States. Vital and Health Statistics. Series 11, No. 234. DH H S

Pub. No. ( PHS 86-1684. Public Health Service. Washington. U.S.

Government Printing Office, July 1986.

Librery of Congrees Cataloging- in- Pubiicetion Data

Drizd, Terence.

Blood pressure Ievela in persons 18-74 yeara of age

in 1976-80, and trends in blood pressure from 1960 to

1980 in the United Statea.

(Series 11, Data from the national health suwey ;

no. 234) (DHHS publication : (PHS) 86-1 684)

Written by Terence Drizd, Andrew L. Dannenberg, and

Arnold Engel.

Bibliography p.

1. Hypertension-United States—Statistics.

2. 8100d pressure—United States—Statistics.

1. Dannenberg, Andrew L Il. Engel, Arnold.

* Ill. National Center for Health Statistics (U. S.)

‘ IV. Title. V. Series: Vital and health statistics.

)Series 11, Data from the national health survey ;

,, no. 234. V1. DHHS publication ; (PHS) 86-1684.

[DNLM: 1. 8100d Pressure—United States—statistics.

2. Hypertansion— United States—statistics,

W2 A N148vk no. 234]

RA407,3.A347 no. 234 362.1 ‘0973021 S 85-32032

[RA645.H9] [61 6.1 ‘3200973021]

ISBN 0-8406-0330-4

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402

National Center for Health Statistics

Manning Feinleib, M. D., Dr. P. H., Director

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Director for Analysisand Epidemiology

Garrie J. Losee, Associate Director for Data Processingand Services

Alvan O. Zarate, Ph. D., Assistant Director for InternationalStatistics

Peter L. Hurley, Acting Associate Directorfor Interviewand Examination Statistics

Stephen E, Nieberding, Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for ProgramPlanning, Evaluation, and Coordination

Monroe G. Sirken, Ph. D., Associate Director for Researchand Methodology

Peter L. Hurley, Associate Director for Vital and HealthCare Statistics

Alice Haywood, Information Officer

Office of Interview and Examination Statistics Programs

Peter L, Hurley, Acting Associate Director

Mary Grace Kovar, Dr. P. H., Special Assistant for DaraPolicy and Analysis

Division of Health Examination Statistics

Robert S. Murphy, Director

Catherine Woteki, Ph. D., Deputy Director

Kurt Maurer, Chiej Survey Planning and Deve[oprnentBranch

Suzanne Haynes, Ph. D., C’hiej Medical Statistics Branch

Clifford Johnson, Chief Nutrition Statistics Branch

Cooperation(//”rhrL’.S.Bureauo.f[he(’emt(.v

Under the Ieg]slation establishing the National Health Survey. !he Public Health Service

is authorized to use. insofar as possible, the sert>ices or facilities of other Federal. State.

or private agencies. In accordance with specifications established b), the National Centerfor Health Statistics, the U.S. Bureau of the Censu~ panictpawd in the design and selection

of the sample and carried out the initial household interview stage of the data collection

and certain vans oftbe statistical !xocessing.

Acknowledgments

The authors would like to thank Drs. Paul Leaverton andEve Moscicki and Mr. Steve Clybum, from the National Heart,Lung and Blood Institute, who provided invaluable technicalassistance in the preparation of sections of this report. Drs.Mary Grace Kovar and Suzanne Haynes and Mr. RobertMurphy from the National Center for Health Statistics offeredmany helpfid comments during review of the manuscript.

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data sources and statistical methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Medical history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Blood pressure measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Statistical methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Findings-National Health andNutrition Examinations urveyII, 1976–80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Systolic blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diastolicbloodpressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Education andbloodpressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joint distributions ofSBPandDBP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Secular trends, 1960-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comparisons ofresults amongthree National Health Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . .Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lktofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

I. Survey design and estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II. Statistical methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111.Demographic andsocioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV. IJmitations ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List oftextfigures

1. Mean systolic bloodpressure among white andblackmen andwomenby age United States, 1976-80 . . . . . . . . . . . . . .2. Mean diastolicbloodpressure amongwhite andblackmen andwomen by age United States, 1976-80 . . . . . . . . . . . . . .3. Prevalenceofdefinitehypertensionemong adults 18-74yearsofagebyageandsex orrace: UnitedStates, 1976-80 . . .4. Prevalence of borderline hypertension among adults 18-74 years of age by age and sex: United States, 1976 -80......5. Number and percentofhypertensives whowere diagnosed, bysex andage: United States, 1976-80 . . . . . . . . . . . . . . . . .6. Prevalence of elevated blood pressure among white and black men and women by age: United States, 1976-80 . . . . . . .7. Prevalence ofhypertension among white andblackmen andwomen 18-74 years ofageusingtraditional definitions and

definitions of the ThirdJoint National Committee forthe Detection, Evaluation, andTreatmentof High Blood Pressure:United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Smoothedweightedfiequencydistribution ofthefwst systolic bloodpressure for white men ages 18–24years bysurvey:United States, NHES 1(1960-62), NHANES 1(1971 -74), NHANESII (1976-80).. . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Smoothedweightedfrequencydistribution ofthefrstsystolicbloodpressurefor white men ages 65-74years bysurvey:United States, NHESI(1960-62), NHANESI (1971-74), NHANESII (1976-80) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Age-adjusted prevalence ofdefmite hypertension among white and black men and womenby survey: United States,NHESI(1960-62), NWNESI(1971-74), NWESII(1976-80) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2

3334

66688

13

19192024

27

30

63656667

79

11121416

17

21

21

23

v

List of text tables

A. Description of blood pressure measurement procedures for NHE,S I, NHANES I, and NHANES II . . . . . . . . . . . . . . . . 4

B. Mean systolic blood pressure by race, sex, and age: United States, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6C. Mean diastolic blood pressure by race, sex, and age: United States, 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8D. Comparison of JNCIII andtraditional hypertension definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15E. Prevalence rates for mild, moderate, and severe hypertension combined, based on JNC III definitions, by race, sex, and

age United States, 1976–80. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . 17F. DistributionofU.S. populationaccording to JNCIIU hypertensioncategories, by race, sex, andcategory: United States,

1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Symbols

. . . Data not available

. . . Categoty not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more tharl zero but less than

500 where numbers are roundedto

thousands

* Figure does not meet standardof

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

vi

Blood Pressure Levels inPersons 18-74 Years of Agein 1976–80, and Trends inBlood Pressure From 1960to 1980 in the United StatesTerence Drizd, M. S. P. H., National Center for Health

Statistics, Division of Health Examination Statistics;

Andrew L. Dannenberg, M. D., M. P. H., National Institutes

of Health, National Heart, Lung and Blood Institute, Division

of Epidemiology and Clinical Applications; and Arnold Engel,

M. D., M. P. H., National Center for Health Statistics, Division

of Health Examination Statistics

IntroductionEssential hypertension is a major risk factor for mrdio-

vascular dk,ease. It markedly increases the risk of death fromcerebrovascular accident, kidney failure, and coronary heartdisease.l Clinical intervention trials have shown decreases inmorbidity and mortality from hemorrhagic strokes, congestiveheart failure, renal failure, and aortic dissections when bloodpressure is reduced? Cardiovascular mortality has decreasedsteadily in the United States since the mid-1960’s3 and, al-though the reasons for this decline have not been completelyestablished, a reduction in uncontrolled hypertension is a lead-ing hypothesis. Previous estimates suggest that in the early1970’s as many as 60 million Americans had elevated bloodpressures.4

The objectives of this report are twofold. The first partpresents current estimates of mean systolic and diastolic bloodpressure and of the prevalence of hypertension in the civiliannoninstitutionalized portion of the U.S. population between theages of 18 and 75 years. Differences among age, race, sex, andeducational groups are examined. These estimates can be usedby (a) clinicians, to compare individual blood pressures againstnational norms, (b) epidemiologists, to compare local or specialstudy samples against national norms, or(c) various public andprivate agencies in planning strategies to combat high bloodpressure.

The second part of this report focuses on trends in bloodpressure and hypertension in U.S. adults since 1960. Thesedata and the age-standardized analyses derived from themspecifically address changes in mean blood pressures and inthe prevalence of various kinds of hypertension, particularlyconcerning differences by race, sex, and age. These data shouldbe particularly useful in evaluating the effectiveness of variousprograms instituted to promote the detection and treatment ofhypertension. These data may provide baseline informationuseful in documenting the proportion of the population undertreatment for hypertension and, of particular concern, thoseunder treatment for mild hypertensions

Three cross-sectional surveys conducted by the NationalCenter for Health Statistics during 1960-80 provide the dataon which the report is based. The surveys included are the firstNational Health Examination Survey ( 1960–62) and the first

and second National Health andveys (1971 –74 and 1976–80,

Nutrition Examination Sur-respectively). Each of the

surveys was designed to assess the health of a nationally repre-sentative probability sample of the U.S. civilian noninstitu-tionalized population at the time the survey was conducted.Every examined person received a basic physical examination,and selected subsets of the samples of the later two surveysreceived additional examination components. Medical historydata were collected for all examined persons. The standardizedexaminations were performed in specially constructed mobileexamination centers that were moved about the country to eachof a number of previously selected primary sampling areas.GeneraJ descriptive data for each of the three surveys are asfollows (for the subsets of examined persons used for thisreport):

National Health Examination Survey 1:

Time span . . . . . . . . . . . . . . . . . . . . . . . . . .

Sample person ages . . . . . . . . . . . . . . . . . .Sample size . . . . . . . . . . . . . . . . . . . . . . . . .Number of examined persons . . . . . . . . . .Response rate...............,.. . . . . .

National Health and Nutrition ExaminationSurvey 1:t

Time span . . . . . . . . . . . . . . . . . . . . . . . . .Sample person ages . . . . . . . . . . . . . . . . . .Sample size . . . . . . . . . . . . . . . . . . . . . . . . .Number of examined persons . . . . . . . . . .Reaponse rate . . . . . . . . . . . . . . . . . . . . . . .

National Health and Nutrition Examination

Survey 11:

Time span . . . . . . . . . . . . . . . . . . . . . . . . . .Sample person ages . . . . . . . . . . . . . . . . . .Sample size . . . . . . . . . . . . . . . . . . . . . . . . .Number of examined persons . . . . . . . . . .Response rate . . . . . . . . . . . . . . . . . . . . . . .

1960-6218-79 years7,7106,67286.5

1971-7418-74 years19,57213,64569.7

1976-8018-74 years18,20912,50468.7

tData from the NHANES I Augmentation Survey were not included

in thase analysea.

A more detailed description of survey design and samplingprocedures is in appendix 1. Statistical notes on the sampledesign, including sample size and national population esti-mates, reliability of data, and sampling and measurement errorare included in appendix II. Demographic and socioeconomicterms are defined in appendix 111.Data limitations are describedin appendix IV.

1

The analyses presented in this report, which are summa-rized below, address questions concerning recent levels of blood

pressure and trends in blood pressure levels and hypertension

in the U.S. civilian noninstitutionalized population ages 18–74

years. Although the midpoints of the three surveys were 1961,1972, and 1978, the three surveys spanned the periocl from1960 to 1980. Because some segments of the U.S. populationare not represented in this subsample (children, adults ages 75

years and over, military personnel, and institutionalized per-

sons), the total number of hypertensives in the U.S. population

cannot be estimated directly from these data. However, someresearchers have used these and other data to develop suchestimates.b

The recently published report of the Joint National Com-

mittee on Detection, Evaluation, and Treatment of High Blood

Pressure (called JNC III) has recommended new and moredetailed definitions for a variety of hypertension categories.7 Inthat report the traditional categories of borderline and definite

hypertension have been merged and redefined as “mild” (dia-

stolic blood pressure (DBP) of 90 to 104 mmHg), “moderate”

(DBP of 105 to 114 mmHG), and “severe” (DBP of 115 ormore mmHg) hypertension. In addition, newly created cate-gories include “high normal” for adults with DBP between 85and 89 mmHg, and other categories related to isolated systolichypertension. The data presented in this report can be used to

estimate prevalence rates for these new categories.However, the major analyses of hypertension described in

this report are based on the following definitions: (a) definitehypertension is defined as systolic blood pressure (SBP) equalto or greater than 160 mmHg and/or DBP equal to or greater

than 95 mmHg and/or taking antihypertensive medication, (b)

borderline hypertension is defined as SBP equal to or greaterthan 140 mmHg but less than 160 mmHg and/or DBP equal toor greater than 90 mmHg but less than 95 mmHg and not takingantihypertensive medication, and (c) isolated systolic hyper-tension is defined as SBP equal to or greater than 160 mmHgand DBP less than 90 mmHg. The decision to employ thetraditional definitions was motivated primarily by a desire tofacilitate the analyses of trends that constitute the latter part ofthk report and to enhance comparisons with previously pub

lished work.The following conclusions highlight the findings from the

NHANES II survey, conducted from 1976 to 1980, withMarch 1, 1978, as the midpoint of the survey:

. About 25 million U.S. adults ( 17.7 percent) had definite hy-

pertension, either diagnosed or undiagnosed. Definite

2

hypertension was more prevalent among black than whiteadults (25. 7 versus 16.8 percent, respectively).

Of the 25 million adults with definite hypertension, about6.6 million (26.4 percent) had not been diagnosed that is,

told by a doctor that they had hypertension or high bloodpressure.

Another 17 million adults (12.0 percent) had borderlinehypertension.

Mean SBP levels were higher among black than white

adults in most age groups.

Mean DBP levels were generally higher among men thanwomen and were generally higher among black than whiteadults.The prevalence rate for hypertension based on the newly

created JNC III definition (DBP equal to or greater th~

90 mmHg and/or SBP equal to or greater than 140 mmHgand/or medicated) was 29.7 percent (about 42 millionadults), about two-thirds h&her than the 17.7 percentestimated using the traditional definition (DBP equal to or

greater than 95 mmHg and/or SBP equal to or greater

than 160 mmHg and/or medicated).

Findings from the three surveys conducted in the period1960–80 include the following

●

●

●

●

●

Mean SBP decreased by 5 mmHg among white adults and

by 10 mmHg among black adults across the period spannedby the three surveys.The prevalence of elevated SBP decreased 5.3 percentamong white adults and 12.6 percent among black adults.

Improvements in mean SBP were greater among olderthan younger adults.

The prevalence of definite hypertension among black adults

decreased from 33.6 to 28.6 percent, but the difference didnot reach statistical significance. No similar decline was

observed among white adults.The prevalence of undiagnosed hypertension decreasedfrom 52.0 to 29.2 percent, the proportion of hypertensiyestaking antihypertensive medication increased from 30.3 to45.4 percent, and the proportion of medicated hyperten-

sive whose hypertension was controlled increased from

39.3 to 51.7 percent.

Data sources and statisticalmethods

The three cross-sectional surveys that provided the dataon which this report is based were quite similar in design andobjectives, but differed in content, size, and response rates.6The first National Health Examination Survey (NHES I) hadas its primary objectives establishing baseline or normativeestimates for adults in a broad variety of medical subject matterareas and estimating the prevalence of certain disease condi-tions.8 The first and second National Health and NutritionExamination Surveys (NHANES I and II) also were designedto provide data for normative and disease prevalence estimates,but had as an additional focus the assessment of the nutritionalstatus of the Nation.9J0 Some blood pressure fmdmgs fromthese surveys have been published previously. 11-‘4

All three surveys were designed to provide data on a na-tionally representative probability sample of the U.S. civiliannoninstitutionalized population at the time the survey was con-ducted. To this end, specially constructed mobile examinationcenters were moved around the country to previously selectedprimary sampling units (PSU’s, usually a county or group ofcounties). The selection of the PST-J’Swas part of a stratfledmultistage probability design that assured, at the end of thesurvey and after appropriate statistical weighting, that the per-sons selected from within the PSU’S and actually examinedwere as respresentative of the U.S. population as possible.

Not all of those persons selected to participate were ex-amined and the response rates varied among the three surveys.In NHES I, 6,672 persons were examined out of the 7,710adults selected, yielding a response rate of 86.5 percent. ForNHANES I and II, comparable response rates were 69.7(13,645 out of 19,572) and 68.7 percent (12,504 out of 18,209).Following the conclusion of each survey, statistical weightsinvolving the probability of selection, adjustment for nonre-sponse, and poststratification by age, race, and sex were gen-erated for each examined person.

Each examined person completed a medical history andother questionnaires, and each received a physical examination,including at least one blood pressure determination by a phy-sician, body measurements, and blood testing. Selected subsetsof the NHANES I and II samples received additional exami-nation components such as electrocardiogram tests, hearingtests, and chest x rays. Further discussion of the content islimited to results important to this report.

Medical history

Specially trained interviewers obtained a medical historyfor each sample person. This history included questions on

whether the individual had ever been told by a doctor that he orshe had high blood pressure or other selected chronic condi-tions, including those commonly associated with long-termelevated blood pressure. Other questions were asked as towhether the individual was taking any medication for highblood pressure currently (or, in the case of NHANES I, withinthe previous 6 months) andlor was pursuing nonpharrnacologictherapy.

Blood pressure measurement

Table A provides data relevant to the collection of bloodpressure data for NHES I and NHANES I and II. In all threesurveys a blood pressure reading was taken by the physician atthe beginning of the physician’s examination with the examineeseated. Additional readings were taken near the middle and atthe end of the 20-minute examination in NHES I. In NHES”Iall blood pressure (BP) measurements were taken while theexarninee was sitting, and all were taken by the physician. TheNHANES I sample was divided into two groups: (a) the Nu-trition sample-those examinees who received the general nu-trition examination and a limited battery of physical tests, and(b) the Detailed sample-a one-fifth subsample of the Nutritionsample who received an additional battery of physical tests. Inthe Nutrition sample of the NHANES I survey, only a singlesitting measurement was taken. b the Detailed sample of theNHANES I survey conducted from 1971–74 and in theNHANES II survey, a second measurement was taken whilethe examinee was supine and a third immediately after with theexaminee sitting, both at the end of the examination. In someinstances the nurse took the second or third measurements.(See the analysis of secular trends for more details.)

Blood pressure was measured indirectly using a standardclinical sphygmomanometer. The middle of the cuff was placedover the bulge in the upper right arm. Using the bell of thestethoscope, the physician noted and recorded the systolicpressure (when the sound was frost heard) and the diastolicpressure (when the sounds disappeared or, if the sounds did notdisappear, when they first became muffled). The followingguidelines were provided for the physicians:

1. The manometer was at eye level for the reader to reducethe possibility of reading errors caused by parallax.

2. While measuring, the rate of fall in pressure was maintainedat 2–3 mrnHg per heartbeat, which was slow enough todetect the first and last sounds but sufllciently rapid toavoid the intermittent trapping of blood between systolicand diastolic levels.

3

Table A. Description of blood preaaure measurement procedures for NH ES 1, NHAN ES 1, and N HANES II

Measurement

Procedure 1St 2d 3d

Time during examination

NHES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Beginning MiddleNHANESl, Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EndBeginning .

NHANESl, Detailed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .

Beginning EndNHANES II....................,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EndBeginning End End

Examiner

NHES 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physician Physician PhysicianNHANESl, Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PhysicianNHANESl, Detailed. .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. .Physician Physician/Nurse Physician/Nurse

NHANES II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, Physician Physician/Nurse Physician/Nurse

Posture

NH ES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sitting SittingNHANESl, Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sitting

Sitting

NHANESl, Detailed. .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .

Sitting SupineNHANES1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sitting

Sitting

Supine Sitting

3.

4.

For diastolic pressure, the level was recorded either at the

point of complete cessation of Korotkoff sounds (fifth

sound) or, if no cessation occurred, at the point of muffling

(fourth sound). In NHES I both the fourth and fifthKorotkoff sounds were recorded.Measurements were recorded to the nearest even milli-meter on the scale.

Statistical methods

The tindings in this report are national estimates based onweighted observations. The data obtained for each examined

person were weighted so that the sum of sampling weights for

all persons drawn from a subuniverse is equal to the number ofpersons in that subuniverse at the midpoint of the survey, as

estimated by the U.S. Bureau of the Census. The weights takeinto account the probability with which persons were drawninto the samples, and certain adjustments based on the knowndemographic characteristics of interviewed or examined per-sons versus all eligible persons, to minimize the effects ofnonresponse and bias. The chance of bias is greater when asubstantial proportion of the persons sampled from a particular

age-sex-income class were not examined than when responserates are high. The additional bias that may be introduced by

nonrandom measurement error is addressed in the discussionsection and in appendix IV.

Unless otherwise specified, statistical significance wasbased on the 5-percent significance level. Most of the analysespresented here are based on t-tests comparing means or prev-

alence rates in two population subgroups. This test consists ofdividing the difference between the two means or prevalence

by the standard error of the difference. An approximation ofthe standard error of a difference d = x – y of the two statistics

x and y is given by the formula

Sd = [s: + s; – 2 Cov (X,y)]lfz

where 5X and SY are the standard errors, respectively, of x and

y. The standard errors were calculated by a balanced replicationtechnique appropriate to the complex survey design and esti-mation procedure.15,’b For most of the analyses in this paper,covariances were assumed to be zero.

For tests of trends across age groups, standard errors werecalculated using a method of Taylor series linearization of approximate formulas incorporated in the computer programs

SURREGR17 and SE SUDAAN.18 Statistical tests for multi-variate categorical data were performed with a method ofweighted least squares that produces statistics which areasymptotically chi-square,’9 using the computer programGENCAT.20 This program makes possible the construction ofmultivariate tests of significance that take into account the fullvariance-covariance matrix. These tests have greater statisticalpower than tests based on comparison of paired estimates, as

described above and in appendix II.Detailed tables 3 and 4 present means that have been

standardized for age by the direct method, as do tables 11– 17.

In tables 3 and 4 the age-standardized means have been cal-culated using the age-specific U.S. population estimates for1978 for all educational groups combined. In tables 1,1–17 andin the sections of the text where comparisons are macle betweensurveys, the age-standardized means have been calculated for

the 1960–62 and 1971 –74 surveys using the reference popula-tion estimates at the midpoint of the 1976–80 survey. The

standardized means and proportions and the standard errors ofthese statistics were estimated by the SESUDAAN program,using Taylor series linearization.’ 8

The reader should be cautioned against making any infer-ences of a longitudinal nature based on data from these cross-sectional surveys. These surveys did not reexamine study

subjects, as would be necessary for making longitudinal com-parisons. In a single cross-sectional survey, differences in

mean blood pressures apparently related to increasing age are,in fact, differences between individuals in different birth cohorts

and cannot be taken as descriptive of a particular individual’sor group’s life experience. Apparent trends in the relationshipbehveen age and blood pressure, when based on cross-sectionaldataj are somewhat misleading.

Cohort analysis of data from the Frarningham Heart Study,for instance, portrayed markedly different patterns in bloodpressure for cohorts followed over time as compared with cross-sectional analysis of data for selected age groups.21 In theFrarningham data, cross-sectional mean blood pressures werelower in women than men in early ages, rose to meet the pres-

sures of men at middle age, and crossed over thereafter to higherlevels. In longitudinal analysis of the Framingham cohort,where pressures were followed as people actually aged, thecrossover after middle age for women was not observed. Bloodpressures in women stayed lower than blood pressures in menat all ages.21Because longitudinal inferences drawn from cross-sectional data may incorrectly portray the effect of aging, anattempt has been made to minimize the tendency to make suchinferences.

5

Findings— National Healthand Nutrition ExaminationSurvey 11, 1976–80

The principal findings in this section regarding the distri-bution of systolic blood pressure ( SBP) and diastolic bloodpressure (DBP) levels, and the estimates for the prevalence ofhypertension derived from them for U.S. adults ages 18-74

years, are based on the mean of the three blood pressuremeasurements obtained on the adult examinees in the 1976–

80 National Health and Nutrition Examination Survey(NHANES II). The mean of the three blood pressure measuresgenerally provides a better predictor of fiture blood pressure

and is less subject to regression toward the mean than a singlemeasurement.22 Hence, the mean provides a physiolo~callymore representative measure than a single pressure for esti-mating the prevalence of hypertension.

Systolic blood pressure

As shown in table B, figure 1, and table 1, mean SBPlevels were significantly higher for men than for women in the

age groups 18–24, 25–34, and 35–44 years. However, for the

age groups 45 –54 and 55-64 years, no significant differenceswere observed between the sexes. By age 65–74 years the

mean SBP level among women was significantly greater thanthat among men (146 versus 142 mrnHg, respectively).

Observed mean SBP levels for black men were less thanthose for white men in the age groups 18–24 and 25–34 years,

but the difference in the 25–34 year age group was not sta-tistically significant (table B). In the age groups 35–44, 45–54,

and 55 –64 years, the mean SBP levels were significantly greater

for black men. The mean SBP levels were equal for black andwhite men ages 65 –74 years.

Racial differences in SBP between white and black womenwere very consistent In every age group, the observed means

for black women were greater than those for white women

(table B). The differences in mean SBP between black and

white women increased from a low of 1 mmHg for ages 18–24

years to a maximum of 11 mmHg for those ages 45–54 yearsand were statistically significant for the age groups 35 years

and over.The mean SBP levels were significantly higher across SUG

cessive age groups for all four race-sex groups (table B). The

difference in mean SBP between extreme age groups was greaterfor women than men (ffom 111 to 146 mmHg for women, and

from 124 to 142 mmHg for men).The difference in mean SBP between extreme age groups

was greater for black adults than for white adults (table B).

SBP means for black men changed from 121 to 142 mmHgover the age span studied, while the comparable figures forwhite men were 124 to 142 mmHg. Among black women, SBP

means changed 39 mmHg across the age range studied (from112 to 151 mmHg), while SBP means among white women in-creased 34 mmHg (from 111 to 145 mmHg).

Diastolic blood pressure

As shown in table C, figure 2, and table 2, mean DBPlevels were significantly greater for black men than for white

Table B. Mean systolic blood pressure by race, sex, and agsx United States, 1976-80

Age

18– 74 18-24 25-34 35-44 45-54 55-64Race and sex

65-74years years years years years years years

All races Systolic blood pressure in millimeters mercury

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 117 118 123 130 137Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

144129 124 125 126 131 137 142

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 111 112 119 129 137 146

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 117 118 122 129 137 144Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 124 125 126 131 137Women, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

142123 111 112 119 127 137 145

Black adults

Both sexes . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 128 116 118 128 137 145 147

Men, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 121 124 131 136 144 142Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 ’112 114 126 138 146 151

6

I

1!50

140

130

120

110

100

./

o

160

150

140

130

120

110

100

Men

18-24 25-34 35-44 45–54

years years years years

Age

~ White women

~ Black womerr

~ 95 percent confidence interval

T

E!%

55-64years

T

65-74years

T

18-24 25-34 35-44 45–54 55-64 65-74years yaars years years yeara years

Age

NOTE Based on the average of 3 blood pressure measurements.

Figure 1. Mean systolic blood pressure among white and black men and women by ag= United States, 1976-80

7

Table C. Mean diastolic blood pressure by race, sex, and age: United State!s, 1976-80

Age

18– 74 18-24 25–34 35-44 45-54Race and sex

55-64 65– 74years years years years years years years

All races Diastolic blood pressure in millimeters mercury

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 73 76 80 83 84 82Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 76 79 82 85 85Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8377 70 73 78 82 82 82

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 73 76 79 83 83 82Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 76 79 82 85 84 82Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 70 73 77 81 82 81

Slack adults

Seth sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 73 77 84 89 88 85Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 75 80 86 88 90 86Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 71 75 82 89 87 85

men in all age groups 35–44 years and above. The amount bywhich the mean DBP for black men was greater than the meanDBP for white men varied between 3 mmHg for those ages 45–54 years (88 versus 85 mmHg, respectively) to 6 mmHg forthose ages 55-64 years (90 versus 84 mmHg, respectively).

Mean DBP levels were significantly greater for blackwomen than for white women in all age groups 35–44 yearsand above (table C). The difference in mean DBP levels be-tween black and white women peaked at ages 45–54 years (89versus 81 mmHg, respectively).

Mean DBP levels for all adults were significantly higher asage increased, changing from 73 mmHg for those ages 18–24years to 82 mmHg for those ages 65–74 years (table C). Afterage 55, the mean DBP plateaued or decreased slightly. Thispattern of a rise followed by a plateau was apparent for bothmen and women. Among men, the change in mean DBP be-tween ages 18–24 years and 45–54 years was 9 mmHg. Forwomen, the comparable change was 12 mmHg. In each agegroup from 18–24 years to 55–64 years, the mean DBP levelsof men were significantly greater than those of women. Themean DBP levels for men and women ages 65–74 years werenot significantly different.

The change in mean DBP among black men over the 18–74 year age span (from 75 to 86 mmHg) was greater than thatamong white men (from 76 to 82 mmHg). The change in meanDBP among black women (from71 to 85 mmHg) was signifi-cantly greater than that among white women (from 70 to 81mmHg). However, for each race-sex group the peak meanDBP occurred before ages 65–74 years, after which the meansdecreased. This flattening or downward turn to the DBP curvewas not found in the Framingham longitudinal analysis,21 andmay be attributable to selective survival.

Education and blood pressure

Several investigators have suggested that education is in-versely associated with mean blood pressure level.z3-25Thisrelationship was also found in the NHANES II data reportedhere. Mean SBP levels were lowest among persons with the

most years of formal education and highest among those withthe least education (table 3). An exception to this relationshipwas found for black men, for whom no significant differenceswere observed between extreme educational groups. As educa-tion among adults ages 18–74 years increased from less than 9years to more than high school, the age-standardized meanSBP decreased significantly, from 129 to 124 mmHg. This in-verse relationship held for both men and women. The 7-mmHgdflerence between less than 9 and 13 or more years of educa-tion among women (from 127 to 120 mmHg) was more thantwice that of men (from 131 to 128 mmHg), and both differ-ences were statistically significant.

Mean DBP levels also showed an inverse relationship witheducational level for adults 18–74 years of age (table 4). Themean, age-standardized DBP among adults at the highest edu-cational level was 78 mmHg, 3 mmHg less than that amongadults in the lowest educational level, 81 mmHg. The differencebetween women in the extreme educational categories was3 mmHg (76 versus 79 mmHg), while that between men in thesame categories was 2 mmHg (80 versus 82 rnmHg). Bothdifferences were statistically significant. Again, for black menan inverse relationship was not observed between mean DBPlevel and education.

The inverse relationship between education and bloodpressure level was evident among both white and black adults.Among white adults, the mean SBP decreased 4 mmHg acrossthe educational levels (from 128 to 124 mmHg), and the meanDBP decreased 2 mmHg (from 80 to 78 mmHg). Among blackadults the comparable figures were 3 and 2 mmHg (SBP from131 to 128 mmHg and DBP from 82 to 80 mmHg). For bothraces and for both SBP and DBP, the differences across educa-tional levels among women substantially exceeded the differ-ences among men.

Hypertension

Epidemiologic studies have established that elevated sys-temic arterial blood pressure increases the risk of coronaryartery disease and cerebrovascular accident.2b-32Studies con-

8

100

90

80

70

.

.

0

100

90

80

~ White men

~ Blackrnen

I x percent conficience interval

T

Men

1- T

18-24 25-34 35-44 45-54years years years yea rs

Age

55-64 65-74years years

~ White vmnwn

~ Black worms.

~ 95 percent confidence interval

TT

18-24 25-34 35-44 45-54 55-64 65-74

years years years years years years

Age

NOTE: Baaed on the average of 3 blood pressure measurements

Figure 2. Mean diastolic blood pressure among white and black men and women by age: United States, 1976-80

9

ducted by the Veterans Administration have clearly demon-strated that this risk is reduced by lowering blood pressure .33’34‘The Hypertension Detection and Follow-Up Program (HDFP)has also demonstrated the benefit of lowering BP in reducingcoronary events. The HDFP trial showed a 17-percent reduc-tion in overall mortality, a 45-percent reduction in deaths fromcerebrovascular diseases, and a 26-percent reduction in deathsfrom myocardial infarction for those in the stepped care (SC)group as compared with the referred care (RC) group, many ofwhom were also receiving medication.35’3b

Prevalence estimates of the extent and distribution ofhypertension in the U.S. adult population as determined fromthe average of the three blood pressure measures obtained inthis study are shown in table 5. The following criteria wereused for these estimates, irrespective of diagnostic status:

●

●

●

●

Definite hypertension: SBP equal to or greater than 160mmHg and/or DBP equal to or greater than 95 mmHgand/or currently taking antihypertensive medication.Borderline hypertension: SBP equal to or greater than140 mrnHg and less than 160 mmHg and/or DBP equal toor greater than 90 mrnHg and less than 95 mmH~ and nottakiig antihypertensive medication.Isolated systolic hypertension: SBP equal to or greaterthan 160 mmHg and DBP less than 90 mmHg.Normotension: SBP less than 140 mmHg and DBP lessthan 90 mmHg, and not taking antihypertensive nnedica-tion.

Definite hypertension

An estimated 25.1 million civilian noninstitutionalizedU.S. adults ages 18-74 years had definite hypertension, basedon the above definition. For all ages combined, the prevalencerate was 17.7 percent, increasing monotonically with age fkoma low of 2.0 percent for adults ages 18–24 years to a highof 45.1 percent for adults ages 65–74 years (table 5 andfigure 3).

Definite hypertension was about equally prevalent amongadult men and adult women (17.4 and 18.0 percent, respectively)(figure 3). The prevalence rates changed rapidly for men in theyounger and middle ages, rising from 2.8 percent for those ages18–24 years to 25.7 percent for those ages 45-54 years. Theprevalence rates among men in the age groups 45–54 yearsand over changed less rapidly, rising from 25.7 percent forthose ages 45–54 years to 38.1 percent for those ages65–74 years.

Prevalence rates for definite hypertension among womenincreased in a stepwise fashion through the age span 18–74years, rising from 1.4 percent for women ages 18–24 years to50.4 percent for women ages 65–74 years.

The overall prevalence rate for definite hypertension amongwhhe adults was 16.8 percent (figure 3). The prevalence ratevaried with age, changing from 1.9 percent for white adultsages 18–24 years to 43.7 percent for adults ages 65–’74 years.The prevalence rates observed among white men (table 5) weresignificantly greater than those among white women in all agegroups under 55 years. The rate for white women ages 65-74years was significantly greater than that for white men in thesame age group (48.3 versus 37.5 percent, respectively). The

10

age-adjusted overall rate for white men, 17.1 percent for menages 18–74 years, was not significantly different from that forwhite women, 16.6 percent.

The age-adjusted overall prevalence rate for definitehypertension among black adults was more than 1.5 timesgreater than that for white adults, 25.7 versus 16.8 percent(figure 3). Again, the rate increased with age, from 2.9 percentfor black adults ages 18–24 years to 59.9 percent for blackaldults ages 65–74 years. In every age group 25–34 years andover the rate for black adults was significantly greater than thatfor white adults.

Most of the difference between black and white adults wasattributed to the much higher rates observed for black womencompared with white women (table 5). The age-adjusted overallprevalence rate for black men (21. 1 percent) significantly ex-ceeded that for white men (17. 1 percent) by roughly one-fourth.In contrast, the overall rate for black women (29.5 percent)was almost 1.8 times greater than that for white women (16.6]percent). In the age groups 35–44 and 45–54 years, the ratesobserved for black women were approximately three timesgreater than the rates for white women, suggesting that hyper-tension may occur considerably earlier among the black femalepopulation than among the white female population. The tend-ency for an early rise in prevalence rates was mirrored in blackmen, although not as strongly.

The relatively small number of younger black adults withdefinite hypertension in the sample limited conclusions aboutage-sex-specific differences between black men and women tothose 45 years of age and over. Among the latter age groups,black women were significantly more likely to be classified asdefinite hypertensive than black men (table 5). Observed ratesranged from 26.0 to 46.4 percent for black men in the threeolder age groups, and from 58.3 to 72.8 percent for blackwomen in the same age groups. The observed rates for blackwomen in these age groups were at least 1.3 times greater thanthose for black men in the corresponding age groups. Theprevalence rate for definite hypertension among black womenages 65–74 years, 72.8 percent, was the highest age-race-sex-specific rate found in the study. Definite hypertension afflictedblack women over age 44 years more than any other populationsubgroup considered.

Borderline hypertension

In addition to the 25.1 million adults ages 18–74 yearswith definite hypertension, there were 17.1 million adults ofthose ages with borderline hypertension, a rate of 12.0 per 100adults. Prevalence rates increased consistently throughout theage span 18–74 years (table 5 and figure 4).

The observed rates for men significantly exceeded thosefor women in all but the 55-64-year age group (table 5). Theoverall rate for men was also significantly higher than that forwomen. As with definite hypertension, the increase in theprevalence of borderline hypertension with age was more rapidfor women than men.

The overall age-adjusted prevalence rate for borderlinehypertension for white adults ages 18–74 years was 11.9 per-cent, while that for black adults was 12.5 percent (table 5). Theage-adjusted overall prevalence rate for black men was similar

60

50

40

30

20

10

0

Sex

~ Adults of both sexes

~ Men

~ Women

~ 95 percent confidence interval

18-74 18-24 25-34 35-44 45-54 55-64 65-74

..>al

‘&20

10

n

R?N

yeara years yeara

Race

Age

70

1-

~ Adults of all races

~ White adults60

~ 81ack adults

~ 50I $)5 percent confidence interval

o

&: 40%.

~g 30

years years yeara years

T

18-74 18-24 25-34 35-44 45-54 55-64 65-74

years years years yeara years years years

Age

NOTE Based on the average of 3 blood pressure meaaurementa. Definite hypertension ia defined as systolic blood pressure> 160 mmHg and/or disstolic bloodpressure >95 mmHg and/or taking antihypertensive medication.

Figure 3. Prevalence of definite hypertension among adults 18-74 years of age by age and sex or race United States, 1976-80

11

30

25

20

00

&0.alG.u 15c1cU-6$a

10

5

0

~ Adults of both sexes

~ Men

~ Women

~ 95 percent confidence interval

T

l-. T

-r-

18-74 18-24 25-34 35-44 45-54 55-64 65-74

years years years yea rs yea rs years yaars

Age

NOTE: Baaed on the average of 3 blood pressure measurement. Borderline hypertension is defined aa systolic blood preaaure ? 140 mmHg but less than

160 mmHg and/or diastolic blood pressure >90 mmHg but less than 95 mmHg, and not taking antihypertensive medication.

Figure 4, Prevalence of borderline hypertension among adults 18-74 years of age by age and sex United States, 1976-80

to that for white men (16.9 versus 15.4 percent, respectively).The rate for black women was nearly identical to that for whitewomen (8.9 versus 8,8 percent, respectively). None of the

overall age-adjusted differences reached statistical significance.No age-specific comparisons were made between white and

black adults or between black men and women because most ofthe age-specific rates for black adults did not meet D?ational

Center for Health Statistics standards of statistical reliability.In contrast to definite hypertension, where the prevalence

rates for black adults were markedly greater than those for whiteadults, race was not significantly associated with the prevalenceof borderline hypertension. The ratio of age-adjusted overallprevalence rates for borderline hypertension for black andwhite adults was 1.05 (12.5/1 1.9), in contrast to the ratioof overall prevalence rates for definite hypertension of 1.53(25 .7/1 6.8). On the other hand, the difference in prevalencerates between the sexes was large for borderline hypertensionand small for definite hypertension. The ratio of age-adjusted

12

prevalence rates for borderline hypertension for men andwomen was 1.74 (15.5/8.9), while that for defite hypefiensionwas 0.97 (17.4/18.0).

Isolated systolic hypertension

Isolated systolic hypertension is a subcategory of definitehypertension, restricted to those definite hypertensives with anSBP equal to or greater than 160 mmHg but with a DBP of lessthan 90 mmHg.7 As seen in table 5, this condition was rarebelow age 55 years; ahnost all the cases found in the NHANESII sample occurred in the age range 55–74 years. The conditionwas significantly more likely to occur in women than men inthe age range 55-74 years (6.3 versus 4.5 percent, respectively).The prevalence rate was higher for black persons ages 55–74years than for white persons in the same age group (8.1 versus5.2 percent, respectively), but the difference did not reachstatistical significance.

Diagnosed dafinite hypertension

Among the estimated 25.1 million U.S. adults 18–74 yearsof age with definite hypertension, 18.4 million (73.6 percent)reported that they had been told by a doctor that they had highblood pressure or hypertension (table 6). The proportion in-creased significantly with age, rising from about 44 percent forthose ages 18–24 years to about 80 percent for those ages 65–74 years.

The age-adjusted prevalence of diagnosed hypertensionwas substantially greater among women than among men over-all (80.5 versus 66.4 percent respectively) (table 6). This sexdifferential was especially marked among adults under 45 yearsof age. The rates of diagnosed hypertension for each sex wereessentially identical in the age groups 45-54, 55–64, and 65–74 years. The diagnosed rates for hypertensives in these agegroups varied between 83 and 84 percent for women and be-tween 71 and 72 percent for men. The diagnosis rates in theseolder age groups were hkgher than the diagnosis rates in theyounger age groups.

The rates presented above suggest that undiagnosed hy-pertension is particularly a problem among adults under 45years of age and is a somewhat more significant problem formen than for women. However, an analysis of the absolutenumber of persons with undiagnosed hypertension suggests adifferent pattern (table 5 and figure 5). Among women, thenumber of hypertensives in the United States who were notdiagnosed rose with age from a low of 69,000 in the age group25–34 years to about 661,000 in the age group 65–74 years.Among men, the number of undiagnosed hypertensives tripledbetween those in the age group 18–24 years and the age group25–34 years (247,000 and 783,000, respectively). Within thefour age groups 25–34 years to 55–64 years, the number ofundiagnosed male hypertensives was markedly greater than thenumber of undiagnosed female hypertensives. These data sug-gest that, from a public health perspective, the most benefitwould be gained by focusing available resources on programsthat insure that men begin regular blood pressure checkups inearly adulthood.

The probability of being diagnosed was somewhat higherfor black adult hypertensives than for white adult hypertensives

(80.9 versus 72.3 percent, respectively) (table 6). This wastrue for men (69. 1 versus 65.9 percent for black and whitehypertensives, respectively), as well as for women (87.6 versus79.3 percent for black and white hypertensives, respectively),although only the latter difference was statistically significant.The more favorable diagnostic experience for black adulthypertensives overall was due primarily to the higher diagnosisrate among black female hypertensives. Black female hyper-tensive ages 35 years and over represent a group of particularinterest, reporting a remarkable average diagnostic rate of nearly90 percent. The relatively small number of black adults withdefinite hypertension in the sample prevented conclusionsabout age-specific differences between white and black adultsof a given sex or between black men and black women.

Medication usage by hypertansives

Over three-fourths of all diagnosed definite hypertensivesreported taking antihypertensive medication “always,” “often,”or “sometimes” (table 6). The proportion varied with age 40.9percent of definite hypertensives ages 18–24 years took medi-cation compared with 85.4 percent of those ages 65–74 years.

Female adult definite hypertensives who had been diag-nosed were more likely than their male counterparts to bemedicated (79.3 versus 68.9 percent, age-adjusted to the com-bmed population) (table 6). The proportion of male hyperten-sive taking medication increased from a low of 37.6 percentfor those ages 18–24 years to a high of 81.8 percent for menages 65–74 years. The pattern for women was not as consistentas that for men, but again the proportion increased with age,from a low of 44.0 percent for women in the 18-24 year agegroup to a high of 87.2 percent for women in the 65–74 yearage group. In every age group, the observed proportion of diag-nosed female hypertensives taking medication was greater thanthat for diagnosed male hypertensives.

The proportion of diagnosed white adult hypertensiveswho were medicated was similar to the proportion of diagnosedblack adult hypertensives who were medicated (75.1 versus72.7 percent, respectively). Diagnosed female hypertensives ofboth races were more likely to be medicated than diagnosedmale hypertensives of the same race (8 1.0 and 68.8 percent forwhite females and males, respectively, and 75.9 and 66.0 per-cent for black females and males, respectively). Black femalehypertensives in the age group 65–74 years repted the highestrate of medication, 88.9 percent. Thus, for every 10 blackwomen diagnosed as hypertensive, 9 reported taking medica-tion. Once again, the relatively limited number of hypertensiveblack adults in the sample proscribed much age-specific sta-tistical testing.

Joint distributions of SBP and DBP

The recently published report of the third Joint NationalCommittee for the Detection, Evaluation, and Treatment ofHigh Blood Pressure (JNC III), among other recommendations,defined new categories of elevated blood pressure to assistpractitioners in classi~ing patients’ degrees of cardiovascularrisk.7 Newly created categories include “high normal” for

13

900

800

700

600

500

400

300

200

100

0

100

80

60

40

Number

~ Men

~ Women

L:::::::::....:.:.:.:.:............................................O. . . . . . . . .

. . . ...+..

. . . .:.:.:.:>:

. . . . . ...<

. . . . . . . . .

. . . . ..O.O

. . . .:,:0: <:,:

. . . .. . . . . . . . .

:+:4 :.:,:

. . . .

. . . . .

. . . .

;,:.:.:.:

. . . .

. . . . . . . . .

18-24 25-34 35-44 45-54 55-64 65-74years years years years years years

Age

Percent

~ Men

20

018–24 25–34 35-44 45–54 55-64 65-74yea rs years years yeara years years

Age

NOTE: Based on the average of 3 blood pressure measurement. Definite hypertension ia defined as systolic blood pressure >160 mmHg andlor diastolic blood

pressure 295 mmHg and/or taking antihypertensive medication.

Figure 5. Number and percent of hypertensives who were diagnosed, by sex and age: United States, 1976-80

14

adults with a DBP between 85 and 89 mmHg, and other cate-gories related to isolated systolic hypertension. (Table Dpresents a side-by-side comparison of the traditional and theJNC 111definitions of hypertension categories.) To more fullymeet the needs of those desiring to assess the implications ofthese new categorizations, tables 7– 10 provide cumulative fre-quency distributions for demographic subgroups within com-monly used SBP categories by DBP categories.

These distributions for age, race, and sex population sub-groups allow the reader to determine what proportion of thesubgroup falls below or above any of the commonly used uni-variate or bivariate definitions of elevated blood pressure. Forinstance, focusing on the definition of elevated blood pressurebased on an SBP of 140 mmHg or more or a DBP of 90 mmHgor more (which includes all the JNC III hypertensive cate-gories), it can be seen in figure 6 and table E that, for all fourrace-sex subgroups, the proportion with elevated blood pressurerose with age, Standard errors for these rates are not providedin tables 7– 10 but can be obtained from Terence Drixd at theNational Center for Health Statistics. Among white men theproportion increased significantly as age increased, from 16.0percent for those ages 18-24 years to 53.0 percent for thoseages 65–74 years. Among white women, the proportion withelevated blood pressure at ages 18-24 years was 2.0 percent,significantly lower than the rate for white men of the same age.However, the proportion of white women with elevated bloodpressure rose rapidly after menopause (ages 45-54 years),resulting in 56.2 percent of white women 65–74 years of agehaving elevated blood pressure.

The increase across age was also evident for black menand women. For black men, the increase across the age span of18–24 years to 65–74 years was from 10.8 to 58.5 percent.The comparable rise for black women was from 8.0 to 66.5percent. Again, the rapid rise in the prevalence of elevatedblood pressure among women after the menopause years canbe seen. The data also show an earlier rise in the prevalencerates for elevated hypertension for black men and women thanfor whhe men and women. This phenomenon was noted abovein the section on definite hypertension.

For every age and sex group except males ages 18-24years, the prevalence rates for elevated blood pressure werehigher for black adults than for white adults. The differenceswere particularly pronounced in the age range 35–64 years,where the rates for black adults exceeded those for white adults

Table D. Comparison of J NC III and traditional hypertension definitions

by 10–20 per 100. By ages 65–74 years, the rates for whiteadults approached the rates for black adults.

Similar analyses can be conducted for any of the hyper-tension categories defined by JNC III. As mentioned earlier,those definitions provide a more detailed or specific classifica-tion for assessing the degree of risk experienced by those per-sons with elevated blood pressure. Because the JNC III defini-tions establish lower values of DBP and SBP to be used asthresholds for a diagnosis of hypertension, table F shows agreater proportion of the population characterized as hyperten-sive when the JNC III definitions are used than when tradi-tional definitions are used.

Based on the JNC III definitions, about one person in four(26.4 percent) was hypertensive (that is, not “normal” or “highnormal”) in the period spanned by the NHANES II survey.The proportion of women classified as “normal” (that is, DBPless than 85 mmHg and SBP less than 140 mmHg) was sig-nificantly higher than the proportion of men so classified (72.1versus 60.0 percent, respectively), as was the proportion ofwhite versus black adults (67.2 and 59.5 percent, respectively).

Approximately 37.4 million U.S. civilian noninstitution-alized adults between the ages of 18 and 74 years fell in one ofthe five hypertension categories at the estimated midpoint ofthe NHANES II survey. Hypertensive persons who havepharmacologically reduced their blood pressure to less than thethreshold values would normally be added to this number inestimating the total hypertensive population of the UnitedStates, and the bottom line of table F shows the proportion ofrace and sex groups that are classified as hypertensive if thoseadults on antihypertensive medication are added to those adultswhose blood pressures are elevated. Using this definition, 29.7percent (about 42.1 million) adults ages 18–74 years werehypertensive.

Figwe 7 shows the proportions of white and black menand women with hypertension, using the traditional (that is,WHO) and the JNC III definitions. The proportions of adultswho were determined to be hypertensive using the expandedJNC III definition were between 30 and 95 percent higher(relatively) than the rates for hypertension using the traditionaldefinition, depending on which race-sex group is considered.The excess prevalence among black adults of both sexes wasmaintained by the new definition. A slight excess of hyperten-sion was found among white men compared with white women(32.5 versus 25.4 percent, respectively, using the 140 mmHg

Hypertension category JNC Ill Traditional

DBP<85mmHg and SBP<140mmHg. . . . . . . . . . . . . . . . . . . . . . . . . . Normal NormalDBP85-89mmHg and SBP<140mmHg . . . . . . . . . . . . . . . . . . . . . . . . High normal NormalDBP90-94mmHg and SBP<160mmHg . . . . . . . . . . . . . . . . . . . . . . . . Mild hypertension Mild hypertensionDBP90-94mmHg and SBP>160mmHg. . . . . . . . . . . . . . . . . . . . . . . . Mild hypertension Definite hypertensionDBP95-104mmHg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mild hypertension Definite hypertensionDBP105-l 14mmHg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moderate hypertension Definite hypertensionDBP>115mmHg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Severe hypertension Definite hypertensionDBP<90mmHg and SBP 140-159 mmHg . . . . . . . . . . . . . . . . . . . . . . . Borderline isolated systolic hypertension Mild hypertensionDBP<90mmHg and SBP>160mmHg . . . . . . . . . . . . . . . . . . . . . . . . . Isolated systolic hypertension Isolated systolic hypertension

NOTE JNC Ill = Third Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Preaaurw DBP = diastolic blood pressure; SBP = systolicblood prassure.

15

70

60

50

40

30

20

10

//

o

80

70

60

50

40

30

20

10

/

‘Lo

White

- ‘r~ White . . .

~ White women

I ~, percent confidence interval

T

18-24 25-34years years

~ Black men

~ !31ackwormsn

I ,, per. ent confidence interval

T

35-44yaara

45-54 55-64yeara years

Age

Black

T.TT

65-74years

T

18-24 25-34 35-44 45-54 55-64years

65-74yesrs yeara years yeara years

Age

NOTE: Baaed on the average of 3 blood pressure measurements with systolic pressure >140 mmHg and/or diastolic pressure >90 mmHg.

Figure 6. Prevalence of elevated blood pressure among white and blaclk men and women by age: United States, 1976-80

16

Table E. Prevalence rates for mild, moderate, and severe hypertension ‘combined, based on JNC 111definitions, by race, sex, and agsrUnited States, 1976-80

[Rates are per 100]

White men White women Black men Black women

Age Rate SE Rate SE Rate SE Rate SE

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.0 1.87 2.0 0.50 10.8 2.37 8.0 2.1425-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.6 1.99 4.4 0.79 23.3 3.03 12.2 3.0535-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.3 2.64 14.9 1.33 41.8 7.99 31.1 4.2445-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40.0 2.23 29.1 2.44 51.6 6.34 53.7 4.8855-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.0 2.30 41.3 2.63 62.9 5.08 59.0 3.4765-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.0 2.53 56.2 2.11 58.5 3.38 66.5 5.29

Table F. Distribution of U.S. population according to J NC III hypertension cate90riee. by race, se% and cete90W United Statea, 1976-80

White Black White White Black BlackHigh blood pressure categoty All adults adults Men Women men women men women

Percent

Normal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.4 67.2 59.5 60.0 72.1 60.5 73.3 54.8 63.4High normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 7.2 7.3 9.1 5.5 9.0 5.6 9.5 5.5Elevated blood pres$ure:

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.4 25.6 33.2 30.9 22.3 30.5 21.1 35.8 31.1

Mild high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.9 14.4 19.1 18.6 11.6 18.4 10.7 20.8 17.8Moderate high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . 1.6 1.4 3.1 1.9 1.4 1.8 1.1 2.9 3.2Severe high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 0.5 ‘i .4 0.7 0.5 0.5 0.4 2.1 0.8Borderline isolated systolic hypertension. . . . . . . . . . . . . . . 7.7 7.8 7.7 8.4 7.1 8.4 7.2 8.7 6.9Isolated systolic hypertension . . . . . . . . . . . . . . . . . . . . . . . . 1.5 1.5 1.9 1.3 1.8 1.3 1.7 1.2 2.3

Elevated blood pressure or medicated . . . . . . . . . . . . . . . . . . . 29.7 28.8 38.2 32.9 26.8 32.5 25.4 38.0 38.4

50

[

~ Systolic blood pressure> 160 mmHg and/or diastolic blood pressure> 95 mmHg and/or medicated

~ Systolic blood pressure> 140 mmHg and/or diastolic blood pressure> 90 mmHg and/or medicated

~ 95 percent confidence interval

40 T T

30

20

10

0

White men White women Black men Black women

Figure 7. Prevalence of hypertension among white and black men and women 18-74 years of age using traditional definitions and definitionsof the Third Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Pressure United States, 1976-80

17

and 90 mmHg definition), and the difference was statistically an SBP of less than 140 mmHg, regardless of medication status.significant. Mild hypertension was significantly more prevalent among men

Of the 37.4 million adults with hypertension in the United than women (18.6 versus 11.6 percent, respectively) and amongStates, over one-half fell in the category defined as mild hyper- black adults than among white adulta (19.1 versus 14.4 percent,tension, that is, with an average DBP of 90 to 104 mmHg and respectively).

18

Secular trends, 1960–80

History

Until the 1950’s, safe and effective medication for long-term outpatient treatment of hypertension was not available.Prior to that time, antihypertensive drugs were very potent, andtheir use often resulted in adverse side effects.37Consequently,only malignant hypertension was treated and such therapy wasgenerally performed in emergency rooms or hospitals. Diureticscame into use in the late 1950’s as the first effective hyper-tension treatment with an acceptably low incidence of adverseeffects.

The advent of the modern period of hypertension treatmentwas signaled by a widespread recognition of hypertension as animportant public health problem in the 1960’s. The FraminghamHeart Study and the Tecumseh Study demonstrated an in-creased risk of stroke and myocardial infarction associated withelevated blood pressure.28’38-42The Veterans AdministrationCooperative Study showed that lowering blood pressure inpersons with moderate or severe hypertension (diastolic bloodpressure (DBP) of 105 mmHg or more) reduced the risks ofstroke and congestive heart failure.33’34’43About 1968, the firstlong-term public programs were developed to begin screeningand treatment of hypertension.

In 1972, the National High Blood Pressure EducationProgram (NHBPEP) was initiated.44 This program was de-signed to develop national recognition of hypertension as apublic health problem of major importance. The National HighBlood Pressure Coordinating Council was formed by the Na-tional High Blood Pressure Education Program to help coor-dinate the efforts of the many groups that had become involvedin hypertension control. Such groups included a wide variety ofvolunteer and professional organizations. The CoordinatingCouncil fimctions today as a forum for consensus and actionfor these groups.

In 1975, the first Joint National Committee on the Detec-tion, Evaluation, and Treatment of High Blood Pressure issuedits report, distributing it to health care providers and organiza-tions.45 Its recommendations included treatment of all adultswith DBP’s of 105 mmHg or greater as well as those withDBP’s of 90– 104 mmHg if other risk factors were present, aformalized stepped care approach to treatment, and avoidanceof ineffective or inappropriate drugs. These recommendationsformed one of the first common treatment gqjdelines for hy-pertension.

In 1979 the results of the Hypertension Detection andFollow-Up Program (HDFP) were published.36,46This multi-center, community-based, randomized, controlled trial com-

pared the effects of a systematic antihypertensive treatmentprogram (Stepped Care) and referral to community-basedmedical therapy (Referred Care). Those persons with a DBPof 90 mmHg or more assigned to the Stepped Care groupachieved consistently better control of their elevated bloodpressure and experienced a 5-year, all-cause mortality 17 per-cent lower than those in the Referred Care group. Mortalitywas also significantly lower for the Stepped Care subgroupwith mild hypertension (entry DBP of 90 to 104 mmHg) com-pared with the corresponding Referred Care subgroup. Theresults suggested that systematic effective management of hy-pertension has the potential to reduce mortality for the largenumbers of persons with elevated blood pressure in the popula-tion, including those with mild hypertension.

In 1980, following a review of the results of the HDFP,the second JNC report was published.47 It offered guidelinesfor the extent of evaluation of persons with elevated bloodpressure, recommended treatment of persons with diastolicblood pressures of 90 mmHg or more, made guarded recom-mendations on isolated systolic hypertension, and updated thestepped care treatment guidelines to include the beta blockers.These updated guidelines also suggested weight reduction inobese patients and sodium control as adjunctive therapy for themanagement of hypertension.

Following the development of new antihypertensive agentsand the publication of the results of new clinical trials in theearly 1980’s, the report of the JNC III was recently published.’It emphasized increased targeting for screening programs andincreased use of nonpharmacologic methods initially and duringlong-term management of hypertension. As pointed out earlier,persons with diastolic blood pressure of 85 to 89 mmHg werenewly categorized as having “high normal blood pressure.”Other new categories were created related to isolated systolichypertension. The stepped care recommendations were updatedto include the beta blockers as acceptable Step 1 agents and theangiotensin-converting enzyme inhibitors and calcium channelblockers as acceptable agents in later steps. “Stepdown” therapywas mentioned for use in selected patients.

Data from repeated cross-sectional blood pressure surveyshave been published for Minnesot%4s’49Baltimore, Md.;50 theState of Marylan~51 Chicago, 111.;52Charleston, S.C.;53NorthKarelia, Finlan@54 and the State of Connecticut.55 Thesestudies appear to have demonstrated improvements in bloodpressure control in a number of populations in recent years.The National Health Examination Survey (NHES) and theNational Health and Nutrition Examination Survey (NHANES)results presented here strengthen these findings by documenting

19

blood pressure trends in a representative sample of the entire

U.S. adult population ages 18-74 years over a 20-year period.

Comparisons of results among threeNational Health Surveys

As described in the introduction, during the period1960– 1980 the NationaJ Center for Health Statistics conductedthree cross-sectional surveys designed to assess the health ofthe civilian noninstitutionalized adult population of the UnitedStates. The first National Health Examination Survey (NHES

I) was conducted in 1960–62.8 The first National Health andNutrition Examination Survey (NHANES I) was conductedin 1971 –74.’ The second NHANES, conducted in 1976–80,was the subject of the first part of this report.9,10 The three

surveys differ in regard to subject matter covered but generally

permit time-related comparisons of selected measures.

Differences among the three surveys dictated the choice ofthe first blood pressure determination for comparisons amongsurveys rather than the mean of three blood pressures, vvhichwas the source of the analyses in the first part of this report.

Only the first blood pressure (BP) determination is availablefor all examinees for all surveys. In NHANES I only 33.3

percent of the adult examinees received the detailed examina-tion in which three blood pressure measurements were made.

Also, in all three surveys only the first blood pressure measure-

ment was taken under the following identical circumstances:

● Only the first determination was always performed withthe examinees in a seated position. In NHANES I andNHANES II the examinee was recumbent for the second

determination.

● The first determination was always made by a physician.The second and third determinations in NHANES I wereusually made by a nurse.

● In all three surveys the fwst determination was made at thestart of the physician’s examination.

Other factors were considered before accepting the premisethat there were no survey-specific biases inherent in the firstdetermination. Standard mercury sphygmomanometers wereused in all three surveys. Regular size adult cuffs (12.5 cm

long) were used on adults in all three surveys. Examination

room temperatures did not differ substantially among the sur-veys. In all of the surveys the first measurement was takenwhile the examinee was seated on the examination table, with-

out support for the back. The hours of examination were iden-tical for all three surveys, so any diurnal variations were con-

stant for all three surveys. The chronologic relationship betweenthe physician’s examination and other, possibly stressful, ex-

amination components was random in all three surveys. Ob-server differences were discounted because of survey design

considerations or as a result of postsurvey analyses. The pos-

*NHANES I was augmented by a separate but similar subsemple measured in

1974-75. The augmentation subsample consisted only of detailed examinees

who were not weighted to be part of the numerically much kwger 1971 –74

sample. Consequently, the augmentation asmple was omitted from furtheranrdysis.

sibility of orthostatic hypotension was discounted, because thefirst determination was always made at the start of the physi-

cian’s examination and was always done with the examineeseated, with no immediately previous recumbent period.

The possibility exists that the first blood pressure may

have been slightly elevated because of exarninee anxiety, (Com-pnring tables 1 and 11, for instance, which present means for

the average of three blood pressure measurements and forthe first blood pressure alone for NHANES H, suggests thatthe difference is about 3 mmHg. If all three pressures used inthe average had been sitting measurements, and if the lastmeasurement had not been subjected to bias due to orthostatichypotension, this difference would have been less.) However,thlere was nothing to suggest that the degree of elevation was

any greater or lesser for any one of the surveys. No sources ofsurvey-specific bias in the first blood pressure measurementwere found.

The systolic blood pressure (SBP) was chosen as the pri-mary measure for comparison among the surveys. Numerous

studies have found that the determination of SBP is more reliablethan that of DBP. In one study comparing clinic and home

blood pressure readings on hypertensive patients it was foundthat 69 percent of the variance in home SBP readings was pre-dicted by clinic SBP readings, while only 30 percent of thevariance in home DBP readings was predicted by clinic DBPreadings.56 Superior reliability of systolic readings was also

i%und in the Framingham study.57 A study by Wilcox on bloodpressure variability using a sound motion picture device for

testing also found a greater variability in the DBP reaclings.58Reliance solely on an SBP determination detracts little

from an evaluation of BP-associated morbidity and mortality.

For instance, one prospective study, using a multiple logistic

model to evaluate the relationship of various cardiovascularrisk factors to total cardiovascular disease mortality in EvansCounty, Georgia, retained SBP pressure while dropping outDBP pressure.59 This greater predictive ability, and the factihat most factors which confound blood pressure measurement

seem to have greater impact on the DBP than on the SBP,recommends the SBP as the measure of choice in an analysisof trends.

The results of the three surveys showed significant im-provement in mean SBP for white and black races and both

sexes over the period covered by the three NCHS surveys(table 1I).b The age-adjusted mean SBP for white men ages

18–74 years was 133 mmHg in 1960–62, 131 nlmHg in197 1–74, and 129 mmHg in 1976–80. For white women ages

18-74 years, the age-adjusted mean SBP fell from 129 mmHgin 1960–62 to 128 mmHg in 1971–74 to 123 mmHg in 1976–80. For black men, these means were 138 mmHg, 136 mmHg,

and 130 mmHg for the three surveys, respectively. The cor-responding means for black women were 138 mmHg, 135mmHg, and 126 mmHg. The differences between the earliestand latest means were significant in each of the four race-sexgroups.

bA more complete presentation of the basic data from NHES I and NHANES I,

including sample sizes for specific age-race-sex subgroups, has been pub-lishe~ll-ls

20

In general, the age-adjusted mean SBP declined more in figures 8 and 9). During the 20-year period, the mean SBPblack adults than in white adults and more in women than in among white adults ages 18–24 years fell only 1 mmHg (frommen over the period. Specifically, the age-adjusted mean SBP 118 to 117 mmHg), while for white adults ages 65–74 years itdeclined 4 mmHg in white men, 6 mmHg in white women, 8 fell 12 mmHg (from 157 to 145 mmHg).mmHg in black men, and 12 mmHg in black women. The One of the original intentions of this report was to examineamount of improvement in SBP was greater for the older age the proportion of the population with an SBP equal to or greatergroups than it was for the younger age groups (for example, see than 160 mmHg. Many individuals with an SBP in the range of

30

20

Eas2

10

0

..”gfzl..e — 1960-62.+ . . . . . . 1971-74

~ ●“+* -- 1976-80, +4 f) Median

E Mean

4

0 /(90 100 110 120 130 140 150 160 170 180

First systolic blood pressure in millimeters mercury

Figure 8. Smoothed weighted frequency distribution of the first systolic blood pressure for whtie men ages 18–24 yeara by survey United States,NHES I (1960-62), NHANES I (1971-74), and NHANES II (1976-80)

20 r

15

10

5

/) I

,/’-,.**”@xe*

_ 1960-62■ ===== 1971-74

/% -- 1976-800 Median❑ Mean

//

1/

1

0 ~/ 1 -. t 1 I & I I .*A 1

0 80 100 120 140 160 180 200 220 240

First systolic blood pressure in millimeters mercury

Figure 9. Smoothed weighted frequency distribution of the first systolic blood prassura for white men ages 65-74 years by survey Unitad States,NHES I (1960–62), NHANES I (1971-74), and NHANES II (1976-80)

21

140– 159 mmHg will not be treated, while some individualswith an SBP initially in excess of 159 mmHg may have their

pressures reduced to less than 160 mmHg after treatment is

begun. However, the small number of sample persons in therace-sex-specific younger and middle age groups with SBP

over 160 mmHg resulted in estimated proportions that did notreach minimum standards for reliability. Consequently, atten-tion was redirected to the proportion of the population with anSBP of 140 mmHg or more.

The age-adjusted proportions of persons with SBP equalto or greater than 140 mmHg decreased across the three surveys

for both races and both sexes (table 11). Specifically, the age-adjusted proportion of white men in that category decreasedfrom 32.4 percent in 1960-62 to 27.0 percent in 1976-80.

The proportion for white women declined from 26.1 to 21.1

percent, for black men from 41.2 to 28.3 percent, and for blackwomen from 39.6 to 26.7 percent over the 20-year time period.Thus, the magnitude of the decline in the proportion of personswith SBP equal to or greater than 140 mmHg was similar

among men and women of the same race, but substantially

greater for black adults than for white adults. Given the higher

proportion of persons with SBP equal to or greater than 140mmHg among black adults in the 1960–62 survey, and given

the larger decline in that proportion among black adults since

that time, the proportion of such persons is similar among thefour race-sex groups in the 1976-80 data 27.0, 21.1, 28.3,

and 26.7 percent for white men and women and black men andwomen, respectively.

The age-specific proportions of persons with SBP equal to

or greater than 140 mmHg declined over the three surveys for

both races and both sexes (table 11). The magnitude of the

decline was greater among the older age groups than among theyounger age groups for both races. In all three surveys theolder age groups consistently had higher proportions of personswith SBP equal to or greater than 140 mmHg than the younger

age groups. For example, this proportion exceeded one-half for

most race-sex groups ages 55 –74 years, while it was less thanone-fifth for most race-sex groups ages 18–34 years.

In contrast to the significant improvements noted for SBPover the three surveys, the results for DBP do not demonstrate

any consistent changes for any race-sex group (table 12). Theseresults are somewhat contrary to what was expected and may

have been the product of problems in the determination of DBP

in the later two surveys. (This issue is explored fimther in the

Discussion section.) Findings in regard to DBP are presentedhere as a preface to analyses of trends in hypertension.

Age-adjusted mean DBP levels showed variable fluctua-tions with no discernible trend overtime for all race-sex groupsexcept white males (table 12). Among white males, the age-

adjusted mean DBP increased from 79 mmHg in NHES I to83 mmHg in NHANES H, and the difference was statisticallysignificant. For all three surveys, black adults had higher mean

DBP levels than white adults, and males generally had higherDBP levels than females, consistent with similar race and sex

relationships for mean SBP measurements. The age-specific

DBP means also showed no consistent trends over the threesurveys (table 12).

The proportion of the population with definite hypertension

(SBP equal to or greater than 160 mmHg and/or DBP equal toor greater than 95 mmHg, and/or taking antihypertensive medi-cation) by age, race, and sex is presented in table 13 for thethree surveys. The age-adjusted proportion of white adults withdefinite hypertension rose from 18.0 percent in 1960–62 to21.0 percent in 1976–80. Among black adults, the age-adjusted

proportion fell from 33.6 percent in 1960-62 to 28,6 percentin 1976–80, but the decline was not statistically significant.The small increase among white adults was more evident inmen than in women, while the larger decrease in black adults

c~ccurred for both sexes similarly (figure 10). The age-specific

proportions of persons with definite hypertension generally re-flected trends similar to their respective race-sex groups overtime.

The proportion of the population with elevated blood pres-sure ( SBP equal to or greater than 140 mmHg and/or DBP

equal to or greater than 90 mmHg, regardless of medicationstatus) is presented in table 14 by age, race, and sex for thethree surveys. The age-adjusted proportion of adults with ele-

vated blood pressure was essentially unchanged over the spanof the three surveys, increasing by only 1.1 percent. The age-

adjusted proportion for males rose by 2.9 percent and fell forfemales by 0.6 percent, but the differences did not reach sta-tistical significance. Among white adults the age-adjusted pro-

portion increased by 1.5 percent, and among black adults fellby 4.1 percent, but again the differences were not statisticallysignificant. Observed age-specific rates tended to increase

among those less than 55 years of age and decreased amongthose age 55 years and over.

The data presented in tables 15–17 and described belowinclude the proportion of persons in each of the hypertension

rubrics as a percent of the total U.S. adult population. This

choice of presentation is intended to address the needs of thosecomparing chronic heart disease rates for the overall LJ.S. pop-ulation, or demographically defined subgroups of that popula-tion. On the other hand, some users of these data may wish to

study proportions for medically defined subgroups of that pop-ulation (for example, persons taking antihypertensive medica-

tion as a proportion of all those with hypertension). Thesereaders are referred to table 18, which presents much of the

data from tables 15-17 with the proportions calculated by thisalternate method.

As shown in table 15, the proportion of persons with un-diagnosed hypertension has declined in the period covered bythe three surveys. Although slight increases were noted forsome race-sex groups between the 1960–62 and 1971 –74 sur-veys, the downward trend between the 1960–62 and. 1976–80surveys was significant for each of the four race-sex groups

except white males, Over the period from 1960–62 to 1976–80, the age-adjusted proportion of white adults with undiag-nosed hypertension fell 1 or 2 percent (from 10.7 to 9.8 percentin men, and from 7.7 to 5.6 percent in women). In contrast, the

rates among black adults of both sexes were more than halved,falling from 21.1 to 9.9 percent among black men and from

13.2 to 4.5 percent among black women.

The declines in age-specific proportions of persons withundiagnosed hypertension were substantially larger among

black adults than white adults in most age groups. While some

22

White womenr35

r

White men

30

t

1960 1965 1970 1975 1980

Year

45

r

Black men

40

t

35

15

10

5

0

T

1960 1965 1970 1975 1980

Yea r

I~ NHES 1

~ NHANES I

~ NHANES ,[

~ 95 percent conficlence interval

I 1-

1960 1965 1970 1975 1980

Year

r Black women

I —r “1 T

1960 1965 1970 1975 1980

Year

---- . . . .I-lgure 1u. Age-adJusted prevalence of definite hypertension among white and black men and women by survey: United States, NHES I(1960-62), NHANES I (1971-74), and NHANES II (1976-80)

23

of the age-specific proportions for black adults were twice ashigh as those for white adults in the 1960–62 study, most ofthe age-specific proportions for black adults were very close tothose of white adults in the 1976–80 survey. In fact, for blackwomen ages 55–74 years in the 1976–80 survey, the propor-tions with undiagnosed hypertension were actually lower thanfor white women in the same age groups, although the differ-ences did not reach statistical significance.

The proportions of persons taking antihypertensive medi-cations are shown in table 16 for each of the three surveys.(The reader is cautioned that the question addressing medica-tion use asked of the respondents in the 1971–74 survey wasslightly different from those used in the 1960–62 and 1976–80surveys. The questions used in those two surveys referred onlyto current medication use, while that used in NHANES I askedabout use in the previous 6 months. This difference would beexpected to result in a slight upward bias of the 1971–74 esti-mates, but the amount of that bias has not been quantified.)This proportion rose between 1960–62 and 1976-80 for eachrace-sex group. Most of the increase was noted betweenNHANES I and NHANES II, even though the period betweenNHES I and NHANES I was nearly twice the period betweenNHANES I and II. The age-adjusted proportion of personstaking antihypertensive medications rose fi-om 3.8 percent in1960-62 to 7.6 percent in 1976-80 for white men, from 7.0 to11.1 percent for white women, from 6.0 to 9.2 percent for blackmen, and from 15.9 to 19.3 percent (not statistically siW”ticant)for black women. While the age-adjusted proportion of personstaking such medications was generally higher among blackadults than among white adults and among women than men,the amount of increase from NHES I to NHANES II wassimilar for each of the four race-sex groups.

With regard to age-specific rates, the largest absolute in-creases in the proportion taking antihypertensive medicationsoccurred generally among persons ages 45–64 years, while thesmallest changes occurred among the age groups 18–34 years.

As shown in table 17, the proportion of persons with con-trolled hypertension markedly increased between NHES I andNHANES II. This proportion at least doubled for each race-sex group: From 1,5 to 3.4 percent for white men, from 2.9 to6.3 percent for white women, from 0.6 to 3.3 percent for blackmen, and from 6.0 to 11.6 percent for black women. The increasewas statistically significant for each race-sex group.

The absolute proportion of persons with controlled hyper-tension (that is, DBP less than 95 mmHg and SBP less than160 mmHg) changed the least among those ages 18–34 yearsover the 20-year period. The age-specific proportions increasedmost among the older age groups; for example, the proportionmore than doubled for whhe persons in each of the age groupsbetween 45 and 74 years. For white adults ages 65–74 years,the proportion of the population subgroup with pharmacologi-cally controlled blood pressure more than doubled, rising from6.7 to 15.2 percent over the 20-year period. Comparable figuresfor black adults ages 65-74 years describe over a fivefold in-crease, from 5.2 percent in 1960–62 to 26.4 percent in1976-80.

The data in tables 18–20 can be used to estimate the pro-portion of all hypertensives who were able to control their

hypertension with medication. In particular, marked changeswere observed for persons 45–74 years of age. During theperiod of the NHES I survey, 11.3 percent of hypertemives inthis age range were controlled (1,859 out of 16,423 (in thou-sands)). This proportion increased to 16.0 percent (3,250 outof 20,318) in 1971–74 and then to 27.3 percent (6,203 out of22,747) in 1976-80.

Tables 18–20 also present the number and proportion ofmedicated hypertensive who successfully controlled theirhypertension. Among all medicated hypertensives ages 45-74years, the proportion with blood pressures less than 140/90mmHg was 33.8 percent in 1960–62, 42.7 percent in 1971–7’4, and 51.2 percent in 1976–80. The proportion rose withineach of the four race-sex groups when only those ages 45–74years were considered. The increase for white men in this ageg?OUP, 7.4 percent, was the smallest observed, while that forblack men, 39.5 percent, was the largest observed. Thesechanges were not tested for statistical significance because oflimited sample sizes in some cells.

Discussion

A number of previous studies have suggested that detection,andcontrol of hypertension have improved in some communitiesover the past decade. Surveys of blood pressure levels in Bal-timore, Md.; Birmingham, Ala.; and Davis, Calif., were donein 1973–74 as part of the HDFP and again in 1977–78 to ‘,assess changes in these communities.60 The surveys measuredthe blood pressures of nonoverlapping random samples of adults~ages30–69 years in the three cities. The mean DBP decreasedfi-om83.2 mrnHg in 1973–74 to 81.7 mmHg in 1977-78 whenadjusted for age, race, sex, and center.60 The prevalence ofelevated DBP (>95 mmHg) and elevated SBP (> 160 mmHg)decreased for almost every age, race, and sex subgroup studied.The proportion of persons aware of their elevated blood pres-sure status and receiving treatment also increased. The propor-tion of persons with actual hypertension who were on treatmentand under control increased from 28 to 43 percent for blackmen, 47 to 61 percent for black women, 28 to 44 percent forwhite men, and 52 to 69 percent for white women over the 5years studied.bo

Blood pressure levels in the Mhmeapolis-St. Paul area weremeasured through surveys in 1973–74 and 1980–8 1.48’49Inthose surveys adults ages 25–59 years (about 95 percent ofwhom were white persons) had mean age-adjusted blood pres-sure decreases of 3 mmHg for men and 2 mmHg for womenover the period examined. Mean blood pressure levels improvedover time for both SBP and DBP. With regard to hypertensiondetection and control, the surveys found improvements in theproportion of hypertensive persons with adequately controlledblood pressures (from 40.4 to 76.1 percent), with inadequatelycontrolled blood pressures (from 13.7 to 8.5 percent), withdiagnosed but untreated hypertension (from 20.4 to 8.8 per-cent), and with undetected hypertension (from 25.5 to 6.6percent).

The Connecticut High Blood Pressure Program has alsorecently reported general improvements (since 19’78–79) inthe proportion of that State’s adult population who were aware,

24

treated, and controlled.ss Their findings suggest that, at least inone State, the trends observed in the HDFP centers and inMinneapolis-St. Paul between 1973 and 1981 may well becontinuing into the present.

These findings are reflected in the National Center forHealth Statistics (NCHS) surveys reported here. A significantreduction was also found in mean SBP and in the proportion ofpersons within race-sex groups with elevated SBP. The propor-tion of persons with undiagnosed hypertension declined signifi-cantly in the period spanned by the three surveys. The propor-tion of persons taking antihypertensive medication increased,as did the proportion of the population whose hypertension wascontrolled. The findings of the surveys described in the firstpart of this discussion were consistently in agreement with theNCHS surveys conducted in the same period. The level ofagreement between the proportions of controlled hypertensivesobserved in these nationally representative surveys (table 18)and those observed in the three HDFP centers discussed above60was remarkable.

The significant improvement in mean SBP for each race-sex group over the three surveys provides supportive evidencefor the beneficial effects of efforts to identify and control ele-vated blood pressure in the U.S. population in recent years.The decline in the proportion of persons with SBP greater thanor equal to 140 mmHg is consistent with the decline in meanSBP, and similarly suggests that improvement in the control ofelevated blood pressure has occurred.

Previous reports have shown that the prevalence of elevatedblood pressure in black adults is consistently higher than inwhite adults.60 The results of these three surveys suggest thatthe difference in prevalence between the races has decreased,and that the decreases in mean SBP and proportion of personswith SBP equal to or greater than 140 mmHg have been largerin black adults than in white adults.

The mean SBP and proportion of persons with SBP greaterthan or equal to 140 mmHg was higher in persons in the olderage groups in all three surveys, which is consistent with otherstudies. The extent to which this difference represents a naturalaging process (such as progressive loss of arterial elasticity) ora widespread preventable form of pathology among the elderlyis uncertain. However, the larger improvements in SBP amongthe older age groups compared with the younger age groups areencouraging.

It is important to determine whether the changes in bloodpressure levels in the period spanned by the three surveys arecaused by factors that affected only those persons at highestrisk or by factors that affected the U.S. population as a whole.The substantial decline in the proportion of the population withSBP greater than 140 mrnHg suggests that the major factor hasbeen an increased identification and treatment of persons withelevated blood pressure. The decrease in the median SBP overthe same time period is smaller but may be partly due to anumber of society-wide changes in lifestyle patterns resultingfrom increased awareness of cardiovascular factors.

The absence of a clear decline in DBP levels over the timeperiod is somewhat puzzling, given that SBP and DBP levelsare highly correlated39 and that most regimens for treatinghypertension tend to focus on lowering the DBP to an accept-

able level. A number of explanations are possible, but the mostlikely involve insufficient attention to the determination of theDBP by the examiners on the later two surveys, or environ-mental conditions in the examination centers which were morelikely to interfere with an accurate determination of the DBPthan of the SBP.

The issue of observer attention may be most productivelyaddressed by comparisons among the three surveys of the 5th,50th, and 95th percentiles of DBP (table 12). These show thatthere were almost no consistent differences among the threesurveys in the 95th percentile, a modest and fairly consistentincrease (2–4 mmHg) among the first and later two surveys inthe 50th percentile, and a larger (2–8 mmHg) increase in the5th percentile. Such a pattern is possible if the examiners in thelater two surveys were inclined to release the pressure on thecuff faster than the recommended 2 mmHg per second. Thispractice would have the effect of raising the DBP, because theexaminer would be apt to miss the last pulse before the actualcessation of Korotkoff sounds. It is also reasonable to suggestthat this effect would be more pronounced at the lower end ofthe DBP distribution, where the examiners might be more likelyto rush the determination. This phenomenon would not be ex-pected to be present for the fwst survey, in which the examinerswere required to record both the fourth and fifth Korotkoffsounds. The difference between the fourth and fifth sounds canbe difficult to detect and requires close attention and adherenceto recommended techniques.

Observer inattention could have consequences in otherways. In particular, because the examiners of the later twosurveys were not required to record both the fourth and fifthsounds, it is possible that once the diastolic value was wellwithin the normotensive range, the physician may have listenedless meticulously for the disappearance of the Korotkoff sounds.In general, the written instructions given to the physicians forthe reading and recording of blood pressures in the later twosurveys were less detailed than in the first survey, and no bloodpressure measurement retraining was provided for the physi-cians. As a consequence, the physicians may not have beenaware of the need for an accurate determination of DBP froman epidemiological standpoint, regardless of the clinical signif-icance of the value.

Some support for the hypothesis of observer inattentioncan be found in the distribution of end digits for DBP measure-ments (see appendix IV). That analysis shows that the physi-cians of the later two surveys were more likely than those of thefirst survey to report DBP values that ended in O or 5, when infact all blood pressure measurements should have been even-numbered and equally likely, thus eliminating the possibility ofan end digit of 5.

The difference in character between the physicians of thefirst survey and the physicians of the later surveys may havehad consequences for the accurate determination of DBP inanother way. It is possible that the older physicians of the latertwo surveys may have suffered more from some degree of hear-ing loss associated with aging than the younger physicians ofthe fwst survey, although it has not been possible to quanti~this effect.

The trends in mean SBP, proportion of persons with SBP

25

greater than or equal to 140 mmHg, and proportion of personstaking antihypertensive medications are unaffected by any dif-ficulties with diastolic readings. The general trends in proportionof persons with diagnosed, undiagnosed, and controlled hyper-tension rely on the accuracy of the diastolic reading only in theupper end of the blood pressure distribution (diastolic greaterthan or equal to 90 mmHg). Therefore, ddliculties with diastolicreadings primarily in the lower end of the distribution wouldhave little or no effect on the analysis of these trends.

The proportion of black adults with definite hypertensiondecreased over the period covered by the three surveys (althoughnot significantly), suggesting that some preventive measuresmay have had an impact on the prevalence of the disease inblack adults. However, no similar decline is evident in the pro-portion of white adults with definite hypertension. One mightspeculate that the lack of a decline is a function of(a) the less-than-perfect DBP measurements, (b) declining cardiovasculardisease mortality over the past two decades, keeping morehypertensive white males alive and contributing to the overallincrease, (c) race-specific changes in lifestyle factors related tohypertension, and/or (d) more mild hypertensives being medi-cated, thus “promoting” them into the definite category. Furtherinvestigation is necessary before any conclusions can be drawn.

A significant decline in the proportion of persons with un-diagnosed hypertension was noted for each of the four race-sexgroups over the 20-year period. This improvement providessupportive evidence for the success of major public healthcampaigns to increase public awareness of hypertension, toincrease physician interest in treating hypertension, and tocreate blood pressure screening programs over that time.

The proportion of persons taking antihypertensive medica-tion has increased over the period spanned by the three surveys.The proportion of adults under age 35 years taking blood pres-sure medication is very low for several reasons. Such personshave a low prevalence of elevated blood pressure when com-pared with older adults. In addition, physicians may tend totreat elevated blood pressure in younger persons with non-pharrnacologic means more readily than older persons. Finally,young men have fewer contacts with physicians and are, there-fore, less likely to have their blood pressure taken.

Among adults age 35 years and older, the increasing preportion of blood pressure medication use with age is consistentwith the increasing prevalence of elevated blood pressure withage. Persons ages 35–74 years were more likely to take Moodpressure medications in 1976–80 than in 1960–62. This in-crea~seis consistent with the hypothesis of increasing awarenessand diagnosis of hypertension over that time period. In addi-tion, part of the increased use of blood pressure medicationssince 1960 may be a response to the recent interest in treatingeven mildly elevated blood pressure, and to the development ofnew antihypertensive drugs which are less toxic and more ef-fective. The higher proportion of blood pressure medicationuse among black adults than among white adults was consistentwith the higher prevalence of elevated blood pressure found inblack adults in all three surveys.

Finally, the proportion of persons with controlled hyper-tension increased significantly for each of the four race-sexgroups. Such results may have been expected, given the trendsin increased awareness and treatment over the 20-year period.

In summary, the changes in blood pressure levels in theperiod spanned by the three surveys are in the anticipated di-rections. Overall, mean SBP has decreased, the prevalence ofelevated blood pressure has decreased, the use of antihyper-tensive medications has increased, the proportion of personswith controlled hypertension has increased, and the improve-ments have been most marked in the population sub~~oupsmost at risk at the beginning of the period. The reasons forthese changes are varied, but perhaps the three most significantare (a) the advent of more effective treatment regimens, (b) agreater awareness by physicians and the general public of therislcsinherent in high blood pressure and of the lifestyle factorsinfluencing blood pressure, and (c) a greater recognition byphysicians of the desirability of treating even mildly elevatedblood pressure. Although a direct causal relationship has notbeen demonstrated, these results do provide suggestive evidencethat various private and public programs (such as the NationalHigh Blood Pressure Education Program) have had somebeneficial effect.

26

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62National Center for Health Statistics, E. R Black Current estimatesfrom the Health Interview Survey, United States, 1976. Vi~a/ andHealth Statistics. Series 10, No. 119. DHEW Pub. No. (PHS) 78-1547. Public Health Service. Washington. U.S. Government Printing

Ofice, Nov. 1977.

63R. N. Forthofer: Investigations of nonresponse bias in NHANES II.Am. J. Epiderniol. 117(4):507-515, 1983.

b4A Comparison and Analvsis of Examined and Nonexamined Per-sons on Medical History characteristics for the First Round of theHealth and Nutrition Examination Sun*e-v.Contract HSM- 110-73-371. Rockville, Md. Westat Inc., Jan. 24, 1974.

65The HANES stud-v. Health Services and Mental Health Adminis-tration Contract. Philadelphia. Institute for Survey Research, Temple

University, Apr. 1975.

66National Center for Health Statistics, H. W. Miller and P. Williams

Factors related to response in a health examination survey, UnitedStates, 1960-62. Vital and Health Statistics. Series 2, No. 36. PHSPub. No. 1000. Public Health Service. Washington. U.S. Gover-nmentPrinting OffIce, Aug. 1969.

67National Center for Health Statistics: Memorandum from Wesley

L. Schaible, Acting Chief, Methodological Research Branch, to Arthur

J. McDowell, Director, Division of Health Examination Statistics.June 21, 1974.

681. R Fisch and J. Frank Oral contraceptives and blood pressures.

JAMA 237:2499-2503, June 1977.

69National Center for Heakh Statistics, M. Rowland Basic data on

hearing levels of adults 25-74 years, United States, 1971-75. Vitaland Health Statistics. Series 11, No. 215. DHE W Pub. No. (PHS)80– 1663. Public Health Service. Washington. U.S. Government

Printing Office, Jan. 1980.

70E. P. McCutcheon and R F. Rushme~ Korotkoff sounds. Circula-tion Res. 20149-161, Feb. 1967.

71L. A. Geddes, W. A. Spencer, and H. E. HotT Graphic recordings

of the Korotkoff sounds. Am. Heart J 57:361-370, 1959.

72w. H. Kir.endall, M. Feinleib, E. J). F&, et al: Recommendations

for human blood pressure determinations by sphygmomanometers.H~pertension 3:509 A-5 19A, 1981.

73E. Ellertsen and S. HumerfelL The observer variation in the meas-

urement of arterial blood pressure. Acts Med. Scan. 184:145 – 157,1968.

29

List of detailed tables

NHANES 11,1976–80

1. Systolic blood pressure by race, sex, and age with weightedpopulation estimates, means, standard deviations, standarderrors, and selected percentiles: United States, 1976–80. . .

2. Diastolic blood pressure by race, sex, and age with weightedpopulation estimates, means, standard deviations, standard

errors, and selected percentiles: United States, 1976–80. . .

3. Systolic blood pressure by race, sex, and educational levelwith weighted population estimates, standardized means,

and standard errors: United States, 1976–80. . . . . . . . . . . .

4. Diastolic blood pressure by race, sex, and educational levelwith weighted population estimates, standardized means,

and standard errors: United States, 1976 -80 . . . . . . . . . . . .

5. Number and percent of population in selected blood pres-

sure categories, by race, sex, and age United States,1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Number and proportion of definite hypertensives diagnosed,

medicated, and controlled, by race, sex, and age UnitedStates, 1976 -80 . . . . . . . . . . . . . . . . . . ..-. . . . . . . . . . . . . . .

7. Joint cumulative frequency distributions of systolic blood

pressure categories by diastolic blood pressure categoriesfor white men by age: United States, 1976-80 . . . . . . . . . . .

8. Joint cumulative frequency distributions of systolic bloodpressure categories by diastolic blood pressure categoriesfor white women by age: United States, 1976 -80 . . . . . . . .

9. Joint cumulative frequency distributions of systolic bloodpressure categories by diastolic blood pressure categories

for black men by age: United States, 1976-80 . . . . . . . . . . .

10. Joint cumulative frequency distributions of systolic blood

pressure categories by diastolic blood pressure categoriesfor black women by age: United States, 1976 -80 . . . . . . . .

31

33

34

35

36

38

40

42

44

46

Trend tables

11, Systolic blood pressure by survey, race, sex, and age with

weighted population estimates, means, standard errors,selected percentiles, and proportions at or above 140mmHg United States, 1960–62, 1971-74, and 1976 -80...

12. Diastolic blood pressure by survey, race, sex, and age with

weighted population estimates, means, standard errors,

selected percentiles, and proportions at or above 90 and95 mmHg United States, 1960-62, 1971-74, and1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Proportion of adult population with definite hypertension

by race, sex, age, and survey: United States, 1960-62,1971 -74, and 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Proportion of adult population with elevated blood pressure

by sex, age, and race: United States, 1960-62, 1971-74,and 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. Proportion of adult population with undiagnosed hyperten-

sion by race, sex, age, and survey: United States, 1960-62,1971-74, and 1976-80 . . . . . . . . . . . . . . . . . . . . . . . . . ...!..

16. Proportion of adult population taking antihypertensive

medication by race, sex, age, and survey: United States,

1960-62, 1971 -74, and 1976-80 . . . . . . . . . . . . . . . . . . . . .

1’7. Propotiion ofadult population withcon&olled h~efiensiofi

by race, sex, age, and survey: United States, 1960-62,1971 -74, and 1976 -80 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18. Number andproportion ofhypefiensives diagnosed, medi-

cated, and controlled, by survey and age United States,1960-62, 1971 -74, and 1976-80 . . . . . . . . . . . . . . . . . . . . .

19. Proportions of hypertensive diagnosed, medicated, (rind

controlled, by sex or race, survey, and age: United States,1960-62, 1971 -74, 1976-80 . . . . . . . . . . . . . . . . . . . . . . . .

20. Proportions of hypertensives diagnosed, medicated, and

controlled, by race, sex, survey. and age: United States,

48

51

54

55

56

57

58

59

60

1960-62, 1971 -74, 1976 -80:.’ . . . . ..~ . . . . . . . . . . . . ..~ 61

30

Table 1. Systolic blood pressure by race, sex, and age With Weighted population estimetes, mean% standerd deviations, standard errors. andsalected percentile= United States, 1976-80

Mean PercentilesPopulation systolic blood Standard Standard

Raca, sex, and age estimate pressure deviation error 50th 75th 90th 95th

ALL RACES’

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WHITE ADULTS

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Woman

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands

141,728

27,44832,75223,65123,03220,35014,496

67,555

13,27515,89511,36711,114

9,6076,297

74,173

14,17316,85612,28411,91810,743

8,198

123,494

23,36228,35720,39220,23518,24312,906

59,198

11,44213,864

9,8089,8658,642.5,576

64,296

11,91914,49410,58410,369

9,6017,329

Millimeters mercury

126 19.8 0.59

117118123130137144

129

124125126131137142

123

111112119129137146

126

117118122129137144

129

124125126131137142

123

111112119127137145

14.214.516.419.120.323.0

17.7

13.714.014.818.319.321.9

21.2

11.712.317.119.721.223.7

19.4

14.314.415.818.519.722.9

17.4

13.713.714.318.118.922.0

20.7

11.612.116.418.720.423.5

0.620.660.780.660.830.83

0.64

0.820.810.990.840.890.85

0.62

0.640.670.850.961.030.95

0.63

0.630.690.810.710.830.89

0.66

0.850.821.090.830.890.90

0.66

0.640.700.821.601.021.06

123

116117120127135141

127

123123125129135140

119

110111117127135143

123

117117120127134141

127

123124125129135140

119

110111115125134

137

125127131140149157

139

131133134141149155

133

119119128139149159

136

126127130140148157

139

13313313314114B155

133

118119127137149

151

136137143154164173

151

141141145155163170

152

125127140154165177

151

136137141153163173

151

141141143155163170

150

125127139151163

143 158 177

163

142143151164175187

162

147148152165175183

163

132133150163175190

162

143143150162171186

162

147147151165171183

162

131133149159172188

llncludes rsces other thsn whits snd blsck. 31

Table 1. Systolic blood pressure by race, sex, and age with weighted population eetimatest means, atendard deviations, standard error% andselected percentiles: United States, 1976-80—Con.

Mean PercentilesPopulation systcvlic blood Standard Standard

Race, sex, and age estimate pressure deviation error 50th 75th 90th 95th

BLACK ADULTS

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . ...9. . . . . . . . . . . . . . . . . . . .45-54 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

,35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands Millimeters mercury

14,740

3,406

3,499

2,5272,259

1,760

1,288

6,592

1,5331,5461,1121,044

801555

8,1 4B

1,873

1,953

1,4151,215

959733

128

116

118

128

137

145

147

130

121

124

131136

144

142

126

112114126

138

146151

22.4 0.81

13.8 1.01

15.B 1,11

19.6 1.37

21.7 1.55

25.5 2.20

23.5 1.45

19.8 1.05

13.7 1.4116.6 1.63

17.2 2.3020.3 2.40

23.3 2.63

20.7 1.10

24,2 0.87

12.7 1.19

13.8 1.4621.0 1.82

23.0 2.10

27.2 2.7724.8 2.30

124 139 157 170

115 123 134 141

116 128 137 145

127 140 153 162137 147 163 183140 159 180 189

143 160 182 195

127 140 156 165

119 128 137 145123 135 144 159

130 142 150 159

135 141 157 ’173

140 157 180 *184140 156 170 183

121 139 159 173

111 119 126 139

114 121 130 135124 139 153 162

137 150 167 183

139 163 180 193

146 165 186 200

32

Tabla 2. Diastolic blood pressure by race, sex, and age with weighted population estimates, means, standard deviations, standard errors, andselacted percentiles: United States, 1976-80

Mean PercentilesPopulation diastolic blood Stendard Standard

Race, sex. and age estimate pressure deviation error 50th 75th 90th 95th

ALL RACES’

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

WHITE ADULTS

,8oth sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years................,,.. . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands

141,728

27,44B32,75223,65123,03220,35014,496

67,555

13,27515,89511,36711,114

9,6076,297

74,173

14,17316,65612,28411,91810,743

8,196

123,494

23,36228,35720,39220,23518,24312,906

59,196

11,44213,8649,8089,8658,6425,576

64,296

11,91914,49410,58410,369

9,6017,329

Millimeters mercurv

79 11.6 0.44 78 66 94 100

73 9.376 10.680 11.083 12.084 11.582 11.7

81 11.3

76 9.279 10.582 10.485 12.085 11.583 11.5

77 11.6

70 6.673 9.678 11.082 11.682 11.482 11.8

79

737679B38382

81

767982858462

77

707377818281

0.360.510.590.580.510.49

0.46

0.440.640.710.630.570.53

0.45

0.450.530.610.710.530.58

727579838381

80

757982848581

76

707277808181

79 8582 9087 9490 9991 9889 98

88 96

81 8766 9389 9693 10093 9990 98

83 92

75 8179 8584 92B9 9789 9789 97

11.4 0.46 78 86 93

9.2 0.40 72 79 8510.4 0.55 75 83 9010.7 0.58 79 86 9311.6 0.59 82 90 9811.3 0.55 82 90 9711.6 0.54 81 69 97

11.1 0.48 80 87 95

9.2 0.48 75 81 8810.3 0.65 79 86 9310.0 0.72 81 B7 9511.8 0.64 84 92 10111.1 0.61 83 92 9911.4 0.56 81 89 98

11.3 0.47 75 83 91

8.3 0.45 70 75 819.4 0.56 71 78 85

10.7 0.59 76 83 9111.1 0.73 80 BB 9511.3 0.5B 81 89 9711.7 0.63 81 88 97

8995

100103103102

101

9197

101105105103

98

848997

101102102

99

899598

103103102

100

9197

100105103102

97

83899699

102102

llnclude~ races Otherthan whita and black.

33

Table 2. Diastolic blood pressure by race, sex, and age with weighted population estimates, means, standard deviations, standard errors, andselected percentiles: United Statea, 1976-80—Con.

Mean PercentilesPopulation diastolic blood Standard Standard

Race, sex, and age astimate pressure deviation error 50th 75th 9oth 95th

BL4CK ADULTS

Both sexes

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands Millimeters mercury

14,740

3,4063,4992,5272,2591,7601,288

81 13.4 0.61

73 9.8 0.6377 11.9 0.7484 12.3 1.2589 13.7 1.2088 13.2 0.79

85 11.7 0.79

80

73

778588

87

83

81

75

79

87

898883

79

71

738287

87

84

89

7982939795

93

90

8187

94

9398

93

9!3

8492

101104107

1Ocl

100

85

97

107

101115

101

98

83

9099

105

10299

104

8999

103111

115105

106

89

102

104

*111

“119107

103

87

93102110

110

103

6,592

1,533

1,548

1,112

1,044

801

555

83 13.5 0.77

75 9.5 0.96

80 12.4 1.46

86 12.1 1.85

88 14.4 1.8990 14.9 1.23

86 11.6 0.72

8,148

1,873

1,9531,4151,215

959733

80 13.3 0.60

71 9.8 0.9675 11.0 0.9982 12.3 1.49

89 13.3 1.51

87 11.4 1.00

85 11.7 1.22

88

77

8090

1009395

Table 3. Systolic blood prassure by race, sex, and educational level with weighted population estimates, standardized means, and standarderrors: United States, 1976-80

Education

Less than 9 years 9-12 years 13 years or more

Population Standard Population Standard PopulationRace and sax

Standardestimate Mean 1 error estimate Meanl error estimate Mean ~ error

All racesz

Both sexes . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . .Women . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

Millimeters

mercury

129 0.74

131 0.97127 0.81

Number in

thousands

69,901

30,27939,621

Millimeters

mercunfNumber in

thousande

Millimeters

mercury

18,997

9,4049,593

126 0.56

130 0.68123 0.58

48,126

25,55022,576

124 0.66

128 0.66120 0.75

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . .Women . . . . . . . . . . . . . . . . . . . . . . . . .

15,944

7,962

7,982

128 0.76

131 1.05126 0.84

61,858

26,862

34,997

126 0.60

130 0.73123 0.61

44,703

23,945

20,757

124 0.68

128 0.67120 0.79

Black adults

Both aexes . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . .Women . . . . . . . . . . . . . . . . . . . . .

3,053

1,4421,611

131 1.78

131 2.28132 2.59

8,042

3,4184,625

130 1.00

131 1.10129 1.19

3,423

1,6051,818

128 1.49

132 2.04

124 1.40

‘Age standardized by the direct method to the overall U.S. population at the midpoint of the survey.‘Includes races other than white and black.

34

Tabla 4. Diastolic blood prassure by race. sex, and educational level with weighted population astimates, standardized means, and standarderrors Unitad States, 1976-80

Education

Less than 9 years 9-12 years 13 years or more

Population Standard Population Standard Population StandardRace and sex estimate Mean 1 error estimate Meani error estimate Meanl error

Number in Millimeters Number in Millimeters Number in MillimetersAll racesz thousands mercury thousanda mercury thousands mercury

Both sexes . . . . . . . . . . . . . . . . . . . . . . 18,997 81 0.64 69,901 79 0.41 48,126 7B 0.55

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,404 82 0.73 30,279 82 0.47 25,550 80 0.56Women . . . . . . . . . . . . . . . . . . . . . . . . . 9,593 79 0.74 39,621 77 0.43 22,576 76 0.59

White adults

Both sexes . . . . . . . . . . . . . . . . . . . . . . 15,944 80 0.68 61,858 79 0.43 44,703 78 0.55

Men . . . . . . . . . . . . . . . . . . . . . ...4. . . 7,962 82 0.78 26,862 82 0.51 23,945 80 0.56Women . . . . . . . . . . . . . . . . . . . . . . . . . 7,982 79 0.77 34,997 77 0.44 20,757 75 0.61

Black adults

Both sexea . . . . . . . . . . . . . . . . . . . . . . 3,053 82 1.16 8,042 82 0.59 3,423 80 1.12

Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,442 82 1.31 3,418 84 0.77 1,605 82 1.26Women . . . . . . . . . . . . . . . . . . . . . . . . . 1,611 83 1.76 4,625 81 0.70 1,818 77 1.03

‘Age standardized by the direct method to the overall U.S. population st the midpoint of the SUIVSY.‘Includes races other than white snd black.

35

Table 5. Number and percent of population in selected blood pressure categories, by race, sex, and age: United States, 1976-80

Both sexes Men Women—

Race and age N2 n3 Pa SE5 N2 n3 P4 &C5 N2 n3 p4 SE5

NORMOTENSIVE1

All races6

18-74 years7. . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . .35-44 yaars . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . .

Whita adults

18-74 yeera7 . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . .65-74 years,...............,..

Black adults

18-74 years7, ,, . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . .25-34 years. . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . .65-74 years. . . . . . . . . . . . . . . . . . .

DEFINITE HYPERTENSIVEa

All races6

18-74 years7 . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .25-34 yeare . . . . . . . . . . . . . . . . . . .35-44 yeare . . . . . . . . . . . . . . . . . . .45-54 yeare . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . .

White adults

18-74 yeare7 . . . . . . . . . . . . . . . . . .

18-24 yeare . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . .45-54 yeara. . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . .

81ack adults

18-74 years7 . . . . . . . . . . . . . . . . . .

18-24 yeare . . . . . . . . . . . . . . . . . . .25-34 yeare, . . . . . . . . . . . . . . . . . .35-44 yeare . . . . . . . . . . . . . . . . . . .45-54 yeare . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . .65-i’ 4 years . . . . . . . . . . . . . . . . . . .

99,601

24,95328,28418,04713,524

9,6245,169

87,933

21,26024,61416,30712,286

8,9864,751

9,111

3,0642,8371,526

861513310

25,065

5622,1552,8915,8617,0656,531

20,805

4431,7682,1264,8206,0135,636

3,790

98348645980948772

7,923

1,8641,9191,196

8481,179

917

6,991

1,5771,6431,069

7661,095

841

769

241227101

627662

2,901

46150205380919

1,201

2,371

37117152300763

1,002

485

8314878

143177

70.3 0.96

90.9 0.9586.4 1.0676.3 1.6758.7 1.4847.3 1.5935.7 1.39

71.2 1.03

91.0 1.0386.8 1.1878.6 1.6560.7 1.5649.3 1.6736.8 1.52

61.8 1.60

90.0 1.1081.’1 2.2760.4 4.5838.’1 4.0629.1 2.3324.1 2.94

17.7 0.58

2.0 0.416.6 0.79

12.2 1.1225.4 1.3634.7 1.1845.1 1.23

16.8 0.62

1.9 0.426.2 0.87

10.4 1.0923.8 1.4833.0 1.2443.7 1.33

25.7 1.09

*2.9 1.1510.0 1.4325.5 3.1543.4 4.0953.8 2.7259.9 2.90

45,330

11,27812,601

8,1506,2444.,5592,449

3~1,948

S1,61110,967

7,2265,6624.,2162,265

4,088

1,3681,180

631458266185

11,748

3691,4721,5202,8563,1282!,402

10,135

332‘i ,23611,1842,5842,7072,092

‘1,388

37205264272372239

3,634

835844522395570468

3,194

708710469359525423

361

106108

38294238

1,292

3295

108176410471

1,086

287786

157343395

183

41719196163

67.1 1.26

85.0 1.6779.3 1.8371.7 2.5556.2 2.2047.5 2.0339.7 1.97

67.5 1.38

84.0 1.8779.1 1.9773.7 2.5857.4 2.0948.8 2.0540.6 2.17

62.0 2.12

89.2 2.3776,3 3,0056.8 8.1343.8 7.2933.2 4.3833.3 3.31

17.4 0.82

“2.8 0.779.3 1.33

13.4 1.6225.7 1.7832.6 1.7138.1 1.55

17.1 0.90

*2.9 0.828.9 1.43

12.1 1.5926.2 1.9331.3 1.7937.5 1.60

21.1 1.46

*2.4 1.18*13.3 2.41*23.8 5.40“26.0 5.6946.4 3.9342.9 4.63

54,270

13,67515,683

9,8977,2805,0652,670

47,985

11,64913,647

8,8116,6244,7692,485

5,022

1,6961,657

895403246125

13,317

193683

1,3713,0053,9364,129

10,670

111532942

2,2353,3063,544

2,403

61143381709576533

4,289

1,0291,075

674453609449

3,797

869933600407570418

408

135119

63333424

1,609

145597

204509730

1,285

94066

143420607

302

414295982

114

73.2 0.80

96.5 0.6793.0 0.8780.6 1.5161.’1 2.0147.1 2.1032.6 1.82

74.6 0.86

97.7 0.5694.2 0.8783.2 1.4163.!3 2.2949.’7 2.3033.9 1.80

61.6 1.47

90.6 2.4684.8 3.3963.2 4.3933.2 4.6025.7 3.1317.’1 3.98

18.0 0.53

*1.4 0.434.1 0.67

11,2 1.1325.2 1.6336.6 1.3250.4 1.73

16.6 0.55

“0.9 0.373.7 0.738.9 0.97

21.6 1.8234.4 1.4648.3 1.80

29.5 1.62

*3.2 1.82*7.3 1.81

*26.9 5.0758.3 4.9560.1 3,8972.8 4.74

See footnotes at end of table,

36

Table 5. Number and percent of population in selected blood pressure categories, by race, sex, end age United Stetes, 1976-80—Con.

Both sexes Men Women

Rece and age N2 n3 P4 CJE5 N2 n3 P4 SES N2 “s P4 SE5

BORDERLINE HYPERTENSIVE

Al I racese

18-74 years7 . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . .

3!i-44 years . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . .66-74 years . . . . . . . . . . . . . . . . . . .

White adulta

18-74 years7, . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . .36-44 years . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . .

Black adults

18-74 yeara7 . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . .26-34 years . . . . . . . . . . . . . . . . . . .35-44 years. . . . . . . . . . . . . . . . . . .45-54 yesra . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . .

ISOLATED SYSTOLICHYPERTENSIVEIO,ll

All racese

18–74yaars7 . . . . . . . . . . . . . . . . . .

18-34 yeara . . . . . . . . . . . . . . . . . . .35-54 years . . . . . . . . . . . . . . . . . . .55-74 years . . . . . . . . . . . . . . . . . . .

White adulta

18-74 yeara7 . . . . . . . . . . . . . . . . . .

18-34 years . . . . . . . . . . . . . . . . . . .35-54 years . . . . . . . . . . . . . . . . . . .55-74 year3 . . . . . . . . . . . . . . . . . . .

Black edults

18-74 years7. . . . . . . . . . . . . . . . . .

18-34 yeara . . . . . . . . . . . . . . . . . . .35-54 years . . . . . . . . . . . . . . . . . . .55-74 years . . . . . . . . . . . . . . . . . . .

17,062

1,9332,3122,7133,6473,6612,796

14,757

1,6591,9762,2303,1293,2442,519

1,839

244315356418

1,680 12.0 0.49

144 7.0 0.80168 7.1 0.70188 11.5 0.88225 15.8 1.02458 18.0 1.21497 19.3 1.03

10,476

1,6281,8221,6972,0141,9191,396

9,115

1,4991,6611,3991,6191,7191,219

1,116

128161217315163132

857

8960

708

759

6360

637

82

260

56

990

121128115119247260

15.5

12.311.514.918.120.022.2

0.67

1.541.151.571.341.781.81

6,586

305490

1,0161,6331,7421,400

5,641

160315831

1,5101,5251,300

723

116154139103137

74

1,315

7122

1,186

1,113

7122984

191

00

191

8.9 0.51

*2.2 0.522.9 0.578.3 1.04

13.7 1.4816.2 1.6117.1 1.11

8.8 0.54

*1.3 0.32*2.2 0.52

7.9 1.0214.6 1.7215.9 1.7017.7 1.24

8.9 1.27

*6.2 2.31*7.9 2.49*9.9 3.79*8.5 3.56

‘14.2 2.46*lool 3.20

1.8 0.15

“0.0 0.02“0.5 0.21

6.3 0.48

1.7 0.17

“0.0 0.03“0.6 0.24

5.8 0.51

2.3 0.56

11.3 2.68

234073

106211237

604

14276097

186220

72

81211

81914

212

19

202

175

19

165

34

00

34

1,472 11.9 0.54

124 7.1 0.88141 7.0 0.78158 10.9 0.82198 15.5 1.20404 17.8 1.21447 19.5 1.12

868

11011498

101218227

15.4

13.112.014.316.419.921.9

0.76

1.711.321.561.471.722.00

177 12.5 1.34

19 *7.2 1.6226 “9.0 1.7024 *1 4.1 3.6422 *1 8.5 3.7945 17.0 2.6041 16.0 2.47

105

111413142627

16.9

*8.4*1 0.4*1 9.5“30.1

2.25

2.452.936.076.694.684.23

‘20.4‘23.7206

2,172

96181

1,895

1,872

70181

1,620

273

260

248

338 11.5 0.11

8 “0.2 0.0613 ‘0.4 0.12

317 5.4 0.36

126

74

115

1.3

“0.3“0.34.5

0.13

0.120.140.44

287 1.5 0.12

6 *0. I 0.0613 *0.4 0.14

268 5.2 0.37

112

54

103

1.3

“0.280.34.5

0.14

0.130.150.47

45 1.9 0.34

2 ‘0.4 0.150--

43 8.1 1.82

11

209

1.2 0.37

0.34

1.72

“0.8

*4.2

lSy~t~li~bl~~dpreasure(SB~ less than 140mmHg anddiaatolic blood presaure (DBP)Ieas than 90mmHgand n0ttaHn9antihYPefiensive medication.2Population estimate in thousanda.3Sample size.%%ighted percent of population subgroup in blood preasura category.5Standard error of percent.‘Includes racea other than white and black.‘Age adjuated bythedirect method to the overall U.S.population atthemidpoint of the survey.8sBpequal toorgrastarthan 160mmHgand DBpequal toorgreater than 95mm Hg, and/or tatin9antihYPs~enaive medication.

‘SBPequsl toorgreater than 140mmHgbutlesa than 160mmHg and/or DBPequ61 toorgreater than 90mmHgbut leas than 95mmHg, andnotteKng entihypenensivemedication.10sBp equaI to or graater than 160 mmHg and OBP Ieaa than 90 mmH9.1lAdja~ant age groups merged to enhance statistical reliabili~.

37

Table 6. Number and proportion of definite hypertensive disgnosed, medicated, and controlled, by rata, sex, and age United States,1976-80

MedicatedDefinite Definite definite

hypertensive Definite hypertensive hypertensiveSample Definite who were hypertensives who who were who were

Race, sex, and age size hypertensivesl diagnosed2 were madicated3 controlle d4 controlled

ALL RACES

Both sexas

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .25-34 years, . . . . . . . . . . . . . . . . . . .35-44 yesrs . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . .

Men

16-74 years5 . . . . . . . . . . . . . . . . . . .

16-24 years . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 yeara . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . .

WHITE ADULTS

8oth sexes

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . .. c.. . .

55-64 years . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . .

Men

18-74 years5 . . . . . . . . . . . . . . . . . . .

16-24 yeara . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . .

Women

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .

25-34 yeare . . . . . . . . . . . . . . . . . . . .

35-44 yeare . . . . . . . . . . . . . . . . . . . .

45-54 yeare . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

2,901

46

150205

380919

1,201

1,292

3295

108

176

410471

1,609

14

55

97204509

730

2,371

37

117

152

300763

1,002

1,086

2877

86

157343

395

1,285

940

66

143

420607

Number in thousanda

25,065

5622,155

2,891

5,8617,065

6,531

11,748

3691,4721,520

2,856

3,1282,402

13,317

193

6831,371

3,0053,936

4,129

20,805

4431,768

2,126

4,820

6,0135,636

10,135

3321,2361,184

2,5842,707

2,092

10,670

111

532

9422,235

3,3063.544

18,438

2461,139

1,807

4,518

5,517

5,211

7,603

122689797

2,017

2,2371,743

10,835

124

450

1,0112,501

3,280

3,468

15,105

186

932

1,274

3,638

4,6164,460

6,538

100587592

1,8191,917

1,524

8,567

66345

682

1,819

2,6992,937

Percent.—

73.6

*43.8

52.862.5

77.1

78.179.8

66.4

‘-33.046.8

52.4

70.6

71.5

72.5

80.5

“64.4

66.0

73.783.2

83.3

84.0

72.3

*41 .9

52.7

60.0

75.5

76.879.1

65.4

“30.047.550.0

70.470.8

72.8

79.3

“77.5

64.8

72.5

81.4

81.682.9

Number in

thousands

13,975

101

6551,111

3,289

4,3704,450

5,213

46331474

1,249

1,6871,426

8,763

55

324

6372,0402,683

3,024

11,610

62

527786

2,700

3,7283,807

4,496

34283

331

1,1401,460

1,248

7,114

28

244

456

1,560

2,2682,559

Percent

74.6

“40.957.5

61.5

72.879.2

85.4

68.9

*37.648.1

59.5

61.9

75.481.8

79.3

*44.O

71.9

63.081.681.8

87.2

75.1

*33.2

56.6

61.7

74.2

80.885.4

68.8

*33.848.3

55.8

62.676.2

81.9

81.0

*32.5

‘70.7

66.8

85.8

84.087.1

Number inthousands

8,637

92458

6561,908

2,800

2,724

2,890

37184

243

596

961870

5,747

55

274

4141,3131,838

1,854

7.331

53

375483

1,576

2,4642,380

2,543

25160202

538866

753

4,788

28

216

282

1,038

1,5981,626

Percent

61.8

*91 .269.8

59.1

58.0

64.161.2

55.7

“80.6*55.4

*51 .2

47.7

57,0

61.0

65.9

“100.0

*64.6

65.064.368.5

61.3

63.2

*65.6

*71 .2

61.5

58.4

66.162.5

56.9

“73.7

*56.4*6 I .0

47.259.3

60.3

67.7

*1 00.0

*68.4

*61 .8

[)6.5;IO.5

63.6

38

Table 6. Number and proportion of definite hypertenaives diagnosed, medicated, end controlled, by race, sax, and aga: Unitad States,1976-80—Con.

MedicatedDefinite Definite definite

hypertensive Definite hypertensive hypertensiveSample Definite who were hypertensive who who were who were

Race, sex, andage size hypertensive’ diagnosad= were medicated3 controlled controlled

BLACK ADULTS

Both sexes

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . .

Man

18-74 years5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . .

Women

18-74 yeara5 . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . .

485

8

314878143177

183

41719196163

302

414295982

114

Number in thousands PercentNumber inthousands

3,790 3,043

98 61348 200645 508980 819948 806772 650

1,388 938

37 22205 102264 180272 198372 270239 166

2,403 2,105

61 39143 98381 328709 621576 536533 483

80.9

*62.1*57.4

78.883.685.084.2

69.1

*59.5*49.6“68.2*72.8

72.7

69.6

87.6

*63.6

*68.586.287.793.090.7

2,180

39128300589563560

607

124B

119109189

130

1,572

27

80181480375430

Percent

72.7

*64.2*64.1

59.171.969.986.2

66.0

“54.7*47.2*66.2*55.2

69.878.5

75.9

*69.6*81 .6●55.2

77.369.988.9

Number inthousands Percent

1,218

39

82149332308308

280

122417588189

938

2758

132274227

219

55.6

“100.0

*64.2*49.5*56.4

54.755.1

51.8

*1 00.0●49.6*13.9‘53.1*42.7*68.5

58.6

‘100.0“73.0*72.9*57.2

60.751.0

lBasedon average of3blood pressures. Systolic blOOdpressure (SBP)zl 60mmHg, diastolic blOOdpreaaure (DBp)~95mmHg, taking antihyPenensive medlcati0n.2Physician diagnosed high blood presaure orhypertenaion.3Reported taking antihypertensive medication’’always,’’’’o ften,” or’’aometimes.’+4SBP<160mmHg and DBP <95 mmHg.5Age-adjusted by the direct method to the combined population of hyperlensives at the midpoint of the survey.

39

Table 7. Joint cumulative frequency distributiona of systolic blood pressure categories by diastolic blood pressure categories for white menby age United Statea, 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than AllCumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 18-24 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . 11,442

Number inthousands

Number in thousands

10,004 10,971 11,287 11,381 11,411 11,442

Percent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,442

7,754

9,45410,60011,21811,413

11,442

87.4

64.276.984.087.087.387.4

95.9 98.6 99.5

67.0 67.7 67.881.3 82.3 82.690.3 92.2 92.595.0 97.3 97.895.8 98.5 99.395.9 98.6 99.5

99.7

67.882.692.698.099.5

99.7

100.067.882,692,698.099.7

100.0

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Leas thsn95mmHg. . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg. , . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 25-34 years Number in thousands

13,295 13,651 13,786Population estimste . . . . . . . . . . . . . . . . . . . . . . . . 13,864 12,190 13,808 13,864

Number inthouaanda

13,864

Percent

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.9

51.070.479.485.787.987.9

95.9 98.5

52.1 52.172.7 73.082.9 83.691.2 92.295.6 98.095.9 98.5

99.4

52.173.083.792.498.699.4

99.6

52.173.083.792.598.799.5

100.052.173.083.792.698.899.8

Leaathan 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Leaathan 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg. .,......,.,.. . . . . . . . . . .Leaathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg. , . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg. ..,......,.,.. . . . . . . . .

7,22510,12411,60012,84413,701

13,831

Agea 35-44 years Number in thousends

9,222 9,612Population estimate . . . . . . . . . . . . . . . . . . . . . . . . 9,808 8,418 9,712 9,721 9,808

Number inthousands Percent

85.8 94.0 98.0 99.0 99.1 100.0All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,808

4,0576,4267,867

8,8359,613

9,783

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less thsn90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Leaathan 95mmHg, . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Leas than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

40.4 41.4 41.4 41.4 41.4 41.462.2 65.2 65.5 65.5 65.5 65.574.7 79.1 80.1 80.2 80.2 80.282.2 87.9 90.0 90.1 90.1 90.185.8 93.6 97.0 97.7 97.8 98.085.8 94.0 96.0 98.9 99.0 99.7

Ages 45–54 yeers

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

7,131 8,490 9,087 9,533 9,730 9,8659,865

Number inthousands

9,865

Percent

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.3 86.1 92.1 96.6 98.6 100.0

Leas thsn80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Laaathan 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less then 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Leas thsn115mmHg . . . . . . . . . . . . . . . . . . . . . . .

3,2665,2646,6197,9929,3599,696

32.0 32.8 33.1 33.1 33.1 33.150.0 52.1 53.1 53.4 53.4 53.4

60.0 65.3 66.6 66.9 67.1 67.1

68.7 77.0 79.3 80.5 80.9 81.072.1 84.7 90.5 93.5 94.4 94.972.3 86.1 92.1 96.1 97.8 98.3

40

Table 7. Joint cumulative frequency distributions of systolic blood pressure categories by diastolic blood pressure categories for white menby age United States, 1976-80—Con.

Cumulative systolic blood prassures

Population Less than Less than Lass than Less than Less than All

Cumulative diastolic blood prassures estimata 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg lavels

Ages 55-64 years

Population estimata . . . . . . . . . . . . . . . . . . . . . . . .

All Ievela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lesathan 90mmHg . . . . . . . . . . . . .. . . . . . . . ... . .Lesathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Laasthan 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65–74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lass than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lass than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

8,642

Number inthousanda

8,642

2,9164,6126,0147,2038,3178,601

5.576

Number inthousands

5,576

2,308

3,5504,1974,8725,3955,530

Numbar in thousands

5,160 6,645 7,580 8,131 8,424 8,642

Percent

59.7

29.544.754.057.959.659.7

2,783

76.9 87.7

32.2 33.050.1 52.063.4 67.071.9 78.776.7 86.576.9 87.7

Number in thousands

3,796 4,462

94.1

33.352.968.781.791.994.1

4,990

97.5

33.753.469.382.694.497.3

5,257

100.033.753.469.683.396.299.5

5,576

Parcent

49.9 68.1 80.0 89.5 94.3 100.0

30.7 36.7 38.8 40.2 41.1 41.442.6 53.7 58.5 61.7 62.8 63.7

47.0 60.9 67.9 72.1 74.2 75.349.5 66.0 76.0 83.0 85.6 87.449.8 67.9 79.6 88.4 93.0 96.849.9 68.1 80.0 89.5 94.3 99.2

41

Tabla 8. Joint cumulative fraquancy distributiona of systolic blood praaaura categoriaa by diastolic blood praasura categories for white womanby aga: United Statas, 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than AllCumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg fevals

Ages 18-24 years

Population eatimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . ,,, . . . . . . .

Less than 80mm Ha. .,, ,, . . . . . . . . . .,...,,,,Less than Ei5mm Ha. . . . . . . . . . . . . , ..,...,,,,Lesathan 90mm Ha. . .,, ,. .,.... . . . . . . . . . . .Leas than 95mmHg. . . . . . . . . . . . . . , . . . . . . . . .Leas than 105mmHg. , .,......,., , . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 25-34 yeara

Population estimate, . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 80mmHg, . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg. ,,, . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lesathan 105mm Ha.......,..,.. . . . . . . . . . .

Less thsn115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 35-44 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .

Less than 85mmHg, . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg, . . . . . . . . . . . . . . . . . . . . . . .Lesathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 45-54 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lass than 80mm Ha . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mm Ha . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lass than 95mm Ha . . . . . . . . . . . . . . . . . . . . . . . .Leas than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .Leas than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

11,919

Number inthousands

11,919

10,38111,40911,76811,844

11,90911,919

14,494

Numbar inthousands

Number in thousanda

11,769 11,866 11,902 11,919 11,919 11,919

Percent

98.7 99,6 9949 100.0 100.0 100,086.7 87.0 87.1 87.1 87,1 87.195.2 95.6 95.7 95.7 95.7 95.798.0 98.5 98.7 98.7 98.7 98.798.5 99.1 99.3 99.4 99.4 99.498.7 99.6 99.9 99.9 99.9 99.998,7 99.6 99.9 100.0 100.0 100.0

Numbar in thousands

14,212 14,392 14,419 14,485 14,485 14,494

Percent

14,494

11,59013,14913,90914,19414,43514,485

10.584

Number inthousands

10,584

6,6478,3799,294

10,00910,38910,537

10,369

Number inthousands

98.1 99,3 99.5 99.9 99.9 100.0

79,8 80.0 80.0 80.0 80.0 80.090.6 90.7 90.7 90.7 90.7 90.795.6 96.0 96.0 96.0 96.0 96.097.2 97.8 97.8 97.9 97.9 97.998.1 99.2 99.4 99.6 99.6 99.698.1 99.3 99.5 99.9 99.9 99.9

Number in thousands

9,587 10,113 10,261 10,479 10,550 10,584

Percent

90.6 95.6 97.0 99.0 99.7 100.0

62.4 62.8 62.8 62.8 62.8 62.877.5 78.6 78.8 79.1 79.2 79.285.1 86,7 87.1 87.7 87.8 87.889.3 93.0 93.8 94.5 94,6 94.690.3 95.’1 96.4 97.9 98.1 98.290.6 95.6 97.0 99.0 99.5 99.6

Numbar in thousands

8,030 9,173 9,870 10,155 10,227 10,369

Percent

10,369

4,9436,834

8,2569,288

10,17710,294

77.4 88.5 95.2 97.9 98.6 100.0

46.5 47.5 47.5 47.5 47.5 47.761.9 64.8 65.8 65.8 65.8 65.970.9 77.3 79.2 79.3 79.5 79.675.6 84.4 88.5 88.9 89.3 89.6

77.2 88.2 94.9 97.3 97.7 98.177.4 88.6 95.2 97.9 98.4 99.3

42

Table 8. Joint cumulative frequancy distributiona of systolic blood pressure categories by diastolic blood pressure categories for white womenby ege United States, 1976-80—Con.

Cumulative systolic blood pressures

Population Less then Less than Less than Less than Less than Alt

Cumulative diestolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 55-64 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Leas than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65-74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lass than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . .Lesathan 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

9,601

Number inthousands

9,601

4,263

6,1757.5648,4679,3139,512

7,329

Number inthousands

7,329

3,3154,7335,6766,4067,0987,278

Number in thousands

5,871 7,330 8,385 8,997 9,307 9,601

Percent

61.2 76.4 87.3 93.7 96.9 100.0

39.1 41.8 43.7 44.1 44.4 44.452.7 59.3 62.8 63.9 64.2 64.358.7 - 69.4 75.4 77.5 78.4 78.860.7 73.8 82.2 86.0 87.6 88.261.2 76.4 86.8 92.6 95.5 97.061.2 76.4 87.1 93.5 96.6 99.1

Number in thousands

3,298 4,567 5,623 6,308 6,748 7,329

Percent

45.0 62.3 76.7 86.1 92.1 100.0

32.7 38.9 42.6 44.6 45.0 45.240.4 51.3 59.1 62.0 63.8 64.643.8 57.9 68.4 73.4 75.8 77.444.8 60.8 73.8 80.6 84.1 87.445.0 62.3 76.6 85.4 91.0 96.845.0 62.3 76.7 86.1 91.9 99.3

43

Table9. Joint cumulative hequency &stributions ofsystolic blood pressure categories bydiastolic blood pressure categories for blaoknlenby age United 8tates. 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than AllCumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg Iavels

Ages 18-24 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

1,413 1,479 1,508 1,527 1,527 1,5331,533

Number inthousanda

1,533

Percent

92.2 96.5 98.4 99.6 99.6 100.0All levela . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

1,0401,3651,4651,5171,5271,533

64.4 67.3 67.3 67.8 67.8 67.883.3 87.6 88.5 89.0 89.0 89.089.2 93.5 95.0 95.6 95.5 95.592.2 96.5 98.4 98.9 98.9 98.992.2 96.5 98.4 99.6 99.6 99.692.2 96.5 98.4 99.6 99.6 100.0

Ages 25–34 years Number in thousands

1,325 1,445 1,475 1,534 1,540 1,546Population estimate . . . . . . . . . . . . . . . . . . . . . . . . . 1,546

Number inthousands Percent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,546

7881,1001,2801,3821,4881,534

85.7

47.466.076.783.385.785.7

93.5 95.4 99,2

51.071.282.889.496.399.2

99.6

51.071.282.889.496.399.2

100.051.071.282.889.496.399.2

49.5 51.068.6 70.180.2 81.786.8 88.391.7 93.693.5 95.4

Lesathan 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Lass than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less thsn105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

980 1,059

Ages 35-44 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . . 1,112 790 1,069 1,088 1,112

Number inthousands

1,112

Percent

71.0 88.1 95.2 96.2 97.8 100.0All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Lass than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

333

502689865

1,0721,100

29.9 29.9 29.9 29.9 29.9 29.9

45.1 45.1 45.1 45.1 45.1 45.1

58.2 62.0 62.0 62.0 62.0 62.0

69.4 77.7 77.7 77.7 77.7 77,7

71.0 88.1 93.7 94.7 96.4 96.471.0 88.1 95.2 96.2 97.8 98.9

Ages 45-54 yaara Number in thousands

684 903 942 991 1,003 1,044Population estimata . . . . . . . . . . . . . . . . . . . . . . . . . 1,044

Number inthousands Percent

65.5 86.5 80.2 95.0 96.1 100.0Alllavels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,044

272434

673830970

1,003

25.3 25.3 26.1 26.1 26.1 26,1

34.6 40.8 41.6 41.6 41.6 41.6

48.4 63,6 64.5 64.5 64.5 64.5

60.2 78.7 79.5 79.5 79.5 79.5

65.5 86.5 89.1 92.9 92.9 92.9

65.5 86.5 90.2 95.0 96.1 96.1

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Leaathan 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Lesathan 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lasathan 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .Leaathan 115mm Ha . . . . . . . . . . . . . . . . . . . . . . .

44

Tabla 9. Joint cumulative frequency distributions of systolic blood pressura cetagories by diastolic blood pressura categories for black menbyag= United 8tataa, 1976-80-Con.

Cumulative systolic blood pressures

Population Less than Less than Less than Less than Less than AllCumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mml-lg 170 mmHg 180 mmHg levels

Ages 55-64 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . . 801

Number inthousands

Number in thousands

373 566 630 678 713 801

Parcent

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65-74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

801

205300424558683734

555

Number inthousands

46.6 70.6 78.6

22.6 24.3 24.828.8 33.8 36.137.1 46.3 48.644.2 58.1 63.746.6 68.7 75.346.6 70.6 78.6

Number in thousands

267 369 459

Percant

84.6

25.636.952.068.080.183.4

498

89.0 100.0

25.6 25.637.4 37.452.6 53.068.9 69.681.3 85.285.8 91.5

516 555

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 167Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 294Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 359Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . . 433Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . . 521Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . . 548

48.1 66.4 82.6 89.7 92.9 100.0

23.0 27.6 30.1 30.1 30.1 30.139.5 47.5 51.1 52.8 52.8 52.841.5 52.5 60.9 63.4 63.4 64.745.9 62.1 73.1 75.6 76.6 77.948.1 66.4 81.4 87.1 89.5 93.848.1 66.4 82.0 89.1 92.2 98.7

45

Tabla 10. Joint cumulative frequency distributions of systolic blood pressure categories by diastolic blood prasaure categories for black womenby age United Statea, 1976-80

Cumulative systolic blood pressures

Population Less than Less than Less than Less thanCumulative diastolic blood pressures

Less than Allestimate 140 mmiig 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 18-24 years

Population estimate.........,.. . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mm Ha, . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Less than 115mm Ha . . . . . . . . . . . . . . . . . . . . . . .

Ages 25-34 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

1,873

Number inthousands

1,873

1,5561,7451,7931,8391,8731,873

1,953

Number inthousands

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mm Ha . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mm Ha, . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg, . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg, . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .

Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 35-44 years

Population estimate, . . . . . . . . . . . . . . . . . . . . . . . .

1,953

1,4521,6771,7371,8691,905

1,953

1,415

Number inthousands

All levels..........,.......,.. . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 45-54. years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .

Lesathan 105mm Ha . . . . . . . . . . . . . . . . . . . . . . .Less than 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

1,415

630822

1,053

1,2081,3741,404

1,215

Number inthousands

1,215

310507693817

1,0811,177

Number in thousands

1,782 1,861 1,873 1,873 1,873 1,873

Percent

95.2 99.4 100.0 100.0 100.0 100.0

81.7 83.1 83.1 83.1 83.190.1

83.193.2 93.2 93.2 93.2 93.2

92.0 95.8 95,8 95.8 95.894.0

95.898.2 98.2 98.2 98.2 98.2

95.2 99.4 100.0 100.0 100.095.2

100.099.4 100.0 100.0 100.0 100.0

Number in thousands

1,886 1,926 1,926 1,937 1,953 1,953

Percent

96.5 98.6 98.6 99.2 100.0 100.0

74.3 74.3 74.3 74.3 74.3 74.385.8 85.8 85.8 85.8 85.8 85.887.8 88.9 88.9 88.9 88.9 88.994.1 95.7 95.7 95.7 95.7 95.796.0 97.5 97.5 97.=5 97.5 97.596.5 98.6 98.6 99.2 100.0 100,0

Number in thousands

1,103 1,231 1,324 1,374 1,382 1,415

Percent

78.0 87.0 93.6 97.1 97.7 1Qo.o

43.0 43.0 44.6 44.6 44.6 44.655.8 56.5 58.1 58.1 58.1 58.168.9 72.0 74.4 74,4 74.4 74.472.9 79.3 82.4 85.4 85.4 85.477.3 85.6 92.3 95.8 96.3 97.178.0 87.0 93.6 97.1 97.7 99.3

Number in thousands

669 864 1,025 1,119 1,130 1,215

Percent

55.0 71.1 84.3 92.1 93.0 100.0

25.5 25.5 25.5 25.5 25.5 25.5

40.2 41.7 41.7 41,7 41.7 41,746.3 53.0 57.0 57.0 57.0 57.049.9 59.2 64.3 64.8 64.8 67,3

55.0 69.7 80.3 84.9 84.9 88.955.0 71.1 83.5 90.5 90.5 96.8

Table 10. Joint cumulative frequency distributions of systolic blood pressure categories by diastolic blood pressure categories for black womanby age United States, 1976-80—Con.

Cumulative systolic blood pressures

Population Less than Less than Less than Less then Less than AllCumulative diastolic blood pressures estimate 140 mmHg 150 mmHg 160 mmHg 170 mmHg 180 mmHg levels

Ages 55-64 years

Populatio neatimate ..<....,..,.. . . . . . . . . . . . .

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg. . . . . . . . . . . . . . . . . . . . . . . . .Leas than 85mmHg. . . . . . . . . . . . . . . . . . . . . . . . .Leas than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Leas then 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Leasthan 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Lesathan 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

Ages 65-74 years

Population estimate . . . . . . . . . . . . . . . . . . . . . . . . .

959

Number inthousands

959

24S426627759880948

733

Number inthousands

Number in thousands

485 635 698 814 863 959

50.5

22.031.141.045.950.550.5

311

66.2 72.8

25.1 25.541.4 42.653.4 55.060.3 63.666.2 71.566.2 72.8

Number in thousands

394 495

Percent

84.9 90.0 100.0

25.9 25.9 25.943.0 43.4 44.461.8 63.2 65.472.3 76.2 79.183.2 87.5 91.784.9 90.0 98.8

585 626 733

All levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Less than 80mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 85mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 90mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 95mmHg . . . . . . . . . . . . . . . . . . . . . . . . .Less than 105mmHg . . . . . . . . . . . . . . . . . . . . . . .Leaathan 115mmHg . . . . . . . . . . . . . . . . . . . . . . .

733

252377463551706725

42.5 53.7 67.6 79.8 85.4 100.0

20.1 24.3 29.3 30.4 32.0 34.330.5 37.2 43,8 45.3 47.8 51.433.5 41.8 50.8 54.7 57.1 63.235.6 45.9 57.1 64.3 66.8 75.242.5 53.7 67.6 78.6 84.3 96.442.5 53.7 67.6 79.8 85.4 98.9

47

Table 11. Systolic blood pressure by survey, rata, sex, and age with weighted population estimatas, means, standard errors, selectedparcantiles, and proportions at or abova 140 mmHg Unitad Statas, 1960-62, 1971 –74, and 1976-80

Mean PercentilesPopulation systolic blood Stendard Propotiion Standard

Suwey, race, sex, and age estimate pressure error 50th 95th >140 mmHg error

1960-62 (NHES 1)

White adults

Both sexes18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yesrsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both sexes18-74 years’ . . . ...!.... . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1971-74 (N HANES 1)

White adults

Both sexes:18–74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands Millimeters mercury

93,856

13,31118,53020,44617,68213,86510,022

44,808

6,1998,9609,8588,6216,6294,541

49,048

7,1129,570

10,5879,0617,2365,481

11,109

1,6802,2732,5622,2771,469

849

5,065

730902

1,1841,129

737382

6,044

9501,3701,3771,148

732467

113,952

21,28723,66319,51520,89117,21111,384

131

118121127135146157

133

124126130135143151

129

113116123134148162

138

118124136147155170

138

121129137143152164

138

115121134151158174

129

119121125133142149

0.53

0.850.430.540.751.221.64

0.65

1.280.580.370.711.601.80

0.59

0.810.700.911.261.892.02

1.29

1.211.202.183.162.304.21

1.38

2.102.182.504,003.156.93

1.99

1.451.693.254.864.536.48

0.40

0.510.490.621.010.860.80

128

118120124132142156

130

122126128134140150

124

112116120130142160

130

114120130142150172

132

120128130140152174

130

114118128144150172

126

120120122130140148

180

144146160176194210

170

152150162170182204

184

132138156180204212

194

144162180208202226

164

148164178182186208

206

138162184

206230

170

140146156170188190

29.2

7.711.122.236.257.271.7

32.4

14.318.029.638.154.963.5

26.1

1.94.7

15.334.459.478.6

40.1

8.717.137.056.372.6B5.2

41.2

15.821.840.154.168.376.8

39.6

3.414.034.458.476.992.1

27.4

9.211.119.035.451.665.7

0.s1

1.341.030.981.831,741.95

1.44

2.681.821.512.602.933.37

0.63

0.711.041.392.492.272.95

1.98

2.742.163.513.424.895.97

2.81

5.435.204.8B6.995.078.80

1.95

2.052.604.735.956.646.31

0.85

1.200.951.571.991.751.54

lAge adjuated by the direct method to the overall U.S. population at the midpoint of tha 1976-80 survey.

48

Tabla 11. Systolic blood prassura by suwey, race, sex, and age with weighted population estimates, means. standard errors. seletiedpercentiIas, and proportions at or abova 140 mmHg United States, 1960-62, 1971-74, and 1976-80—Con.

Mean PercentilesPopulation systolic blood Standard Proportion Standerd

Survey, race, sex, and age estimate pressure error 50th 95th > 74(7 mm~g error

1971-74 (N HANES I)—Con.

White adults—Con.

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearaT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both aexas18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55–64yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Man:18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lB-24yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1976-80 (N HANES 11)

White adults

8oth sexes18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numbar inthousands Millimetare mercuw

54,377

10,20711,559

9,44110,073

8,1664,931

59,575

11,08012,10410,07410,818

9,0456,454

12,850

2,8412,7702,3082,2651,5691,097

5,689

1,2931,1601,0071,042

707480

7,161

1,5481,6101,3011,224

861617

123,494

23,36228,35720,39220,23518,24312,906

59,198

11,44213,864

9,8089,8658,6425.576

131

124125127135140146

128

115116123131143152

135

117125133146149159

136

123129136142144157

135

113122130150153162

126

117118122130138145

129

123124125132139144

lAge adjustedby the direct method to the overall U.S. population at the midpoint of the 1976-80 survey.

0.47

0.710.690.811.101.100.94

0.49

0.600.480.711.291.241.04

0.94

1.180.921.304.222.672.63

1.21

1.951.592.134.323.273.46

1.20

1.081.081.665.264.173.00

0.62

0.650.580.770.710.820.97

0.62

0.900.780.990.770.920.98

130

122124126132138142

122

114115120130140150

130

118124130138145156

130

122130132130140150

126

110120125146152160

122

116118120128136140

128

120124124130138140

166

144150154172180190

170

136140160170190195

186

142150170200186210

180

146150180190180210

190

138155170200190210

166

140142150168180190

166

150150150170180190

29.7

14.716.321.238.649.759.6

25.2

4.26.1

16.932.453.370.3

36.6

7.918.432.049.365.678.9

36.3

11.521.431.344.060.977.8

37.0

4.916,232.653.969.479.8

23.9

8.39.3

15.630.145.257.5

27.0

14.315,517.134.147.055.2

1.12

2.091.582.342.542.671.81

0.89

0.780.741.352.582,101.95

1.97

1.473.273.696.235.152.48

2.44

2.906.155.937.566.933.03

1.83

1.513.373.866.948.083.29

1.01

1.020.801.401.591.831.89

1.23

1.831.412.272.012.101.95

49

Table 11. Systolic blood pressure by survey, race, sex, and aga with waighted population estimates, means, standard errors, selectedpercentiles, and proportions at or above 140 mmHg: United Statas. 1960-62, 1971-74, and 1976-80—Con.

Mean PercentilesiDopulation systolic blood Standard Proportion Standard

Survey, race. sex, and age estimate pressure error 50th 95th > 140 mmHg error

1976-80 (N HANES 11)—Con.

White adulta—Con.

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

81ack adults

8oth sexas18-74 years3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years.................,.. . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . .,, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

‘thousands Millimeters mercury

64,296

11,91914,49410,58410,369

9,6017.329

14,740

3,4063,4992,5272,2591,7601,288

6,592

1,5331,5461,1121,044

801555

8,148

1,8731,9531,4151,215

959733

123

110112120128138146

128

115118128137146147

130

119123131134145144

126

111114126140146150

0.73

0.570.650.851.101.021.20

0.75

0.960.881.332.092.191.63

1.07

1.451.522.012.863.231.60

1.23

1.251.351.802.622.462.85

120

110110118126135142

124

114116,126130140142

126

1!8120130130140140

120

110110124138140148

168

130136150166180190

172

142150160180196198

170

142150158170194190

176

134140160182200200

21.1

2.63.3

14.226.343.659.2

27.5

7.410.229.240.057.660.5

28.3

11.314.834.629.157.856.5

26.7

4.36.5

25.049.557.563.5

1.05

0.600.741.162.002.402.61

1.41

1.701.064.094.453.053.96

2.16

2.912.426.967.316.083.73

1.78

1.281.834.513.544.296.54

‘Age adjusted by tha direct method to the overall U.S. population at the midpoint of tha 1976-80 survey.

50

Table 12. Diastolic blood pressure by survey, race, sex, and age with weighted population aatimatas, means. standard errors, selectedpercentiles, and proportions at or above 90 and 95 mmHg: United States, 1960-62, 1971 –74, and 1976-80

Mean PercentilesPopulation diastolic blood Stendard Propotiion Proportion

Survey, race, sex, and age estimete pressura error 5th 50th 95th >90 mrrrffg>95 mm/-Jg

1960–62 (NHES 1)

White adults

Both sexes:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both aexe~18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1971-74 (NHANES 1)

White aduita

Both sexe.%18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years, . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousanda Millimeters mercury

93,856

13,31118,53020,44617,68213,86510,022

44,808

6,1998,9609,8588,6216,6294,541

49,048

7,1129,570

10,5879,0617,2365,481

11,109

1,6802,2732,5622,2771,469

849

5,065

730902

1,1841,129

737382

6,044

9501,3701,3771,148

732467

113,952

21,28723,66319,51520,89117,21111,384

78

717479828482

79

727680838381

78

697377818484

83

727885909290

83

738084889188

83

727686919392

81

747882858685

0.42

0.670.390.670.890.640.76

0.53

1.230.570.890.740.740.97

0.43

0.680.430.650.760.771.01

0.68

0.871.131.181.581.422.82

1.01

1.921.791.382.281.844.24

0.77

0.961.191.472.042.493.40

0.28

0.360.340.420.610.470.53

‘Age adjusted by the diract method to the overall U.S. population at the midpoint of the 1976-80 auruay.

60

505860646662

60

486060646464

60

505860626662

60

525866666864

60

526066667068

60

585866686864

60

586062667068

78

70747B808280

80

727680828280

78

707276808280

82

727882889090

83

758082889088

80

727682889090

80

747880848684

100

9092

10010210610B

100

9294

100102102106

100

869096

102110110

112

90100110124120120

110

90100110120112114

116

90100110124126124

102

9095

102108108108

17.6

5.58.0

18.024.532.927.9

19.4

9.110.823.526.330.225.7

16.1

2.35.5

12.922.835.429.7

30.6

7.418.934.945.955.554.8

31.7

8.728.234.144.856.340.5

30.2

6.412.935.746.954.766.5

24.1

6.314.124.734.640.537.6

8.9

2.83.59.1

13.714.815.8

9.5

4.44.9

11.814.812.313.7

8.4

1.42.16.5

12.617.217.5

21.5

2.912.526.932.738.342.4

22.9

3.519.626.731.439.637.8

20.8

2.47.9

27.134.137.146.2

12.8

2.55.5

12.619.323.721.9

51

Table 12. Diastolic blood pressure by survey, rata, sex. and age with Weigtlted population eatimata% meens, standard errors, selectedpercentiles, and proportiona at or above 90 end 95 mmHg: United Stetas, 1960–62, 1971-74, and 1976-80—Con.

Mean PercentilesPopulation diastolic blood Standard Proportion Propotiion

Survey, race, sex. and aga estimate pressure error 5th 50th 95th >90 mm/-/g >95 mmHg

1971-74 (N HANES I) —Con.

White adults—Con.

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black adults

Both saxes:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

lB-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearal . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1976-80 (NHANES 11)

White adults

Both sexes18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yeara. c. . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl, . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yesrs. . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years. . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . .. l....... . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands

54,377

10,20711,559

9,44110,073

8,1664,931

59,575

11,08012,10410,07410,818

9,0456,454

12,850

2,8412,7702,3082,2651,5691,097

5,689

1,2931,1601,0071,042

707480

7,161

1,5481,6101,3011,224

861617

123,494

23,36228,35720,39220,23518,24312,906

59,198

11,44213,864

9,8089,8658,6425,576

Millimeters mercury

83

768184878685

79

717579838686

85

74

8189929291

87

76

8491929391

84

727887939190

80

747781858584

83

778183878684

0.31

0.490.510.620.670.660.55

0.33

0.460.320.510.700.570.63

0.48

0.780.810.881.751.510.91

0.74

0.981.581.332.472.021.17

0.60

1.040.971.151,872.011.25

0.50

0.430.540.610.610.570.55

0.52

0.530.690.740.670.620.56

64

606668706866

60

566060647068

62

586070707270

68

606870757070

60

526070707466

60

5860646B6B64

64

606268706865

82

788084868684

80

707480808484

82

748088909090

85

768090889090

80

728085929088

80

727880848482

80

788084868684

104

9096

105110108108

100

B890

100105108108

110

90104110120115120

110

94106110120118116

110

90102110116110120

100

9098

100106104106

102

96100100110108105

28.6

9.219.930.943.142.837.9

20.0

3.68<5

18.926.738.537.3

35.2

8.123.947.652.757.252.4

58.4

11.232.554.745.657.456.6

32.7

5.617.642.158.857.149.1

26.5

10.318.126.739.739.035.7

32.2

16.527.033.445.743.134.9

14.7

4.07.7

16.423.224.420.7

11.0

1.23.39.0

15.723.122.8

23.3

3,412.331.238.643.735.9

25.0

4.115.436.335.047.4:36.3

22.0

2.910.227.241.640.735.5

12.8

3.67.2

11.822.419.519.1

15.7

5.611.614.626.722.618.3

lAga sdjusted by the direct method to the overall U.S. population at the midpoint of the 1976-80 survey.

52

Table 12. Diastolic blood pressura by suwey. race, sax, and aga with weighted population estimates, means, standard errors, seleotedpercentiles, and proportions at or abova 80 and 95 mmHg: United Statas, 1960-62, 1971-74, and 1976-80—Con.

Mean PercentilesPopulation diastolic blood Standard Proportion Proportion

Survey, race, sex, and age estimate pressure error 5th 50th 95th >90 mm/-/g >95 Mm/-/g

1976-80 (NHANES 11)—Con.

White adults—Con.

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . .

81ack adults

Both sexes18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women:18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number inthousands Millimeters mercury

64,296

11,91914,49410,58410,369

9,6017,329

14,740

3.4063,4992,5272;2591,7601,288

6,592

1,5331,5461,1121,044

801555

8,148

1,8731,9531,4151,215

959733

78

717479838484

82

747985909087

84

768288889186

81

737683918887

0.51

0.460.570.610.790.630.69

0.55

0.740.661.331.390.960.77

0.77

1.381.411.912.221.270.80

0.60

1.180.911.581.701.351.17

60

586060656562

60

586064707066

64

606265707066

60

565860707068

78

707278808282

80

747888909088

82

748090869088

80

707684909086

100

8890

100102104108

110

92100106116116110

110

94106110112124110

108

9095

105118110110

21.2

4.49.5

20.534.135.236.2

33.9

11.820.145.852.254.246.7

36.0

13.926.852.842.956.446.2

32.2

10.114.840.360.252.347.2

10.2

1.73.09.1

18.416.819.6

17.5

3.79.2

23.532.028.924.4

20.4

4.713.433.225.635.425.7

15.3

2.85.8

15.937.623.423.4

‘Age adjusted by the direct method to the ovsrall U.S. population at tha midpoint of the 1976-80 survey.

53

Tabla 13. Propotiion of adult population with dafinite hypertension by race, sex, age, and survey: United States, 1960-62, 1971-74, and1976-80

1960-62 (NHES ~ 1971-74 (NHANES /) 1976-80 (NIIANES 1/)

Definite Standard Definite Standard Definite StendardRace, sex, and age hypertension error hypertension error hypertension error

WHITE ADULTS

Both sexes

lB-74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . ,,, , . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLACK ADULTS

Both sexas

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years....,.........,,. . . . . . . . . . . . . . . . . . . . . . .55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18–74yearsl, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18.0

4.2

5.312.421.634.353.6

17.6

6.26.8

15.320.930.544.0

1B.3

2.53.99.6

22.237.861.5

33.6

6.117.832.143.553.877.2

30.8

*6.321.830.934.650.863.3

36.9

*5.915.233.252.356.98B.5

0.74

1,030,710.791.662.532.85

0.99

1.940.901.692.123.333.77

0,89

0.740.861.292.453.054.02

2.21

1.973.753.584.185.357.64

3.17

3.666.995.866.867.97

14.32

2.57

2.574.123.846.349.065.09

Percent of population

19.1

3.16.114.725.638.64B.O

20.2

4.98.4

18.1

28.2

38.1

41.3

17.9

1.4

4.011.523.239.253.1

33.9

3.816.036.650.859.364.2

32.8

*4.816.142.345,354.058.6

34.8

“3.016.032.355.463.668.5

0.53

0.580,721.081.521.711.40

0.84

1.161.371.932.022.541.62

0.61

0.310.541.061.892.251.85

1.48

0.992.724.435.694.633.44

2.46

1.545.526.667.886.423.97

1.76

1.072.394.726.046.674.60

21.0

4.5

8.714.730.0

38.449.2

22.3

6.9

12.917.2

32.4

38.0

43.6

19.8

2.1

4.6

12.3

27.8

38.853.4

28.6

4.511.3

29.048.7

58.1

63.0

26.0

*4.7

14.4

34.733.653.945.2

30.7

*4.2

8.824.6

61.7

61.776.5

0.82

0.660.821.281.471.301.42

0,97

1.081.472.081.851.821.91

0.82

0.570.771.212.011.761.86

1.53

1.382.213.445.003.333.87

1.84

2,323.766.828.BO5.334.45

2.04

2.052.644.534.384.494.93

‘Age ad]usted by the direct method to the oversll U.S. population at the midpoint of the 1976-80 survey.

54

Table 14. Proportion of adult population with elevated blood pressure by sex, age. and rac- United Statea, 1960-62, 1971–74, and 1976–80

Totall White Black

Sex and age 1960-62 1971-74 1976-80 1960-62 1971-74 1976–80 1960-62 1971-74 1976-80

Both sexes

18-74 years2 . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . .

Men

18-74 yesrs2 . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . .

Women

18–74years2 . . . . . . . . . . . . . . .

18–24 years . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . .35–44yaars . . . . . . . . . . . . . . . .45–54 years . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . .

34.3 35.6 35.4

10.6 12.3 14.715.6 19.6 20.829.8 32.2 33.044.4 46.9 47.162.3 59.4 56.773.8 70.3 63.1

38.2 40.2 41.1

18.8 18.9 22.823.3 27.5 31.237.4 38.1 39.547.2 52.8 52.159.3 59.3 58.665.9 65.4 62.0

30.8 31.4 30.2

3.5 6.3 7.18.6 12.3 11.0

22.7 26.7 27.041.8 41.5 42.365.0 59.5 55.080.3 74.1 63.9

Percent of population

33.2 34.6 34.7

10.4 12.6 14.614.7 18.8 20.728.1 29.6 30.842.4 45.8 45.960.9 58.4 55.273.1 69.3 61.9

37.4 39.7 40.9

18.7 19.7 23.622.3 27.2 31.537.0 36.0 37.646.0 53.0 52.058.3 58.9 57.665.0 64.0 60.6

29.3 29.8 29.1

3.1 6.1 6.07.6 10.8 10.4

19.8 23.6 24.639.1 39.1 40.163.3 57.9 53.179.8 73.4 63.0

44.9 45.6

13.5 11.322.4 28.243.5 54.560.6 57.478.8 71.885.2 80.0

46.5 47.4

20.9 15.931.9 33.644.2 60.556.3 53.374.8 67.576.8 79.3

44.3 44.3

7.9 7.516.1 24.243.0 49.964.8 61.082.8 75.392.1 80.6

40.8

15.522.447.958.970.571.7

43.7

20.231.553.850.971.768.7

38.4

11.515.143.465.869.474.0

1includes sII other races not shown separately.

2Ageadjusted bythedirect method totheoverall U.S. population atthemidpoint of the1976-80suwey.

NOTE Elevated blood pressure includes resdings ofeithersystolic blood preasure ofatleast 140mmHg ordiastolic blood pressure ofatleast 90mmHg or both.

55

Table 15, Propotiion ofadukpopulation with undiagnosed hypatienaion klyraca, aex, aga, andsuNeY United States, 1960-62, 197’l-74,and 1976-80

1960-62 (NHES /) 1977 -74( NHANES 1) 1976-80 (NHANES //)

Undiagnosed Standard Undiagnosed Standard Undiagnosed Standard

Race, sax, andaga hypertension error hypertension error hypertension arror

WHITE ADULTS

Both sexes

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 yesrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8LACK ADULTS

Both saxas

18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . ...<. . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

I 18-74 years’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years ., . . . . . . . . . . . . . . ...8 . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-i’ 4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.2

3.22.77.5

12.814.924.1

10.7

5.54.69.6

13.616.024.6

7.7

1.10.95.6

12.013.823.6

16.7

*3.211.620.023.925.824.0

21.1

*6.320.826.622.533.122.7

13.2

“0.8*5.714.325.3

*18.625.0

0.53

0.970.550.701.321.692.16

0.73

1.921.041.321.712.093.48

0.65

0.620.400.841.482.192.41

1.72

1.583.323.624.144.685.78

2.96

3.666.576<337.225.698.96

1.85

0.772.402.894.366.947.84

Percent of population

11.2

2.74.9

10.415.820.323.0

13,4

4,46,5

14.118.622.224.1

9.3

1.13.47.0

13.118.622.2

17.1

3.510.518.426.222.932.6

18.7

*4.8“12.7

19.329.024.932.7

15.8

*2.59.0

17.723.921.332.4

0.47

0.520.600.921.271.491.09

0.70

1.081.121.501.692.221.32

0.60

0.270.510.961.632.191.58

1.35

0.982.233.855.344,113.06

2.26

1.545.116.047.536.873.97

1,52

1.011.794.055.484.963.58

7.6

3.24.57.7

10.111.413.0

9.8

5.27.2

10.512.213.415.0

5.6

*1.31,95.18.09.5

11.6

6.9

2.44.38.0

10.311.211.6

9.9

“3.3“6.214.511,017.216.8

4.5

*1.7*2.9“3.09.76.27.7

0.56

0.510.510.961.251,200.79

0.68

0.860.921.501.571.381.58

0.54

0.440.530.751.601.430.83

0.65

0.831.302.332.171.871.83

1.18

1.992.594.664.313.522.20

0.83

1.151.701.372.721.992.10

lAgeadjusted bythedirect method totheoverall U.S. population at the midpoint of the 1976 -80 survey.

56

Table 16. Proportion of adult population taking antihypertensive medication by race, sex, age, and survey United States, 1960-62, 1971-74,and 1976-60

1960-62 (NHES O 1971-74 (NHANES /) 1976-80 (NHANES lo

Standard Standard StandardRace, sex, and age Medicated error Madicated error Medicated error

WHITE ADULTS

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lB-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BLACK ADULTS

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

1B-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years...............,.. . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.5

‘0.81.31.95.0

12.819.8

3.8

“0.5*0.6*1.53.59.1

13.5

7.0

*1.O2.02.36.5

16.125.0

11.3

“2.06.37.9

13.614.937.4

6.0

*1.3*2.8%.7*8.629.9

15.9

*3.59.6

12.22i.421.243.5

0.39

0.290.330.340.701.591.82

0.44

0.330.380.520.991.952.65

0.56

0.460.590.651.072.272.38

0.99

1.181.942.103.452.995.93

0.91

1.351.793.843.137.32

1.71

2.093.032.765.025.598.66

Percent of population

6.1

“0.0“0.52.76.9

15.620.9

5.1

*O. 1“0.6*2,2

5.914.414.7

6.9

“0.43.27.8

16.625.7

11.5

“0.2*3.9

9.117.125.725.2

8.1

“0.9*8.6

“13.0*14.522.2

14.2

“0.3*6.29.5

20.634.827.6

0.24

0.050.200.460.811.240.97

0.43

0.100.390.761.112.151.14

0.38

0.140.501.321.671.40

1.10

0.091.372.304.104.942.38

1.50

0.884.545.695.5B2.73

1,47

0.172.202.355.516.863.70

9.4

“0.31.93.9

13.320.429.5

7.6

‘0.32.03.4

11.616.922.4

11.1

“0.21.74.3

15.023.634.9

14.8

*1.13.7

11.926.132.043.5

9.2

‘0.8“3.1

*1O.7*1O.523.523.5

19.3

*1.4*4.112.839.539.158.6

0.30

0.140.370.511.081.090.93

0.29

0.230.500.590.991.421.32

0.47

0.170.540.851.681.501.26

1.02

0,901.122.343.462.504.00

1.10

0.831.383.625.383.333.76

1.60

1.451.683.414.514.745.13

‘Age adjusted by the direct method to the overall US. population at the midpoint of the 1976-80 survey.

57

Table 17. Proportion of adult population with controlled hypertension by race, sex, age, and survey: United States, 1960-62, 1971-74,and 1976-80

1960-62 (NHES /) 7971-74 (NHANES 1) 1976–80 (NHANES //]

Controlled Standard Controlled Standard Controlled Standard

Race, sex, and age hypertensicm error hypertension error hypertension error

WHITE ADULTS

Both sexes

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74years1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45–54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8LACK ADULTS

Both sexes

18–74yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25-34 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65–74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men

18–74 years] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35–44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55–84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 vears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women

18-74 yearsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25–34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2

“0.81.1

1.02.44.2

6.7

1.5

“0.5“0.6

“0.4*1.3

3.0

5.4

2.9

“1.0

‘1.6

1.53.45.2

7.7

3.6

“2.0

*3.8

*3.4“4.0

*3.7*5.2

‘0.6

*2.8

*1.1

6.0

*3.5

*6.4

“4.0

*8.O

*6.4*9.5

0.32

0.29

0.340.21

0.511,31

1.35

0.39

0.330.38

0.270.701.79

1,59

0.44

0.46

0.54

0.460.711.23

2.26

0.87

1.18

1.69

1.441.76

1.743.79

0.43

1.79

1.15

1.41

2.092.76

1.523.043.336.91

Percent of population

2.7

“0.0

0.11.3

3.47.0

8.4

2.2

*o. 1

*O. 1

“0.92.4

6.9

6.2

3.1

“0.21.64.47.2

10.2

4.6

‘0,0

“3,1

‘4. 7“7.0

7.2

8.5

“3.7

*5.4

*8.3*4.5

8.2

5.1

*O. 1

*5.3

*4. 1

“6.0

*9.58.7

0.21

0.050.03

0.28

0.561.03

0.68

0.28

0.100.09

0.430.60

1.58

0.70

0.33

0.11

0.381.05

1.301.00

0.67

0.05

1.352.012.82

2.441.61

1.26

3.725.48

3.51

2.46

0.78

0.092.19

1.852.19

3.561.80

4.9

*O. 11.12.2

5.811.515,2

3.4

‘0.7

2.03.8

8.2

10.9

6.3

“0.2

1.42.47.7

14.4

18.5

7.9

‘0.8

“2.1

4.7

12.118.726.4

3.3

“1.0

*1.5*4.3

8.2

13.1

11.6

“1.4‘3.0

*7.2

18.8

27.536.5

0.26

0.08

0.270.370.720.95

0.97

0.25

0.29

0.450.810.96

1.08

0.39

0.17

0.46

0.691.22

1.211.18

0.96

0.79

0.751.792,79

2.224.68

0.71

0.691.452<40

1.683.69

1.44

1.451.27

2.834.65

3.796.75

‘Age adjusted by the direct method to the oversll U.S. population at the midpoint of the 1976-80 survey.

58

Table 18. Number and proportion of hypertensive disgnosed, medicsted, and controlled, by survey and age: United States, 1960-62,1971-74, 1976-80

1960-62 (NHES /) 7977 -74( NHANES /) 7976-80 (NHANES //)

18-74 78-44 45–74 18-74 18-44 45-74 18-74Status

18-44years

45-74years years years years years years years years

Population estimate . . . . . . . . . . . . . . . . . . . . . . .Definite hypartensives . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . .

Definite hypertenaives whoweredisgnosed . . .

Definite hypertensives who were diagnosed . . .

Definite hypertensives who were medicated . . .

Definite hypertensives who were medicated . . .

Medicsted hypertensive who were controlled. . .

Medicated hypertensives who were controlled. . .

106,85221,972

20.6

10,549

48.0

6,654

30.3

2,616

39.3

60,2585,649

9.2

2,098

37.8

1,162

20.9

757

65.2

46,59416,423

35.2

8,451

51.5

5,492

33.4

1,859

33.8

Number in thousands

128,147 73.404 54,74326,766 6,447 20,318

Percent

20.9 8.8 37.1

Number in thousands

10,826 1,800 9,026

Percent

40.4 27.9 44.4

Number in thousands

8,610 996 7,614

Percent

32.2 15.4 37.5

Number in thousands

3,737 487 3,250

Percent

43.4 48.9 42.7

141,72830,762

21.7

21,786

70.8

13,975

45.4

7,232

51.7

83,8518,014

9.6

4,738

59.1

1,867

23.3

1,029

55.1

57,87722,747

39.3

17,049

74.9

12,109

53.2

6,203

51.2

59

Table 19. PropoRions ofhypeRensives diagnosed, medicated, andcdtirolled, byeexor race, suwey, andage: United States, 1960-62,1971-74, 1976-80

7960-62 (NHES /) 1977 -74( AVfAfdE.S /) 7976-80 (NHANES //)

18– 74 18-44 45-74 18-74 18-44 45-74 18-74 18-44 45-74Sex, rata, andstatus years years years yaars yaars yaars years years years

Men

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension . . . . . . .Definite hypertensives who were diagnosed . . . . . . . .Definite hypertensives who were medicated. . . . . . . .Medicated hyperteneives who were controlled. . . . .

Women

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . .Definite hypertensives who were diagnoaed. . . . . . . .Definita hypertensive who were medicated. . . . . . . .Medicated hypertensives who were controlled. . . . . .

Whita adults

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . .Definite hypertenaives who were diagnoaed. . . . . . . .Definite hypertenaives who were medicated. . . . . . . .Medicated hypertensives who were controlled. . . . . .

Black adults

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . .Definite hypertensives who were diagnosed. . . . . . . .Definite hypertensives who were medicated. . . . . . . .Medicated hypertensive who were controlled. . . .

10,050

19.B37.320.335.6

11,!323

21.357.138.741.0

18,015

19.248.629.940.4

3,768

33.946.532.532.7

3,184

11.127.0

8.857.8

2,365

7.552.437.267.5

4,074

7.839.518.368.5

1,331

20.433.928.555.1

6,865

30.842.025.732.0

9,558

39.358.239.034.7

13,941

33.551.333.335.9

2,438

63.053.534.722.6

Number in thousanda

13,037 3,886 9,151

Percent

21.4 11.0 35.B32.8 23.8 36.624.8 9.9 31.143.9 41.5 44.3

Number in thousands

13,729 2,562 11,168

Percent

20.4 6.7 38.347.7 34.2 50.939.2 23.9 42.743.1 53.5 41.7

Number in thousanda

22,440 4,983 17,457

Percent

19.7 7.7 35.338.9 23.4 43.331.9 13.1 37.344.4 44.7 44.3

Number in thouaends

4,182 1,398 2,784

Percent

32.5 17.7 56.547.8 41.4 51.133.2 23.1 38.340.4 60.4 34.3

5,201

22.5

61.534.342,8

5,561

21.080.056.357.1

25,922

21.069.944.851.7

4,216

28.678.651.753.3

5,066

12.549.116.841.1

2,948

6.876.334.7466.9

6,496

9.058.021.257.1

1,280

13.673.136.547.7

0,135

37.567.643.043.1

2,612

40.980.861.455.8

19,426

37.873.952.751.0

2,936

55.380.958.355.0

60

Table 20. proportions of hypertensive diagnosad, medicatad, and controlled. by race, se% suweyt and a9a United State.% 1960-62,1971-74, 1976-80

1960-62 (NHES ~ 197? -74( NHANES ~ 1976-80 (NHANES //)

18-74 18-44 45-74 18-74 78-44 45-74 78-74 18-44Race, sex, and status

45– 74years yaars years years years years years years years

WHITE ADULTS

Men

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . . .Definite hypertensives who ware diagnosed . . . . . . . .Definite hypertensives who were medicated . . . . . . . .Medicated hypertensives who were controlled . . . . . .

Women

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertenaion. . . . . . . . .Definite hypertensives whowera diagnosed . . . . . . . .Definite hypertensive who were medicated . . . . . . . .Medicated hypertensives who were controlled . . . . . .

BLACK ADULTS

Men

,Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with dafinite hypertension. . . . . . . . .Definite hypertensives who were diagnosed . . . . . . . .Definite hypertensive who were madicated . . . . . . . .Medicated hypertensive who were controlled . . . . . .

Women

Definite hypertensives . . . . . . . . . . . . . . . . . . . . . . . . . .

Adult population with definite hypertension. . . . . . . . .Definite hypertensives who were diagnosed . . . . . . . .Definite hypertensive who ware medicated . . . . . . . .Medicated hypertensive who were controlled . . . . . .

8,322

18.6

39.221.139.0

9,693

19.856.637.541.1

1,617

31.929.617.814.6

2,152

35.659.243.638,3

2,496

10.0

32.29.4

54.8

1,578

5.851.132.274.9

609

21.69.27.5

73.5

721

19.5

54.746.352.6

5,826

29.442.326.136.6

8,115

37.357.738.535.6

1,007

44.842.024.0

3.4

1,430

60.9

61.542.230.3

Number in thousands

11,161 3,179 7,982

Percent

20.5 10.2 34.431.2 19.5 35.824.9 8.9 31.343.4 36.7 44.2

Number in thousands

11,280 1,805 9,475

Percent

18.9 5.4 36.046.5 30.2 49.638.8 20.4 42.345.0 50.8 44.4

Number in thousands

1,809 674 1,135

Parcent

31.8 19.5 50.941.3 40.1 42.024.4 14.3 30.348.2 56.8 45.8

Number in thousands

2,373 725 1,649

Percent

33.1 16.2 61.052.8 42.6 57.340.0 31.3 43.836.7 61.9 28.8

13,177

22.3

61.134.144.2

12,745

19.879.156.856.5

1,715

26.0

66.035.435.6

2,501

30.787.262.960.2

4,270

12.2

47.515.245.2

2,226

6.078.332.7

67.6

681

16.264.326.318.1

599

11.483.148.1

65.0

8,907

37.0

67.743.244.0

10,519

38.579.260.755.3

1,034

43.167.141.442.9

1,901

65.488.5

67.559.1

61

Appendixes

Contents

I. Survey design and estimation procedures. .................................................................. 62 Surveydesign ........................................................................................ 62 Estimationprocedures ................................................................................. 6: Nonresponsebias ..................................................................................... 6:

II. Statisticalmethodology .................................................................................. Measuresofvariability ................................................................................ Datareiiability .......................................................................................

III. Demographic and socioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Limitationsofdata......................................................................................

Appendix figure

I. Smoothed weighted frequency distribution of the first diastolic blood pressure for white men ages 18-24 years by survey: United States, NHES I (1960-62), NHANES I (197 l--74), and NHANES II (1976-80) . . , . . , . . . . . . . . . . . . . . . . . .

List of appendix tables

I. Sample sizes and response rates for NHES I ( 1960-62), NHANES I (197 l-74), and NHANES II ( 1976-80), by age. . . . II. Percent of persons with blood pressure reading ending in zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65

6~ 6f

Appendix ISurvey design and estimationprocedures

Survey design

The sampling plans for the first National Health Examina-tion Survey (NHES I) and the first and second National Healthand Nutrition Examination Surveys (NHANES I and II) havebeen described at length in earlier publications.s-]o Each of thesurveys utilized a stratified multistage probability design inwhich a sample of the civilian noninstitutionalized populationof the United States was selected. Excluded from the selectionfor all three surveys were persons residing on reservation landsof American Indians, and excluded from selection for NHES Iand NHANE S I were persons residing in Alaska or Hawaii.

Successive stages in the sampling process dealt with pri-mary sampling units (PSU’s-a standard metropolitan statisticalarea, a county, or a small group of contiguous counties), censusenumeration districts (ED’s), segments (clusters of households),households, eligible persons, and sample persons. In the firststage of sample selection for each survey, the approximately1,900 PSU’S into which the United States is subdivided weregrouped into superstrata. There were 42 such superstrata forNHES I, 40 for NHANES I, and 64 for NHANES II. Amodified Goodman-Kish controlled selection technique wasused to select ftom each superstrata one or more PSU’S (alsocalled stands) to be included in the sample.61Forty-two PSU’Swere selected for inclusion in NHES I, 65 for inclusion inNHANES I, and 64 for inclusion in NHANES II.

EDs (within-PSU geographic areas with similar numbersof households) were then selected for subsequent sampling.For NHANES I and NHANES II, the EDs within each PSUwere further grouped into “poverty” and “nonpoverty” stratato allow oversampling among the “poverty stratum” ED’s. Asystematic sample of segments (clusters of households) wasselected from within the ED’s,

At the third stage of sampling, lists of all eligible samplepersons within each segment were made. From these lists sys-tematic random samples in each age-sex group were selected tobe examined, using the following sampling rates:

Suwey and age/sex group Sampling rate

NHES I

18-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/2

NOTE A list of references follows the text.

SamplingSurvey and age/sex group—Con. rate—Con,

NHANES I

18-19 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/420-44 years

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/4Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/2

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 1/7

NHANES II

18-59 yeara . . . . . . . . . . . . . . . . . . . . . . . . . 1/4

60-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 3/4

Of the 7,710 persons included in the NHES I sample, 6,672(86.5 percent) were interviewed and examined. Comparablefigures for NHANES I and II, ages 18–74 years, were 13,645of 19,572 and 12,504 of 18,209 (69.7 and 68.7 percent, re-spectively).

Estimation procedures

All data presented in this report are based on” weighted”observations. That is, data recorded for each sample personare inflated to characterize the subuniverse from which thatsample person was drawn. The weight for each examined personis a product of the reciprocal of the probability of selecting theperson, an adjustment for nonresponse cases (that is, personsnot examined), and a poststratified ratio adjustment. The latterincreases precision by making the final sample estimates of thepopulation agree approximately with independent controls pre-pared by the U.S. Bureau of the Census for the noninstitu-tionalized population of the United States as of the approximatesurvey midpoint by age, sex, and race.

Nonresponse bias

In any health examination survey there exists the potentialfor three levels of nonresponse: Household interview nonre-sponse, examination nonresponse, and item nonresponse.Household interview nonresponse is defined as the proportionof those sample persons who do not complete the householdmedical histo~ questionnaire. Examination nonresponse is theproportion of those sample persons who initially respond to thehousehold demographic questions and some or all of the medicalhistory questionnaire, but who subsequently do not come to theexamination center for an examination. Item nonresponse re-

63

suits from sample persons who do not complete some portionof either the household interview questionnaires or the exam-ination protocol.

The response rates for all three surveys are presented intable I. The summary response rates varied from a high of 86.8percent for NHES I down to 68.7 percent for NHANES II. Ineach of the surveys an inverse relationship between age andresponse rate was observed. That is, as age increased, the re-sponse rate decreased. The magnitude of the difference wassimilar among the surveys, with an approximate 10 percentdecline in response rates between the youngest and oldest agegroups observed for each of the three surveys.

Intense efforts were undertaken during each survey todevelop and implement procedures and inducements that wouldreduce all types of nonresponse and thereby reduce the poten-tial for bias in the survey estimates. Several studies have beenconducted to evaluate the effectiveness of these procedures andto quanti~ any systematic bias that may have occurred. Forinstance, a comparison of the 1976 National Health InterviewSurvey (NHIS)62 and NHANES 1163suggests that there is nota large nonresponse bias in some health-related variables because of the close agreement on selected interview items inNHANES II data with comparable items in the 1976 NHISdata, for which there was a nonresponse rate of only 4 percent.An earlier analysis comparing examined and nonexamined(but interviewed) persons from the first 35 stands of NHANES Ifound the two groups quite similar with respect to health char-acteristics being compared.64 A third study found no differencebetween examined and nonexamined persons selected for par-ticipation in NHANE S I with respect to health-related vari-ables,cs A study of factors relating to response in NHES Ifound that 36 and31 percent of the nonexamined and examinedpersons viewed themselves as being in excellent health, while 5and 6 percent of the nonexamined and examined persons re-ported being in poor health.66 Finally, a study of NHES Iexaminees involving comparisons between two extreme groups,

NOTE A list of references follows the text.

Table 1. Sample sizas and response rates for NHES I (1960-62),NHANES I (1971-74), and NHANES II (1976-80), by age

Totalsample Number Percent

Survey and age size examined examined

NHES I

18-74 years . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . .25-34 yeara . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . .4.5-54 years . . . . . . . . . . . . . . . . .55-64 years . . . . . . . . . . . . . . . . .65-74 years . . . . . . . . . . . . . . . . .

NHANES I

18-74 years . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . .35-44 yeara . . . . . . . . . . . . . . . . .45-54 years....,.........,,.55-64 years..............,..65-74 years . . . . . . . . . . . . . . . . .

NHANES II

18-74 yeare . . . . . . . . . . . . . . . . .18-24 years . . . . . . . . . . . . . . . . .25-34 years . . . . . . . . . . . . . . . . .35-44 years . . . . . . . . . . . . . . . . .45-54 years . . . . . . . . . . . . . . . . .55-64 years.............,,..65-74 years . . . . . . . . . . . . . . . . .

6,955960

1,4531,5531,343

997649

19,5723,1313,6823,1842,2921,8915,392

18,2092,7133,0312,2362,1493,8684,212

6,039866

1,3001,3781,164

809522

13,6452,2972,6942,3271,5991,2623,466

12,5042,0542,2371,5891,4532,5562,615

86.890.289.588.786.781.180.5

69.773.473.273.169.866.764.3

68.775.773.871.167.666.162.1

those who participated in the survey with no persuasive effortand those who participated only after a great deal of persuasiveeffort, found that differences between the two groups generallyhad little effect on estimates, based on numerous selected ex-amination and questionnaire items.G7

These findings have been interpreted as evidence that nolarge bias exists between the two groups for the items investi-gated and provide support for the belief that there is little biasintroduced to the findings because of differences in healthcharacteristics between examined and nonexamined persons.

64

Appendix IIStatistical methodology

Measures of variability

Because the statistics presented in this report are based ona sample, they may differ from the figures that would have beenobtained if a complete census had been taken using the samesurvey instruments, instructions, interview and examinationpersonnel, and procedures. The probability design of the samplepermits the estimation of standard errors and standard deviationsthat are appropriate for the design and weighted estimatesshown in this report.

The standard error is primarily a measure of the variationinherent in the process of estimating a population mean from asample mean. As calculated for this report, the standard erroralso reflects part of the variation that arises in the measurementprocess. It does not include estimates of any bias that might becontained in the data,

The estimation of sampling errors for a sample of the typeof the National Health and Nutrition Examination Survey isdifficult for at least two reasons (a) measurement error and“pure” sampling error are confounded in the data because it isdifticult to find a procedure that will either completely includeboth or treat one or the other separately, and (b) the surveydesign and estimation procedure are complex and, accordingly,require computationally involved techniques for the calculationof variances. The estimates of standard errors are themselvessubject to errors that may be large if the number of cases or thenumber of primary sampling units involved in the calculation ofvariances is small.

Estimates of the standard errors for selected statistics usedin this report are presented in most of the tables in this report.These estimates have been calculated by a replication techniquethat yields overall variability through observation of variabilityamong random subsamples of the total sample. 15,16These esti-

NOTE A list of references follows the text.

mated sampling errors do not reflect any residual bias thatmight still be present after attempted correction for nonresponse.

The standard deviation is a measure of the dispersion ofthe observations in a sample, and is useful in describing how anindividual observation compares with the mean of the sample.As calculated for this report it also reflects part of the variationthat arises in the measurement process. The estimates ofstandard deviations presented in the detailed tables were cal-culated using the pseudoreplication method. 15,]6

Data reliability

The criteria for reliability of estimates shown in this reportconsisted of the following (a) that the sample size on which theestimate is based be at least 25 persons, and (b) that the esti-mated coefficient of variation (that is, the standard error of themean divided by the mean) be less than 30 percent. Thus, if thesample size was too small or if the variation regarding the meanwas too large, an asterisk was placed next to the value on thetable. This estimate is considered neither precise nor stableenough to meet reliability standards. However, the va’lues areshown to give an impression of the observed distribution and topermit users to combine data into useful categories.

The following sample sizes were required for the presen-tation of percentile estimators given in this repom

Percentile Sample size

both . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1025th and 75th . . . . . . . . . . . . . . . . . . . . . . . . . 2010th and 90th . . . . . . . . . . . . . . . . . . . . . . . . . 50

5thand 95th............,.,.,.. . . . . . . . 100

If these minimum sample sizes were not me; there is an asteriskin the cell.

65

Appendix 11IDemographic andsocioeconomic terms

.4ge-In the first National Health Examination Survey,age at last birthday prior to the census interview was used asthe criterion for inclusion in the sample. Data in the detailedtables and text of the report are shown by age at the time of thecensus interview, regardless of age at examination.

In the first and second National Health and Nutrition Ex-amination Surveys, two ages were recorded for each ex-aminee: The age at last birthday at the time of examination andat the time of the census interview. The age criterion for in-clusion in the sample used in these two surveys was defined asage at the time of the census interview. The adjustment andweighting procedures used to produce national estimates werebased on the age at interview. Data in the detailed tables andtext of the report are shown by age at the time of the examina-tion, except that those few who became 75 years of age by thetime of the examination are included in the 65–74 year agegroup.

Race—For all three surveys, race was recorded as “white:’“Negro,” or “other.” “ Other” included Japanese, Chinese,Aemerican Indian, Korean, Eskimo, and all races other than

white and black. Mexicans were included with “white” unlessdefinitely known to be American Indian or other nonwhiterace. Black persons and those of mixed black and other parent-age were recorded as “Negro.” When a person of mixed racialbackground was uncertain about his race, the race of his fathervvasrecorded.

Education—In all three surveys each person was classifiedby education according to the highest grade of school completed.The only grades counted were those attended in a regular gradedpublic or private school where persons were given formal edu-cation, whether during the day or at night, on a full-time orpan-time attendance basis. A “regular” school is one that ad-vances a person toward an elementary or high school diploma,or a college, university, or professional degree. Education re-ceived in vocational, trade, or business schools outside theregular school system was not counted in determining the high-est grade of school completed. If a person attended school in aforeign country, at an ungraded school, with a tutor, or underother special circumstances, the nearest equivalent of his high-est grade attended was given.

66

Appendix IVLimitationsof data

The comparabfity of the blood pressure measurement pro-cedures of the first National Health Examination Survey andthe first and second National Health and Nutrition ExaminationSurveys may be indirectly evaluated by measuring shifls in thefrequency distributions of systolic and diastolic blood pressuremeasurements (SBP’S and DBP’s, respectively) in an age-race-sex group in which no shifts would be expected. White malesages 18–24 years are an example of such a group. This demo-graphic subgroup has little hypertension and is, therefore, not atarget group for any significant blood pressure control measures.Also, males would not have taken any contraceptive medica-tion. Such contraceptive medication may result in a rise of asmuch as 5–6 mmHg SBP.6S

As can be seen from figure 8 in the text, the curves forSBP’S for the three surveys practically coincide, as expected.The curves for the DBP’s (see figure I), however, are separated,with succeeding surveys reflecting sequentially higher DBP’s.Of considerable interest is the wide separation between the

NOTE A list of references follows the text.

later surveys and the initial 1960–62 survey, a difference thatis more marked in the lower part of the distribution.

The consistency of the rightward shift throughout the dis-tribution between the diastolic curves of 1960–62 and 1976–80 maybe due to a deficiency in the training of the physicianstaking the readings. Extra attention was paid to blood pressuremeasurement in the 1960–62 survey. For example, “the nurseraised the manometer to the physician’s eye leveL”6During theblood pressure determination, the physician obtained separatereadings for both the fourth and fifth phases. Both numberswere recorded on the form in addition to the systolic level. It ishighly likely tha~ because of the necessity of recording numbersfor both the fourth and fti phases, the physician was forced toconcentrate his attention on the diastolic determinations. How-ever, in the 1971–80 surveys physicians received no instruc-tions on takhg blood pressures. The physicians were instructedto read the manual for an overall description of how to conductthe examination. Additional evidence supporting the contentionthat more attention was paid to taking the blood pressures in1960–62 than in 1971–80 is provided by the data for end-digitpreference. The percent of persons with an end digit of O is

40

_ 1960-62..=.. = 1971-74_ - 1976-80

30

zmo 20kL

10

0 Jo 40 50 60 70 80 90 100 110

First diastolic blood pressure in millimeters mercury

Figure 1. Smoothed weighted frequency distribution of the first diastolic blood pressure for white men ages 18-24 years by survey: United States,NHES I (1 960-62), NHANES I (1971 –74), and NHANES II (1 976-80)

67

shown in table II. As can be seen, preference for the zero end

digit is markedly greater in the two later surveys than in the1960–62 survey. Suppression of the end-digit preference iscommonly regarded as an indication that more conscious atten-tion is being paid in taking blood pressure readings. It is possible

that the bias in DBPs might be somewhat less of a factor when

taking the blood pressures of persons in the older age groupsbecause the observer would be more attentive to the possibilityof elevated blood pressures. However, differential analysis ofthese groups would be difficult because of the admixture ofhigh numbers of medicated people in these groups.

Another possible explanation for the shift in DBP distribu-tions is a possible reduction in hearing acuity among the phy-

sicians of the 1976–80 survey. All of the physicians involvedin the 1960–62 survey were young (internal medicine residents),

as were most of the physicians used in the 1971 –74 survey.

However, nearly all the physicians used in the 1976-80 surveywere retired practitioners. An approximate 40-year examiner’s

age differential existed between the 1960-62 and 1976–80

surveys. No hearing tests were taken on any of the physiciansinvolved. Assuming their hearing approximated that of the U.S.male population, and that the fundamental frequency of a“typical” heartbeat is 500 hertz or lower, one would expect the

percent of persons responding to a 500-hertz tone at a thresholdlevel of 20 decibels or better to fall from 96.7 percent at ages25–34 years, and 80.5 percent at ages 55–64 years, to 77.7percent at ages 65–74 years.G9 It should be noted that the bloodpressure determinations did not take place in a soundproof

NOTE: A list of references followsthe text.

Table Il. Percent of persons with blood pressure reeding endingin zero

systolic Diastolicblood blood

Swvey pressure pressure

NHES I . . . . . . . . . . . . . . . . . . . . . . . . . . 32.4 34.7NHANES I . . . . . . . . . . . . . . . . . . . . . . . . 47.3 42.9NHANES II . . . . . . . . . . . . . . . . . . . . . . . . 51.3 51.5

NOTE Ages 18-74 years.

room, so the hearing thresholds could be considerably higher.A deterioration in average hearing levels for the physiciansemployed in the 1976–80 survey may be postulated, but it isnot possible to quantify this effect with these data.

The increased lability of the DBP compared with the SBP

reflects the more difficult task presented to the auditory system

(peripheral and central) by the diastolic end point. This iscaused by the following

1.

:2.

The amplitude of the Korotkoff sounds following the onsetof the first phase increases rapidly in volume, whereassounds following the commencement of the muffling as-

sociated with the fourth phase take a relatively longer timeto die out.TQT1

The fourth phase involving muffling abruptly changes the

quality of the sound to a soft blowing nature. This results

from a marked diminution or disappearance of sound fre-quencies above 60 hertz.70’72 The curtailing of the fre-quency spectrum above 60 hertz results in a loss of audi-

bility because hearing sensitivity is greater at higherfrequencies. The American Heart Association committeereport on recommendations for human blood pressure

determination notes that the determination of the fifth phase

(diastolic pressure) depends on the position of the steth~scope over the artery, the efilciency of the stethoscope intransmitting sounds of low intensity, and the sensitivity ofthe observer’s hearing.72 An effect of hearing acuity on the

fifth sound level was noted in a Scandinavian study withthe remark that observerL seemed to have very high read-

ings for the dktstolic fifth sound, which may have beenassociated with her slightly deficient hearing.73

Thus, a deficiency in the training of the observer wouldprobably result in diastolic readings biased upward, because

tihe observer might not attempt to find the difllcult end point oftlhe fifth phase but instead cut it off at a somewhat higher level.This would be especially notable for a low diastolic reading(below 70 in the case of white men average age 18-24 years)

as it makes no clinical difference whether a person has diastolicpressure of 65 or 55 mmHg. The upward bias due to inattentionwould be expected to be less frequent at higher diastolic read-ings, which might appear more unusual for a particular age-sex

glroup and consequently might assume more clinical significance.

* u.S. GOVERNMENT PRINTING_OFF~~E: 1986- 491- 33 5/ 4 (j I) 17

68

Vital and Health Statisticsseries descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the deta col-

lection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research—Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collectad data, and contributions to

statistical theory. Studies also include comparison of

U.S. methodology with those of other countries.

Analytical and Epidemiological Studies—Reports pre-

senting analytical or interpretive studias based on vital

and health statistics, carrying the analysis further than

the expository typas of reports in the other series.

Documents and Committee Reports-Final reports of

major committees concerned with vital and health sta-

tistic and documents such as recommended model vital

registration laws and revised birth and death certificates.

Comparative International Vital and Health Statistics

Reports-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Data From the National Health Interview Survey-Statis-

tics on illness, accidental injuries, disability, use of hos-

pital, medical, dental, and other services, and other

health-related topics, all based on data collected ]n the

continuing national household interview sutvey.

Data From tha National Health Examination Survey and

the National Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population

with respact to physical, physiological, and psycho-

logical characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit finite universe of persons.

Data From the Institutionalized Population Suweys— Dis-

continued in 1975. Repons from thesa surveys are in-

cluded in Saries 13.

Data on Health Resources Utilization—Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

Data on Health Resourcas: Manpower and Facilities—

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys-Statistics on health and

health-related topics collected in special surveys that

are not a parl of the continuing data systems of the

National Center for Health Statistics.

Data on Mortality-Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demo-

graphic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marriage, and Divorce—Various sta-

tistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records baaed on sample surveys of those records.

Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectively.

Data From the National Survey of Family Growth—

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 15-44 years

of age.

For answers to questions about this report or for a list of titlas of

reports published in these series, contact:

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782

301-436-8500

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