Trends in the Incidence of Hypertension Among Healthy Adults Across 6 Decades

To determine long-term trends in the incidence of hypertension.

Healthy adults in Olmsted County, Minnesota, from 1962 to 2012 were identified and studied with follow-up through 2024. One blood pressure (BP) reading for each calendar year (as available) through follow-up was identified. Hypertension was defined by BP ≥130/80 mm Hg or ≥140/90 mm Hg in 2 different calendar years or by use of antihypertensive medication. Analyses were adjusted for calendar period, age, sex, race, tobacco smoking, nontobacco substance use, depression/anxiety, dyslipidemia; family history of diabetes mellitus or hypertension, body mass index, systolic and diastolic BP, and fasting blood glucose level. Cumulative incidence estimates of hypertension accounted for death as a competing risk and were adjusted to characteristics of the 2000-2012 subcohort.

There were 8323 healthy adults studied (mean age, 39 years). Risk factors for hypertension were older age, male sex, Black race, past and current tobacco smoking, current substance use, depression/anxiety, family history of diabetes or hypertension, higher systolic and diastolic BP, higher blood glucose level, higher body mass index, and period. For the baseline periods of 1963-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2012, the adjusted 20-year cumulative incidence of hypertension defined by BP ≥130/80 mm Hg was 45%, 47%, 54%, 70%, and 67%; by BP ≥140/90 mm Hg was 22%, 24%, 26%, 35%, and 33%; and by medication use alone was 13%, 12%, 13%, 17%, and 19%, respectively.

A large increase in the incidence of hypertension among healthy adults occurred in the 1990s, with subsequent stabilization.