County Prevalence, Awareness, and Control of High Blood Pressure From Health Kiosks in the United States, 2017-2024

As the leading modifiable risk factor for death in the United States, hypertension requires timely and locally detailed surveillance. Current estimates of the high blood pressure (BP) care continuum are lagging national averages from sample surveys with low participation and unknown subnational variation. This study explores the use of self-service health kiosks in retail stores as an alternative source for subnational estimates of prevalence, awareness, and control.

We analyzed data from adult kiosk users (n=1270 485) across 1892 counties in 49 States (except Massachusetts) and the District of Columbia in a serial cross-sectional analysis from November 2017 to September 2024. High BP was defined as self-reported diagnosed (aware) or elevated BP (systolic ≥140 mm Hg or diastolic ≥90 mm Hg). Among those aware, control was defined as BP <140/90 mm Hg. Small area estimates for counties were calculated using multilevel regression and poststratification based on individual and areal socio-demographic covariates. We compared the prevalence of diagnosed hypertension with the Behavioral Risk Factor Surveillance System 2021.

The analytic sample had a mean age of 42.0 years (SD=15.6). Prevalence of high BP was 51.9% in 2017 to 2018 and 50.4% in 2023 to 2024. In 2023 to 2024, awareness and control were 73.7% and 61.8% and county-level prevalence ranged from 39.5% to 63.1%. Similar hotspots in the Southeast were identified in both the kiosk and Behavioral Risk Factor Surveillance System (Spearman ρ=0.52).

Health kiosk data reveal substantial spatial and socio-demographic variation in high BP. Near real-time subnational surveillance of health kiosk users can provide insights to guide interventions and track progress.