Background To reduce the cardiovascular disease burden, Healthy People 2020 established U.S. hypertension goals for adults to: (1) decrease prevalence to 26.9%. (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment. Methods and Results To assess current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999–2012 data in twoyear blocks were assessed in adults ≥18 years old age-adjusted to U.S. 2010. From 1999–2000 to 2011–2012, prevalent hypertension was unchanged (30.1% vs. 30.8%, p=0.32). Hypertension treatment (59.8% vs. 74.7%, p<0.001) and proportion of treated adults controlled (53.3% to 68.9%, p=0.0015) increased. Hypertension control to <140/<90 mmHg rose every two years from 1999–2000 to 2009–2010 (32.2% vs. 53.8%, p<0.001) before declining to 51.2% in 2011–2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (a) increasing body mass index with prevalent hypertension (odds ratio [OR] 1.44). (b) lack of health insurance (OR 1.68) and <2 healthcare visits/year (OR 4.24) with untreated hypertension. (c) healthcare insurance (OR 1.69), ≥2 healthcare visits/year (OR 3.23) and cholesterol treatment (OR 1.90) with controlled hypertension. Conclusions The NHANES 1999–2012 analysis suggests that Healthy People 2020 goals for hypertension: (1) prevalence show no progress (2) treatment was exceeded (3) control has flattened below target. Findings are consistent with evidence that: (a) obesity prevention and treatment could reduce prevalent hypertension (b) healthcare insurance, ≥2 healthcare visits/year, and guideline-based cholesterol treatment could improve hypertension control.

Hypertensive patients with clinic blood pressure (BP) uncontrolled on ≥3 antihypertensive medications, i.e., apparent treatment resistant hypertension (aTRH) comprise ~28%–30% of all uncontrolled patients in the U.S. However, the proportion receiving these medications in optimal doses is unknown; aTRH is used, since treatment adherence, BP measurement artifacts, and optimal therapy were not available in electronic record data from our >200 community-based clinics Outpatient QUuality Improvement Network (OQUIN). This study sought to define the proportion of uncontrolled hypertensives with aTRH on optimal regimens and clinical factors associated with optimal therapy. During 2007–2010, 468,877 hypertensive patients met inclusion criteria. BP <140/<90 defined control. Multivariable logistic regression was used to assess variables independently associated with ‘optimal therapy’ (prescription of diuretic and ≥2 other BP medications at ≥50% of maximum recommended hypertension doses). Among 468,877 hypertensives, 147,635 (31.5%) were uncontrolled; among uncontrolled hypertensives, 44,684 were prescribed ≥3 BP medications (30.3%) of which 22,189 (15.0%) were prescribed ‘optimal’ therapy. Clinical factors independently associated with optimal BP therapy included black race (OR 1.40 [95% CI 1.32–1.49]), chronic kidney disease (1.31 [1.25–1.38]) diabetes (1.30 [1.24–1.37]), and coronary heart disease risk equivalent status (1.29 [1.14–1.46]). Clinicians more often prescribe optimal therapy for aTRH when cardiovascular risk is greater and treatment goals lower. Approximately one in seven of all uncontrolled hypertensives and one in two with uncontrolled aTRH are prescribed ≥3 BP medications in optimal regimens. Prescribing more optimal pharmacotherapy, for uncontrolled hypertensives including aTRH, confirmed with out-of-office BP, could improve hypertension control.