Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use by County and Rural-Urban Classification — United States, 2017

Abstract

In 2017, approximately one in three U.S. adults reported having been told by a health care professional that they had high blood pressure (hypertension) (1). Although hypertension prevalence is well documented at national and state levels, less is known about rural-urban variation and county-level prevalence. To examine prevalence of self-reported hypertension and antihypertensive medication use by rural-urban classification and county, CDC analyzed data reported by 442,641 adults aged ≥18 years who participated in the 2017 Behavioral Risk Factor Surveillance System (BRFSS). In rural (noncore) areas, 40.0% (unadjusted prevalence) of adults reported having hypertension, whereas in the most urban (large central metro) areas, 29.4% reported having hypertension. Age-standardized hypertension prevalence was significantly higher in the most rural areas, compared with the most urban areas within nearly all categories of age, sex, and other demographic characteristics. Model-based hypertension prevalence across counties ranged from 18.0% to 55.0% and was highest in Southeastern* and Appalachian † counties. Model-based county-level prevalence of antihypertensive medication use among adults with hypertension ranged from 54.3% to 84.7%. Medication use also was higher in rural areas compared with use in most urban areas, with prevalence highest in Southeastern and Appalachian counties as well as counties in the Dakotas and Nebraska. CDC is working with states to enhance hypertension awareness and management through a strategy of team-based care that involves physicians, nurses, pharmacists, dietitians, and community health workers. The increased use of telemedicine to support this strategy might improve access to care among underserved populations.

Society of behavioral medicine statement on COVID-19 and rural health

“…Because of the high rates of risk factors for severe COVID-19 illness in rural populations, specifically older age (60 and older), and younger adults with heart disease, cancer, chronic obstructive pulmonary disease (COPD), or diabetes, it is projected that 50% of noninstitutionalized rural adults are at high risk for hospitalization and serious illness if they are infected with COVID-19, compared to 46.9% and 40% of micropolitan and metropolitan adults, respectively [ 15 ]. While similar rates of asthma have been found in rural versus urban areas (e.g., Ownby et al [ 16 ]), hypertension [ 17 ], and obesity and overweight [ 18 ] are found to be more common in rural than urban areas. The Centers for Disease Control (CDC) also recently added asthma, hypertension, and obesity and overweight to risk factors for severe COVID-19 illness [ 19 ].…”

Association of Cardiovascular Disease Risk Factors With Sociodemographic Characteristics and Health Beliefs Among a Community-Based Sample of African American Adults in Minnesota

“…This would not explain the higher prevalence of CVD risk factors we observed because rural-dwelling adults consistently experience worse CV health and increased CVD risk factors compared with urban adults independent of race. [21][22][23][24] The Jackson Heart Study (JHS) is a contemporary, prospective, community-based cohort of AA adults designed to investigate CVD risk factors. 25 We again observed higher prevalence of CVD risk factors in our participants compared with the JHS, including current smoking (25% vs 13%), hyperlipidemia (47% vs 33%), and diabetes (34% vs 19%).…”

Urban-rural differences in COVID-19 exposures and outcomes in the South: A preliminary analysis of South Carolina

“…The adverse impacts of existing health disparities for people living in rural areas continue to be a major source of concern during preparation for and response to widespread disasters. Rural residents, across all racial/ethnic groups, are at greater risk from the five leading causes of death, including heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke, compared with urban Americans [11][12][13]. Behavioral risk factors for hypertension, diabetes, and COPD such as obesity, poor nutrition, smoking, and alcohol consumption, are also higher in rural areas than non-rural places [14,15].…”