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Original Articles

Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City

Sonia Y. Angell, MD, MPH; Renu K. Garg, MPH; R. Charon Gwynn, PhD; Lori Bash, MPH; Lorna E. Thorpe, PhD, MPH and Thomas R. Frieden, MD, MPH

From the New York City Department of Health and Mental Hygiene (S.Y.A., R.K.G., L.E.T., T.R.F.), New York, NY; Mailman School of Public Health (C.G.), Columbia University, New York, NY; and Bloomberg School of Public Health (L.B.), Johns Hopkins University, Baltimore, Md.

Reprint requests to Sonia Angell, MD, MPH, New York City Department of Health & Mental Hygiene, Division of Health Promotion and Disease Intervention, 2 Lafayette, 14th Floor, CN-46, New York, NY 10007. E-mail sangell{at}health.nyc.gov

Received May 13, 2008; accepted July 25, 2008.

Background— Hypertension-related risk in urban areas may vary from national estimates; however, objective data on prevalence and treatment in local areas are scarce. We assessed hypertension prevalence, awareness, treatment, and control among New York City (NYC) adults.

Methods and Results— The NYC Health And Nutrition Examination Survey (HANES), modeled on the national HANES, was conducted in 2004 with a representative sample of noninstitutionalized NYC residents 20 years of age. Hypertension outcomes were examined with interview and examination data (n=1975). Multiple logistic regression was used to assess factors associated with control among adults with hypertension. We found that 25.6% of NYC adults had hypertension. Blacks had a higher prevalence than whites (32.8% versus 21.1%, P<0.001), as did Hispanics (26.5% versus 21.1%, P<0.05). Foreign-born residents who had lived in the United States for <10 years had lower rates than those who had lived in the United States longer (20.0% versus 27.5%, P<0.05). Among adults with hypertension, 83.0% were diagnosed, 72.7% were treated, and 47.1% had hypertension controlled. Of those treated, 64.8% had hypertension controlled. After adjustment for sociodemographic variables among all adults with treated hypertension, lack of a routine place of medical care was most strongly associated with poor control levels (adjusted odds ratio 0.21, 95% confidence interval 0.07 to 0.66). Among nonelderly adults with treated hypertension, blacks had 4-fold lower odds than whites of having hypertension controlled (adjusted odds ratio 0.24, 95% confidence interval 0.06 to 0.92).

Conclusions— In NYC, hypertension is common and frequently uncontrolled. Low levels of control are associated with poor access to care. Racial disparities in prevalence and control are evident among nonelderly adults.

Key Words: blood pressure • cardiovascular diseases • epidemiology • hypertension • prevention

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