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

Objective: To determine long-term trends in the incidence of hypertension. Patients and Methods: 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. Results: 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. Conclusion: A large increase in the incidence of hypertension among healthy adults occurred in the 1990s, with subsequent stabilization.