General Population and Global Cardiovascular Risk Prediction

Hypertension afflicts a substantial proportion of the adult population worldwide and a growing number of children. Numerous genetic, environmental, and behavioral factors influence the development of hypertension across the life course. In turn, hypertension has been identified as one of the significant causal risk factors for cardiovascular disease (CVD), including heart disease, peripheral vascular disease, stroke, and renal disease. Using the current definition of hypertension, data from recent United States National Health and Nutrition Examination Surveys (NHANES) from 2015 to 2018 indicate that the age-adjusted prevalence of hypertension among adults 20 years of age and older in the United States was 47.3%, or nearly one in two adults, with 51.7% of men and 42.8% of women affected. Among the entire population, approximately 121.5 million U.S. adults are estimated to have hypertension. When high-quality out-of-office modalities for measuring blood pressure are included, prevalence rates tend to be even higher. Prevalence rates increase dramatically with age, from 28.2% to 60.1% to 77.0% among those aged 20 to 39, 40 to 59, and 60 years or older, respectively. Trends in the prevalence of hypertension have tended to follow similar patterns in all racial/ethnic groups from the 1990s to the present. Despite significant advances in understanding the risk factors, pathogenesis, and sequelae of hypertension and multiple trials over the past five decades indicating the benefits of antihypertensive therapy, hypertension remains a significant public health problem. This chapter discusses these and many other related issues.