Trends and Determinants of Blood Pressure Control in US Hypertensive Patients: Insights from NHANES 1999-2021.

This study analyzes trends and determinants of blood pressure control among hypertensive patients in the United States (US) using National Health and Nutrition Examination Survey NHANES data from 1999 to 2021. Blood pressure control rates improved through 2013 but declined thereafter. Applying machine learning methods such as XGBoost, we identify hypertension awareness and antihypertensive medication use as the strongest predictors of successful control. In contrast, resistant hypertension, chronic kidney disease, and elevated low-density lipoprotein (LDL) levels are associated with poorer control. The shift from JNC7 to JNC8 hypertension guidelines reclassified some individuals from uncontrolled to controlled, influencing observed trends. Additionally, a reduction in antihypertensive medication use among female patients may have contributed to the recent decline. These findings highlight the critical role of medication adherence and patient awareness in maintaining blood pressure control.