Approximately 120 million adults in the United States have high blood pressure, which works out to nearly 48% of the adult population. That number has held steady in recent years, with surveys from 2021 to 2023 showing 47.7%, virtually unchanged from earlier estimates. What’s more alarming than the number itself is what happens next: only about 1 in 4 of those 120 million people actually have their blood pressure under control.
How High Blood Pressure Is Defined
Since 2017, the threshold for a hypertension diagnosis has been 130/80 mm Hg. That was a significant shift from the previous cutoff of 140/90, and it brought millions more Americans into the “high blood pressure” category overnight. The lower number reflects growing evidence that cardiovascular damage begins well before blood pressure reaches the old threshold. Stage 2 hypertension, which typically calls for more aggressive treatment, starts at 140/90.
Rates by Age and Sex
High blood pressure becomes dramatically more common with age. Among adults 18 to 39, about 22% have it. That jumps to 55% for those aged 40 to 59, and by age 60 and older, nearly 75% of adults are affected.
Men are more likely than women to have high blood pressure overall: 51% compared to about 40%. But that gap is almost entirely driven by younger adults. Among 18- to 39-year-olds, men are more than twice as likely as women to have hypertension (31% vs. 13%). In the 40 to 59 range, men still lead (59% vs. 50%). By age 60 and beyond, the rates are essentially the same for both sexes, hovering around 74 to 75%.
Where You Live Matters
High blood pressure isn’t evenly distributed across the country. The highest rates cluster in the South, particularly in the Mississippi Delta, southern Texas, western Oklahoma, southwestern Arizona, northeastern Georgia, and southern Illinois. These same areas also tend to have the lowest rates of blood pressure control, creating a double problem: more people are affected and fewer are getting effective treatment. County-level data from 2022 shows prevalence ranging from under 5% in some areas to over 90% in others, a gap that reflects deep differences in access to care, diet, poverty, and other social factors.
The Control Problem
The most striking part of the data isn’t how many people have high blood pressure. It’s how few have it managed. Of the 120 million adults with hypertension, roughly 100 million are uncontrolled, meaning their blood pressure remains above the recommended threshold despite the condition being diagnosable and treatable. Only about 27 million people, roughly 1 in 4, have their blood pressure under control.
The breakdown helps explain why. About 60% of adults with hypertension are aware they have it, meaning 4 in 10 don’t even know. Among those who are aware, about half are receiving treatment. And among those being treated, many still aren’t reaching their target numbers. Each step in that chain loses people, so the final percentage with controlled blood pressure is far smaller than it should be. These numbers have not improved measurably in recent years.
Health and Financial Consequences
In 2023, high blood pressure was listed as a primary or contributing cause of 664,470 deaths in the United States. It raises the risk of heart attack, stroke, kidney disease, and heart failure, making it one of the most consequential conditions in American health.
The financial toll is substantial too. High blood pressure cost the US an estimated $219 billion in 2019. On an individual level, people with hypertension spend roughly $2,800 more per year on medical care than people without it. Among privately insured adults seeking outpatient care, that gap was even wider in 2021, closer to $2,900 more per year. These costs include medications, office visits, lab work, and treatment for complications that could have been prevented with earlier control.
Why the Numbers Stay High
Despite decades of public health campaigns, the prevalence of hypertension in the US has remained stubbornly close to 48% since at least 2017. Awareness, treatment, and control rates have also flatlined. Several forces keep these numbers in place. High blood pressure has no symptoms in most people, so there’s no pain or discomfort pushing them to seek care. Treatment is lifelong, and many people stop taking medications when they feel fine. Lifestyle factors like high sodium intake, low physical activity, and obesity remain widespread. And in the communities with the highest rates, access to consistent primary care is often limited.
The scale of the problem is hard to overstate. Nearly half of all American adults are walking around with a condition that silently damages blood vessels and organs, and the vast majority of them don’t have it under control. That gap between prevalence and control is where most of the preventable heart attacks, strokes, and kidney failures in this country come from.