Hypertension affects roughly 1.4 billion adults worldwide, making it one of the most common chronic conditions on the planet. In the United States alone, about half of all adults over 20 have high blood pressure, though the burden falls unevenly across age groups, races, income levels, and even geography. Understanding who is most at risk can help you recognize whether you or someone close to you might be living with undiagnosed high blood pressure.
Men vs. Women: A Shifting Gap
Men are more likely than women to have hypertension at nearly every stage of life. Between 2015 and 2018, the age-adjusted U.S. prevalence was 51.7% in men and 42.8% in women. The gap is widest in younger adults: among those aged 18 to 39, 31.2% of men had hypertension compared to just 13.0% of women. By age 40 to 59, the numbers narrow to 59.4% versus 49.9%. And after 60, the difference nearly disappears, with 75.2% of men and 73.9% of women affected.
That closing gap reflects a steeper rate of increase in women as they age. Hormonal changes around menopause play a significant role, as the protective cardiovascular effects of estrogen diminish. This means women who had normal blood pressure their entire lives can develop hypertension relatively quickly in their 50s and 60s.
Black Americans Face the Highest Rates
Racial disparities in hypertension are stark. Among all U.S. adults, 57.1% of non-Hispanic Black Americans have hypertension, compared to 43.6% of non-Hispanic White Americans and 43.7% of Hispanic Americans. The disparity is especially pronounced among women: 56.7% of Black women have hypertension, versus 36.7% of White women and 36.8% of Hispanic women. Among men, the pattern holds but the gap is smaller (57.2% vs. 50.2% and 50.1%).
These differences stem from a combination of genetic predisposition, higher rates of salt sensitivity, and deeply rooted structural factors like limited access to healthy food, chronic stress from discrimination, and inequities in healthcare access. The result is not only higher prevalence but also higher rates of complications like stroke, heart failure, and kidney disease in Black communities.
Age: Not Just an Older Person’s Problem
Hypertension prevalence rises sharply with age. Three out of four Americans over 60 have the condition. But younger adults are far from immune. Nearly one in three men between 18 and 39 already has elevated blood pressure, and younger adults are the least likely to know it. Among Americans aged 18 to 39 with uncontrolled blood pressure, 53% were completely unaware of their condition. That number drops to 29% for adults 70 and older, largely because older adults see doctors more frequently.
Children and adolescents can also develop hypertension, though it’s much less common. Current estimates put the prevalence at about 3.5% of U.S. children and teens, with overweight and obese children at the highest risk. While childhood hypertension doesn’t cause heart attacks in kids, it is linked to early arterial damage, thickening of the heart muscle, and kidney complications that set the stage for serious problems later in life.
Pregnancy Raises Unique Risks
About one in seven pregnancies in the U.S. is affected by a hypertensive disorder, and the rate is climbing. Between 2017 and 2019, the prevalence rose from 13.3% to 15.9% of delivery hospitalizations. These conditions range from chronic high blood pressure that existed before pregnancy to pregnancy-specific disorders like preeclampsia, which can cause dangerously high blood pressure along with organ damage.
Hypertensive disorders during pregnancy are a leading cause of pregnancy-related death in the United States. They’re strongly associated with severe complications including heart attack and stroke during or shortly after delivery. The effects also extend beyond pregnancy: women who develop high blood pressure during pregnancy face an elevated risk of cardiovascular disease for years afterward, even if their blood pressure returns to normal after delivery.
Income, Education, and Where You Live
Socioeconomic factors have a measurable impact on hypertension risk. Adults with a college degree are roughly 25% less likely to have hypertension than those who didn’t finish high school. Higher income shows a similar protective pattern: adults earning $50,000 or more per year have about a 21% lower incidence compared to those earning under $25,000. People who report a negative net worth have double the prevalence of those with positive net worth. These patterns reflect the cascading effects of better access to healthcare, healthier food, safer neighborhoods for exercise, and lower levels of chronic financial stress.
Geography matters too. In the U.S., hypertension is most prevalent and least well controlled in the South. Counties in the Mississippi Delta, southern Texas, western Oklahoma, southwestern Arizona, northeastern Georgia, and southern Illinois carry the heaviest burden. These are often areas where poverty rates are higher, healthcare facilities are fewer, and the population skews older, creating a perfect storm for undiagnosed and unmanaged high blood pressure.
People With Diabetes and Kidney Disease
Hypertension and other chronic conditions frequently overlap. About one in five adults with high blood pressure also has chronic kidney disease, and the relationship runs in both directions: high blood pressure damages the kidneys over time, and failing kidneys raise blood pressure by disrupting fluid balance and hormone regulation. Among people with diabetes, the overlap is even more common. Roughly one in three adults with diabetes also has chronic kidney disease, and the vast majority of people with diabetes will develop hypertension at some point.
Millions Don’t Know They Have It
Globally, an estimated 600 million adults with hypertension, about 44%, don’t know they have the condition. Only about 320 million, or 23% of those affected worldwide, have their blood pressure adequately controlled. In the U.S., among adults with uncontrolled blood pressure, 38% are unaware of their diagnosis. That’s 15.6 million people walking around with dangerously elevated readings and no idea.
Young adults are the most likely to be in the dark, but income and employment also play a role. Adults with higher household incomes and those who are employed are actually more likely to be unaware, possibly because they feel healthy and skip routine checkups. On the other hand, simply having visited a healthcare provider in the past year cuts the likelihood of being unaware by about 39%. Hypertension is often called the “silent killer” because it rarely produces symptoms until it has already caused significant damage to the heart, kidneys, brain, or blood vessels. The only reliable way to catch it is to have your blood pressure measured.