Factors Associated With Uncontrolled Blood Pressure and Its Association With Cardiovascular and All-Cause Mortality Among Adults Receiving Antihypertensive Therapy: A Retrospective Cohort Study Using NHANES 2013-2018 Linked Mortality Data

Background: Uncontrolled blood pressure remains common among adults in the United States receiving antihypertensive therapy.However, contemporary nationally representative evidence examining associated factors and subsequent mortality within the same treated population remains limited.Objective: To identify factors associated with uncontrolled blood pressure and examine its association with all-cause and heart disease mortality.Methods: This retrospective cohort study used National Health and Nutrition Examination Survey (NHANES) 2013-2018 data linked to mortality through 2019.Adults receiving antihypertensive therapy with complete data were included.Uncontrolled blood pressure was defined as mean systolic pressure of at least 130 mmHg or diastolic pressure of at least 80 mmHg.Survey-weighted logistic and Cox regression were performed.Results: The sample included 3,311 adults, representing an estimated 42,895,551 US adults after application of the NHANES examination weights.Uncontrolled blood pressure affected 56.9%.Higher odds were found among other Hispanic adults (adjusted odds ratio (AOR) 1.50, 95% confidence interval (CI), 1.08-2.07),non-Hispanic Black adults (AOR 1.63, 95% CI, 1.29-2.05),and non-Hispanic Asian adults (AOR 1.68, 95% CI, 1.15-2.45).Uncontrolled blood pressure was not significantly associated with all-cause mortality (adjusted hazard ratio (HR) 1.24, 95% CI, 0.87-1.78)or heart disease mortality (adjusted HR 0.97, 95% CI, 0.51-1.84).Conclusion: Uncontrolled blood pressure remained common and differed across population groups.Future studies should use repeated measurements, objective treatment data, and longer follow-up.