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Discordance in National Estimates of Hypertension Among Young Adults

Nguyen, Quynh C.a; Tabor, Joyce W.b; Entzel, Pamela P.b; Lau, Yanc; Suchindran, Chirayathd; Hussey, Jon M.b,e; Halpern, Carolyn T.b,e; Harris, Kathleen Mullanb,f,g; Whitsel, Eric A.a,h

doi: 10.1097/EDE.0b013e31821c79d2
Hypertension: Original Article

Background: In the United States, where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential.

Methods: Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)—a nationally representative field study of 15,701 participants aged 24–32—was referenced against NHANES (2007–2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study.

Results: Hypertension rates (BP: ≥140/90 mm Hg) were higher in Add Health compared with NHANES (19% vs. 4%), but self-reported history was similar (11% vs. 9%) among adults aged 24–32. Survey weights and adjustments for differences in participant characteristics, examination time, use of antihypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic examinations conducted by NHANES III (1988–1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intraclass correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively.

Conclusions: The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV participants suggests an unexpectedly high risk of cardiovascular disease among US young adults and warrants further scrutiny.


From the aDepartment of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC; bCarolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; cDepartment of Economics, Princeton University, Princeton, NJ; Departments of dBiostatistics and eMaternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, NC; fDepartments of Sociology and gPublic Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC; and hDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Submitted 17 April 2010; accepted 3 January 2011.

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01-HD31921), with cooperative funding from 23 other federal agencies and foundations.

Information on how to obtain the Add Health data files is available on the Add Health website (

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Editors' note: Related articles appear on pages 542 and 544.

Correspondence: Quynh C. Nguyen, Department of Epidemiology, Cardiovascular Disease Program, Bank of America Center, UNC Gillings School of Global Public Health, Suite 306-E, 137 East Franklin St, Chapel Hill, NC 27514. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.