Association of Lifestyle Factors With Blood Pressure Control Among Hypertensive U.S. Adults: An Analysis of the National Ambulatory Medical Care Survey (NAMCS) 2010–2015

Background Hypertension remains a leading contributor to cardiovascular morbidity in the United States, yet blood pressure control in outpatient settings remains suboptimal. Lifestyle factors and sociodemographic characteristics may influence blood pressure control, but their real-world associations in ambulatory care are not fully understood. This study aimed to assess the association between lifestyle factors, including body mass index (BMI), physical activity, and smoking status, as well as sociodemographic characteristics, and blood pressure control among adults with diagnosed hypertension in U.S. outpatient settings. Methodology A cross-sectional analysis was conducted using the National Ambulatory Medical Care Survey from 2010 to 2015. Adults with diagnosed hypertension were included. Blood pressure control was defined as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg. Survey-weighted descriptive and multivariable logistic regression analyses were performed to assess associations between lifestyle factors, sociodemographic characteristics, and blood pressure control. Results The final sample included 30,655 unweighted visits, representing 626,165,887 weighted visits nationally. Obesity was independently associated with lower odds of blood pressure control compared with normal BMI (odds ratio = 0.857; 95% confidence interval = 0.774-0.949; p = 0.003). Patients with private insurance had higher odds of blood pressure control than those insured through Medicaid. Non-Hispanic Black adults demonstrated significantly lower odds of blood pressure control compared with non-Hispanic White adults. Documented exercise and tobacco counseling were not independently associated with control. Conclusions Blood pressure control in U.S. outpatient settings is influenced by BMI, insurance status, and race or ethnicity, highlighting the need for targeted and sustained interventions beyond routine lifestyle counseling.