Hypertension Prevalence, Diagnosis, and Management for Post‐9/11 US Veterans

BACKGROUND: Hypertension prevalence, diagnosis, and treatment vary by age, sex, and race and ethnicity in the general US population and for veterans. Less is known about the youngest veterans (ie, discharged post-9/11), including growing subsets of women and some racial and ethnic subgroups. METHODS: In this cross-sectional study, national Veterans Health Administration data were used to identify post-9/11 veterans receiving Veterans Health Administration care in 2001 to 2023. Proportions with clinical hypertension (patients with hypertension diagnostic code[s], antihypertensive medication fills, or blood pressure measurements ≥140/90), undiagnosed hypertension, and untreated hypertension were calculated. Crude and adjusted prevalence ratios for hypertension measures were presented by sex and by race and ethnicity, adjusting for demographics and comorbidities. RESULTS: Among 1 181 007 veterans (mean age, 33.5±9.4 years; 12.3% women), 44.9% had clinical hypertension, among them 49% undiagnosed and 26% untreated. Compared with men, women were associated with 5% lower risk of clinical hypertension (adjusted prevalence ratio, 0.95 [95% CI, 0.93-0.96]) and untreated hypertension (adjusted prevalence ratio, 0.61 [95% CI, 0.60-0.63]) but had higher risk of undiagnosed hypertension (adjusted prevalence ratio, 1.17 [95% CI, 1.16-1.18]). Compared with White veterans, Black veterans were associated with 9% higher risk of hypertension but 26% lower risk of undiagnosed and 19% lower risk of untreated hypertension. CONCLUSIONS: Nearly half of post-9/11 veterans met hypertension criteria, and among them 49% were undiagnosed and 26% were untreated. Tailored screening and self-measured blood pressure monitoring to reduce prevalence and improve management might curb potential differences among these veterans.