Nearly half of all U.S. adults have hypertension. According to the most recent national data, covering August 2021 through August 2023, 47.7% of American adults age 18 and older meet the criteria for high blood pressure. With roughly 258 million adults in the country, that translates to well over 120 million people.
What Counts as Hypertension
The threshold might be lower than you think. Under guidelines from the American Heart Association and the American College of Cardiology, hypertension starts at a systolic reading (the top number) of 130 mm Hg or a diastolic reading (the bottom number) of 80 mm Hg. Anyone already taking blood pressure medication also counts. Stage 1 hypertension covers readings of 130–139 systolic or 80–89 diastolic. Stage 2 begins at 140/90 or higher.
These thresholds, updated in 2017 and reaffirmed in 2025 guidelines, pulled millions more Americans into the hypertension category compared to the older cutoff of 140/90. That shift is one reason the percentage looks so high, but it reflects real cardiovascular risk. Heart attack and stroke risk begins climbing well before blood pressure hits 140.
Who Is Most Affected
Hypertension doesn’t hit every group equally. The starkest disparity is racial: 58% of Black adults in the U.S. have hypertension, compared to an overall age-adjusted rate of 44.5%. That gap has persisted for decades and is driven by a mix of genetic factors, chronic stress, neighborhood environments, and unequal access to care. Hispanic and white adults fall closer to the national average, with rates in the low-to-mid 40s.
Age is the single strongest predictor. Blood vessels stiffen over time, and the prevalence of hypertension climbs sharply with each decade of life. Among younger adults (18–39), rates are relatively low, but by age 60 and older, the majority of Americans have elevated readings. Men tend to develop hypertension earlier in life than women, though the gap narrows after menopause as women’s rates catch up.
Where Rates Are Highest
Geography matters, too. Counties across the Deep South consistently show the highest hypertension rates and the lowest rates of blood pressure control. The Mississippi Delta, southern Texas, western Oklahoma, southwestern Arizona, northeastern Georgia, and southern Illinois are particular hotspots. In some counties, more than 63% of adult patients have hypertension. Meanwhile, parts of the country see rates below 49%. These regional patterns track closely with poverty, access to healthcare, and diet.
Millions Don’t Know They Have It
High blood pressure rarely causes symptoms until it has already damaged organs. That’s why it’s called a silent condition. Roughly 11 million Americans with hypertension are unaware their blood pressure is too high and aren’t receiving any treatment. They feel fine, so they never get checked or don’t follow up after an elevated reading at a pharmacy kiosk or doctor’s visit.
Even among those who know they have hypertension, control is a challenge. Of the tens of millions of Americans diagnosed with high blood pressure, nearly half don’t have it managed below target levels. Some struggle with medication side effects or costs. Others find it hard to maintain the dietary changes and physical activity that help keep numbers down. The result is a massive population walking around with uncontrolled blood pressure, silently accumulating damage to the heart, kidneys, brain, and blood vessels.
The Financial Toll
Hypertension costs the U.S. an estimated $219 billion a year, a figure that includes hospitalizations, medications, doctor visits, and lost productivity. On an individual level, people with high blood pressure spend roughly $2,800 to $2,900 more on medical care each year than people with normal readings. Those costs add up quickly over a lifetime, especially since hypertension often leads to more expensive conditions like heart failure, kidney disease, and stroke.
Why the Number Keeps Growing
Several forces are pushing hypertension rates higher. Americans are aging. Obesity rates continue to climb, and excess weight is one of the strongest modifiable risk factors for high blood pressure. The average American diet remains extremely high in sodium, with most of it coming from processed and restaurant food rather than the salt shaker. Sedentary lifestyles, chronic stress, and poor sleep compound the problem. And because hypertension develops gradually without symptoms, many people don’t take action until they’re already well into stage 2 territory or dealing with a complication.
The net effect is a condition that touches nearly every other household in the country, costs hundreds of billions of dollars, and remains poorly controlled in a staggering share of those who have it.