The prevalence of heart failure (HF) and hypertension, respectively, are on the rise among U.S. adults, according to two separate studies published in JACC that use data from the National Health and Nutrition Examination Survey (NHANES).

In the HF study, Ahmed Sayed, MD, et al., found the crude prevalence of HF increased 43% between 1988 and 2023, from 3.3 million adults (2.1%) to 7.4 million adults (3.0%). No change in age-standardized prevalence was observed.

At the same time, Sayed and colleagues also noted a major shift in underlying risk factor profiles among those with HF, with the prevalence of obesity (32.5% to 60.4%), diabetes (21.2% to 36.2) and chronic kidney disease (38.6% to 52.3%) on the rise and high blood pressure (80.7% to 49.1%), hypercholesterolemia (71.5% to 22.6%) and history of previous myocardial infarction (59.3% to 42.1%) on the decline. Additionally, significant reductions in cardiovascular and all-cause mortality were observed, while non-cardiovascular deaths increased.

"Sayed and colleagues deliver a remarkable atlas of heart failure in the United States over 35 years, revealing a stable age-standardized prevalence but profound shifts in the underlying risk profile, with rising obesity, diabetes, and chronic kidney disease reshaping the clinical landscape," said JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC.

According to the authors, "these changes reflect a complex interplay between the medical innovations, better implementation, and improved clinical management of some risk factors in parallel with increasing prevalence of other risk factors." They add: "If tackling the combined burdens of hypertension, dyslipidemia and myocardial ischemia proved essential in reducing the burden of HF previously, then addressing the combined burden of cardiovascular-kidney-metabolic (CKM) syndrome will be equally necessary for reducing the burden of HF in the future."

In a related editorial, John W. Ostrominski, MD, and Michael M. Givertz, MD, FACC, note that the findings also underscore the need for increased focus on HF prevention, especially clinical trials with innovative designs, recruitment strategies and interventions. "These may include trials evaluating new modes of preclinical HF detection (eg, biomarkers, advanced imaging, and artificial intelligence–based electrocardiography and echocardiography analysis) and smaller-scale simple trials evaluating surrogate endpoints, such as transitions between early HF stages."

In the hypertension study, results showed an overall increase in the burden of cardiometabolic risk factors among U.S. adults with high blood pressure from 1999 to 2023. According to the findings, one in five people are living with hypertension, hyperlipidemia and diabetes and only 25% have all three conditions controlled – a trend that has remained static for more than a decade.

The patterns centered on treatment and control are "concerning," said study authors Hyeok-Hee Lee, MD, et al. "Disrupting this stagnation may be essential for reducing the burden of hypertension-related morbidity and mortality in the United States."

In other findings, the prevalence of obesity also increased during the same period from 43.7% to 52.4%, as did high risk drinking from 7.4% to 11.2%. Smoking remained stable from 15.2% to 15.3%. According to the authors, with obesity now surpassing 50% and closely aligned with hypertension and diabetes, future preventive efforts should simultaneously target these conditions.

Other opportunities for improving outcomes, include targeted interventions at key groups like young adults, females and socioeconomically disadvantaged communities who are less likely to receive treatment or have risk factors under control.