A cross-sectional analysis of blood pressure measurements collected from self-service kiosks in U.S. retail stores showed that nearly one-half of adult users had high blood pressure. Prevalence rates among these users were higher than those observed in traditional national health surveys.
The study evaluated data from nearly 1.3 million adults (aged 18 to 99 years) who used Pursuant Health kiosks located in Walmart and CVS stores in 49 states (excluding Massachusetts) and the District of Columbia from November 2017 through September 2024. High blood pressure was defined as either a self-reported diagnosis of hypertension or a measured systolic blood pressure (BP) of 140 mm Hg or higher, or diastolic BP of 90 mm Hg or higher.
Results
Prevalence of High Blood Pressure
The prevalence of high blood pressure was 50.0% (95% CI, 49.7%-50.2%) from 2017to 2018 and 47.6% (95% CI, 47.4%-47.8%) from2023to 2024.
Disparities by Race/Ethnicity
The highest prevalence was observed among non-Hispanic Black adults. In 2023 to 2024, prevalence was 55.6% (95% CI, 55.1%-56.0%) among non-Hispanic Black adults, 50.4% (95% CI, 50.1%-50.7%) among non-Hispanic White adults, and 41.0% (95% CI, 40.7%-41.4%) among Hispanic adults.
Differences by Age and Rurality
Higher prevalence was noted among adults aged 65 years or older (eg, 2017to 2018: 71.9%; 95% CI, 71.3%-72.6%) and adults residing in rural areas (eg, 2017to 2018: 51.2%; 95% CI, 50.6%-51.8%) across all periods.
Blood Pressure Control Among Diagnosed Patients Among individuals with a self-reported hypertension diagnosis, 32.1% (95% CI, 31.7%-32.5%) in 2017to 2018 and 28.1% (95% CI, 27.8%-28.3%) in 2023 to 2024.
Comparison With National Surveys
Compared with data from the National Health and Nutrition Examination Survey (NHANES), the analytic sample showed higher estimates of high BP (2017to March 2020: 40.7%; 95% CI, 37.9%-43.5%; 2021to 2023: 36.8%; 95% CI, 34.4%-39.4%).
The prevalence of self-reported hypertension diagnosis in the analytic sample was 34.7% (95% CI, 34.4%-34.9%) in 2017to 2018 and 35.9% (95% CI, 35.7%-36.1%) in 2023to 2024, which was slightly higher than NHANES estimates for 2017to March 2020 (31.8%; 95% CI, 29.6%-34.1%) and 2021to 2023 (30.5%; 95% CI, 28.6%-32.4%). These rates were similar to the Behavioral Risk Factor Surveillance System (2019: 32.6%; 95% CI, 32.3%-32.9%; 2023: 34.3%; 95% CI, 34.0%-34.6%).
Sample Characteristics
The analytic sample (n = 1,270,485) had a mean (SD) age of 42.0 (15.6) years; 608,538 women (47.9%) and 661,947 men (52.1%). Participants self-reported their race and ethnicity as follows: 87,553 non-Hispanic Asian (6.9%), 232,050 non-Hispanic Black (18.3%), 336,503 Hispanic (26.5%), 532,561 non-Hispanic White (41.9%), and 81,818 other race or ethnicity (6.4%). Rural residents accounted for 219,086 (17.2%) of users.
Mean (SD) systolic and diastolic BP for the sample were 126 (19.8) mm Hg and 80.7 (12.2) mm Hg, respectively.
Study Definitions and Limitations
High blood pressure was defined as either self-report of a hypertension diagnosis or elevated systolic BP (140 mm Hg or higher) or diastolic BP (90 mm Hg or higher). A diagnosis of hypertension was based on a positive response to, “Have you ever been diagnosed with high blood pressure by a health provider?”
The study authors noted several limitations: the convenience sampling approach, potential selection bias (individuals at risk for hypertension may be more likely to use kiosks), differences in BP measurement protocols compared with NHANES (only a single measurement required at kiosks, with no protocol for measurement accuracy), and lack of information on pharmacological or lifestyle treatment for hypertension. Kiosk use declined during the COVID-19 pandemic but returned to prepandemic levels.
Public Health Implications
The authors stated that self-service health kiosks have the potential to complement traditional surveillance methods, particularly for monitoring populations underrepresented in national surveys, such as racial and ethnic minorities and rural residents. Over two-thirds of Americans shop at Walmart monthly, with rural and minority populations more likely to do so, enhancing kiosk reach.
The results indicate that retail health kiosks do not yield nationally representative estimates of hypertension prevalence but can augment efforts to monitor blood pressure at the population level as response rates to national surveys decline.
Funding and Disclosures
This study was conducted by researchers from Emory University's Rollins School of Public Health and Pursuant Health LLC. Funding was provided by grants from the National Institutes of Health. Disclosures are listed in the original article.
Source: JAMA Cardiology
