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BACKGROUND: Hypertension-related deaths in the United States have sharply increased over the past decade. Understanding factors behind this concerning trend is crucial to guide public health strategies.OBJECTIVES: This study sought to examine changes in prevalence, treatment, and control of cardiometabolic risk factors among U.S. adults with hypertension.METHODS: Using National Health and Nutrition Examination Survey, we identified 21,822 adults with hypertension from 1999 to 2023. Trends in age-adjusted prevalence of diabetes, hyperlipidemia, obesity, smoking, and high-risk drinking, as well as in age-adjusted treatment and control rates for hypertension, diabetes, and hyperlipidemia, were assessed.RESULTS: In adults with hypertension, prevalence of diabetes increased from 17.2% (95% CI: 14.6%-20.2%) in 1999-2000 to 27.8% (95% CI: 25.2%-30.7%) in 2021-2023. Among patients with hypertension and diabetes, the proportion receiving treatment for both conditions rose until 2009-2010 but subsequently plateaued (71.6% in 2021-2023; 95% CI: 67.5%-75.4%). A similar trend was observed for the proportion achieving control of both conditions, which remained at 31.2% in 2021-2023 (95% CI: 26.5%-36.3%). Prevalence of hyperlipidemia decreased in adults with hypertension but was still high at 73.1% (95% CI: 70.6%-75.4%) in 2021-2023. Among patients with hypertension and hyperlipidemia, treatment and control rates for both conditions increased only until around 2007; the respective rates were 50.4% (95% CI: 47.2%-53.6%) and 32.3% (95% CI: 29.5%-35.2%) in 2021-2023. Prevalence of concurrent diabetes and hyperlipidemia in adults with hypertension nearly doubled from 12.5% (95% CI: 10.6%-14.7%) in 1999-2000 to 21.3% (95% CI: 19.0%-23.8%) in 2021-2023. Among patients with hypertension, diabetes, and hyperlipidemia, the treatment rate for all 3 conditions increased until 2007-2008 and plateaued afterward (62.1% in 2021-2023; 95% CI: 56.6%-67.2%). The control rate for all 3 conditions followed a similar trend but remained low at 26.3% (95% CI: 20.8%-32.6%) in 2021-2023. Prevalence of obesity and high-risk drinking increased over time, whereas prevalence of smoking held steady.CONCLUSIONS: The burden of cardiometabolic risk factors among U.S. adults with hypertension has increased overall, with concurrent diabetes and hyperlipidemia now affecting more than 1 in 5. Only one-quarter of adults with hypertension, diabetes, and hyperlipidemia have all 3 conditions controlled-a proportion that has not improved in more than a decade.