Hypertension in Asian Americans

Hypertension (HTN) in Asian Americans is especially important, because they are the fastest growing racial population in the United States in terms of percentage. Asian Americans are defined as “any of the original peoples of the Far East, Southeast Asia, or Indian subcontinent.” From 1990 to 2000, the [Page 378]population of Asian Americans increased by 48 percent (overall U.S. rate was 13 percent). In 2003, Asian Americans made up 5 percent of the U.S. population. Between 2003 and 2050, the population of Asian Americans will increase by 213 percent (overall U.S. rate 49 percent). That will be 33.4 million, 8 percent of the U.S. population. Central obesity is an important risk factor for coronary heart disease in South Asians. Obesity increases the blood pressure (BP) in Asian Americans, and weight loss decreases their BP. Hypertension occurs at lower levels of obesity in South Asians than in Western populations.

HTN is one of the strongest risk factors for coronary heart disease and stroke, two of the leading causes of death in all U.S. populations. Higher salt intake is associated with higher BP in China. In China, salt intake is higher than in the West. Stroke is more common in Asian Americans than in Caucasians. Higher salt intake is one of the most important risk factors for their higher stroke mortality rate than seen in the West. HTN is a greater risk factor for stroke in Asian Americans than in Caucasians, with diastolic BP (DBP) being particularly implicated.

The prevalence of HTN (BP above 140/90 or taking HTN medication) varies among the Asian American populations. A study of Chinese living in San Francisco found a prevalence of HTN of 69 percent. Another study of Asian Americans in northern California found the prevalence of HTN to be 22 percent in Chinese, 26.9 percent in Filipinos, 21.7 percent in Japanese, and 18.6 percent in “other Asians.” Among Koreans in Maryland, 32 percent had HTN. In comparison, in 2004, the prevalence of HTN in the United States was 29.3 percent. A study found that Filipino men and women had higher BPs than other Asian American groups.

While the Asian-American population is diverse, hypertension is, in general, an increasing problem across the ethnic group.

In San Francisco in 2005, of the Chinese Americans with HTN, 41 percent were taking antihypertensive medication, and only 6 percent of them had their HTN under control (BP below 140/90). In Maryland in 2001, of the Korean Americans (aged 60–89) with HTN, 33.6 percent were taking antihypertensive medication, and 7.5 percent were under control. In 2004, the overall U.S. treatment rate for hypertensives was 53.7 percent, and control rate was 33.1 percent.

There are little data comparing the response to antihypertensive medications of Asian Americans and Caucasians. One study found that Chinese were more responsive to one BP medication than Caucasians. Another study found that the response of persons from the Indian subcontinent to HTN medications was similar to that of Caucasians.

These data demonstrate the need for more education of Asian Americans regarding the importance of HTN and its control. It also shows the need for more effective treatment of HTN by the physicians caring for this population.

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