Hypertension in Hispanic Americans

Hypertension (HTN) is high blood pressure (BP), above 140/90mmHg. Hispanics are the largest and fastest growing ethnic minority in the United States, increasing from 14.5 million in 1980 to 37.4 million in 2002. Hispanic is not a racial term, but it refers to a diverse ethnic group, comprised of people from different cultures and ancestries. The two major subgroups of U.S. Hispanics are those from Mexico and Latin America, living mainly in southwest states, and those from the Caribbean, living mainly in Florida and the northeastern states. Most available data involve Mexican Americans, the largest group. HTN is seen in 25.1 percent of Mexican Americans, 27.4 percent of Caucasians, and 40.5 percent of African Americans. Obesity increases the BP in these patients, and weight loss significantly decreases their BP. The prevalence of obesity in Mexican Americans is 29 percent in men and 40 percent in women. In Caucasians, it is 27 percent in men and 30 percent in women.

In 2000, 16 percent of Caucasians and 19 percent of Mexican Americans in San Antonio, Texas, had HTN. A study in Mexico City found that 19 percent of Mexicans there had HTN. In a study in San Antonio, Mexican Americans had higher all-cause, cardiovascular, and coronary heart disease mortality than Caucasians. HTN is a major risk factor for cardiovascular disease.

There are little data on the prevalence of HTN in Caribbean Hispanics. A study in northern Manhattan found that the prevalence of HTN was 58 percent in Caribbean Hispanics compared with 43 percent in Caucasians. They were 62 percent Puerto Rican, 12 percent Cuban, and 12 percent from other Caribbean islands and South America.

The causes of the differences in prevalence of HTN between Hispanics and Caucasians is unknown. Most of the differences are due to socioeconomic factors, and the importance of genetic factors is unknown.

In 2002, 49.8 percent of Mexican Americans who had HTN were aware of it. Of those with HTN, 34.9 percent were being treated for HTN, and only 17.3 percent had their BP under control (below 140/90).

The BPs of Hispanic Americans with HTN can be brought under control with a combination of lifestyle changes and medication. Decreasing salt intake, restriction of alcohol, losing weight if overweight, and regular exercise can significantly lower BP. BP medications are effective in Hispanic Americans with HTN. Some barriers to treatment have been identified, including language problems, poverty, and lack of access to primary care physicians. Many Hispanic men seek a machismo image in which admission of an illness and a need for treatment is a sign of weakness and is discouraged. Also, many Hispanic families have a strong sense of fatalism, feeling that “It is God's will and no treatment will make much difference.” Initiatives must be designed to reduce these barriers and increase education about the importance of HTN in our Hispanic communities.