Quality of hypertension care among Mexican American adults

Background: Mexican American adults, whose numbers are growing, have low rates of hypertension treatment and control, placing them at high risk for cardiovascular disease morbidity and mortality. Objectives. In a national sample of Mexican American adults, we examined: 1) 10-year changes in hypertension prevalence, treatment and control among subgroups; 2) current levels of blood pressure control and the prevalence of comorbidities among those with hypertension and; 3) the association of clinician advice on hypertension control. Design. Cross-sectional analysis of changes in hypertension prevalence, awareness, treatment and control; NHANES data, 1988-1994 and 1999-2004. Participants: Mexican American women and men, aged 25-84 years, who underwent a standardized physical examination including blood pressure measurement (total N= 6,451 including both time periods). Measurements: Physiologic measures of blood pressure, BMI, and diabetes. Survey questionnaire assessment of blood pressure awareness and treatment. Results: The prevalence of hypertension increased over the 10-year period, although rates of hypertension awareness and treatment improved. Unfortunately, control remained suboptimal in two-thirds of Mexican Americans with significant declines in several important subgroups. Among individuals treated for hypertension, 26% of women and 18% of men had blood pressures ≥160/100 despite treatment. Clustering of CVD risk factors was common; 83% of hypertensive adults were overweight/obese; 23% also had diabetes. Conclusion: Our results suggest no change in hypertension control in the 10-year period, mitigating gains in awareness and treatment rates. The quality and intensity of treatment provided to Mexican Americans is a substantial problem; strategies to improve control rates must be a public health priority.