Hispanics' hypertension better controlled with equal access to care

Sep 13 2007

With equal access to medical care and medication, Hispanic men and women have as good or greater chance as non-Hispanics of controlling their high blood pressure, researchers reported in Hypertension: Journal of the American Heart Association.

“Poor blood pressure control in Hispanics is not due to biological factors associated with race or ethnicity,” said Karen L. Margolis, M.D., M.P.H., senior clinical investigator at the HealthPartners Research Foundation in Minneapolis, Minn. “If treated aggressively with a good medication regimen, Hispanics have an equal chance of controlling blood pressure.”

Population-based research has shown that hypertension awareness, treatment and control is lower among Hispanics compared to non-Hispanic whites and blacks.

When researchers studied blood pressure control in Hispanics as part of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), they found that Hispanics responded as well or better than non-Hispanics.

Hispanics were less likely to have their blood pressure controlled when entering the study despite a similar proportion being on blood pressure medication. But at the four-year follow-up, blood pressure was controlled in 72 percent of Hispanic whites and 69 percent of Hispanic blacks compared to 67 percent of non-Hispanic whites and 59 percent of non-Hispanic blacks.

At two years, Hispanic whites had 20 percent greater odds of achieving blood pressure control compared to non-Hispanic whites, after researchers adjusted for demographic differences and co-morbidities such as diabetes, smoking and existing cardiovascular disease. Hispanic blacks had similar odds of achieving blood pressure control; however, non

Hispanic blacks had 27 percent lower odds of achieving blood pressure control at two years. When participants from Puerto Rico and the Virgin Islands were excluded in a separate analysis at two years, blood pressure control was equivalent in Hispanics and non-Hispanic whites enrolled at sites in the mainland U.S. and Canada.

The ALLHAT study included 32,642 Hispanic whites, Hispanic blacks, non-Hispanic whites and non-Hispanic blacks in a randomized practice-based trial in 623 sites in the United States, Canada, Puerto Rico and the U.S. Virgin Islands.

Researchers conducted ALLHAT to determine what type of drug was more effective in preventing the cardiovascular complications of hypertension in high-risk men and women. Participants were seen every three months the first year and every four months thereafter. All had hypertension and at least one additional risk factor for coronary heart disease.

Participants were treated with one of three initial drugs, and then additional therapy if the hypertension was not controlled. “The goal was for participants to reach a blood pressure less than 140/90 mmHg.”

“This was the first study to compare blood pressure control in these four race-ethnicity categories,” said Margolis, who is also an associate professor of medicine at the University of Minnesota. Hispanic ALLHAT participants were more likely than non-Hispanic participants to have higher, uncontrolled blood pressure despite treatment at the time of enrollment, she said.

Margolis stressed the importance of controlling blood pressure in Hispanics, the largest ethnic minority in the United States at 14 percent of the population. “Blood pressure was controlled in more than two-thirds of Hispanic ALLHAT participants with commonly available medications,” she said. “The low rate of blood pressure control in U.S. Hispanics is does not appear to be a result of biological factors.

“Hispanics are less likely to have health insurance or a regular source of medical care and are less likely to receive preventive services. This suggests methods we can use to attack the problem of blood pressure control in Hispanic populations.”

Efforts to improve blood pressure control in Hispanics should also focus on improving hypertension knowledge and awareness, doctor-patient communication, access to medical care and affordable medications, the researchers concluded.

“Physicians treating Hispanic hypertension patients should treat them with the same medications as non-Hispanics,” she said. “If they use the right medications with aggressive follow-up, Hispanic patients' blood pressure can be controlled just as well as non-Hispanics'.”

“The Hispanic population needs to know that high blood pressure is a serious and common problem and must be treated,” Margolis said.