Predictors of Hypertension Awareness, Treatment, and Control Among Mexican American Women and Men

  • Andrea Bersamin
  • Randall S. Stafford
  • Marilyn A. Winkleby
Original Article



The burden of hypertension and related health care needs among Mexican Americans will likely increase substantially in the near future.


In a nationally representative sample of U.S. Mexican American adults we examined: 1) the full range of blood pressure categories, from normal to severe; 2) predictors of hypertension awareness, treatment and control and; 3) prevalence of comorbidities among those with hypertension.


Cross-sectional analysis of pooled data from the National Health and Nutrition Examination Surveys (NHANES), 1999–2004.


The group of participants encompassed 1,359 Mexican American women and 1,421 Mexican American men, aged 25–84 years, who underwent a standardized physical examination.


Physiologic measures of blood pressure, body mass index, and diabetes. Questionnaire assessment of blood pressure awareness and treatment.


Prevalence of Stage 1 hypertension was low and similar between women and men (∼10%). Among hypertensives, awareness and treatment were suboptimal, particularly among younger adults (65% unaware, 71% untreated) and those without health insurance (51% unaware, 62% untreated). Among treated hypertensives, control was suboptimal for 56%; of these, 23% had stage ≥2 hypertension. Clustering of CVD risk factors was common; among hypertensive adults, 51% of women and 55% of men were also overweight or obese; 24% of women and 23% of men had all three chronic conditions-hypertension, overweight/obesity and diabetes.


Management of hypertension in Mexican American adults fails at multiple critical points along an optimal treatment pathway. Tailored strategies to improve hypertension awareness, treatment and control rates must be a public health priority.


Mexican American hypertension health care practice patterns secondary prevention 



The authors thank Dr. David Ahn for his statistical and analytical expertise and Alana Koehler for her technical assistance in preparing the tables and figures. This research was supported by Public Health Service Training Grants T32 HL 07034 (AB) and K24 HL 086703 (RSS), both from the National Heart, Lung, and Blood Institute. This project was also supported by the Network for Multicultural Research on Health and Healthcare, Dept. of Family Medicine - UCLA David Geffen School of Medicine, funded by the Robert Wood Johnson Foundation.


  1. 1.
    Ong KL, Cheung BMY, Man YB, Lau CP, Lam KSL. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007;49(1):69–75.CrossRefPubMedGoogle Scholar
  2. 2.
    Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003;290(7):891–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Neal B, MacMahon S, Chapman N; Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. The Lancet 2000;356(9246):1955–64.CrossRefGoogle Scholar
  4. 4.
    Wong ND, Thakral G, Franklin SS, L'Italien GJ, Jacobs MJ, Whyte JL, et al. Prevention and rehabilitation: preventing heart disease by controlling hypertension: impact of hypertensive subtype, stage, age, and sex. American Heart Journal 2003;145(5):888–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003;290(2):199–206.CrossRefPubMedGoogle Scholar
  6. 6.
    Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension 2008;52(5):818–27.CrossRefPubMedGoogle Scholar
  7. 7.
    He J, Muntner P, Chen J, Roccella EJ, Streiffer RH, Whelton PK. Factors associated with hypertension control in the general population of the United States. Arch Intern Med. 2002;162(9):1051–8.CrossRefPubMedGoogle Scholar
  8. 8.
    US Census Bureau. 2008 National Population Projections. 2008 [cited 2008 November 18]; Available from:
  9. 9.
    Angel J, Angel R. Aging trends - Mexican Americans in the Southwestern USA. Journal of Cross-Cultural Gerontology 1998;13(3):281–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D'Agostino RB, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham heart study. JAMA 2002;287(8):1003–10.CrossRefPubMedGoogle Scholar
  11. 11.
    DeNavas-Walt C, Proctor B, Smith J. Income, poverty, and health insurance coverage in the United States: 2007. Washington DC: US Government Printing Office; 2008.Google Scholar
  12. 12.
    Ogden LG, He J, Lydick E, Whelton PK. Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension 2000;35(2):539–43.PubMedGoogle Scholar
  13. 13.
    Hubert HB, Snider J, Winkleby MA. Health status, health behaviors, and acculturation factors associated with overweight and obesity in Latinos from a community and agricultural labor camp survey. Prev Med. 2005;40(6):642–51.CrossRefPubMedGoogle Scholar
  14. 14.
    Sundquist J, Winkleby M. Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men. Int J Epidemiol. 2000;29(3):470–477.CrossRefPubMedGoogle Scholar
  15. 15.
    Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006. Diabetes Care 2009;32(2):287–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Farquhar I JJ, Weir E. Costs of concomitant illnesses among patients with hypertension and diabetes. Abstr Acad Health Serv Res Health Policy Meet 2000.Google Scholar
  17. 17.
    Hertz RP, Unger AN, Ferrario CM. Diabetes, hypertension, and dyslipidemia in Mexican Americans and non-Hispanic whites. Am J Prev Med. 2006;30(2):103–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S. Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc. 2007;55(7):1056–65.CrossRefPubMedGoogle Scholar
  19. 19.
    National Center for Health Statstics. Response Rates & CPS Population Totals. 2009 [cited 2009 July 23]; Available from:
  20. 20.
    Lenfant C, Chobanian AV, Jones DW, Roccella EJ. Seventh report of the joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure (JNC 7): resetting the hypertension sails. Hypertension 2003;41(6):1178–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26 Suppl 1:S5–20.Google Scholar
  22. 22.
    Neese JW, Duncan P, Bayse DD, et al. Development and evaluation of a hexokinase/glucose-6-phosphate dehydrogenase procedure for use as a national glucose reference method. HEW Publication No. (CDC) 77–8330. HEW. USPHS, Centers for Disease Control and Prevention, 1976.Google Scholar
  23. 23.
    Natarajan S, Santa Ana EJ, Liao Y, Lipsitz SR, McGee DL. Effect of treatment and adherence on ethnic differences in blood pressure control among adults with hypertension. Ann Epidemiol. 2009;19(3):172–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Molenaar EA, Hwang SJ, Vasan RS, Grobbee DE, Meigs JB, D'Agostino RB, Sr., et al. Burden and rates of treatment and control of cardiovascular disease risk factors in obesity: the Framingham Heart Study. Diabetes Care 2008;31(7):1367–72.CrossRefPubMedGoogle Scholar
  25. 25.
    Wong ND, Lopez V, L'Italien G, Chen R, Kline SE, Franklin SS. Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med. 2007;167(22):2431–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006;47(2):296–308.CrossRefPubMedGoogle Scholar
  27. 27.
    Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006;24(2):215–33.CrossRefPubMedGoogle Scholar
  28. 28.
    Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006;144(7):485–95.PubMedGoogle Scholar
  29. 29.
    Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3–10.CrossRefPubMedGoogle Scholar
  30. 30.
    Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care 2003;26(3):917–32.CrossRefPubMedGoogle Scholar
  31. 31.
    Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese? estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) 2008;16(10):2323–30.CrossRefGoogle Scholar
  32. 32.
    Winkleby MA, Kim S, Urizar GG, Ahn D, Jennings MG, Snider J. Ten-year changes in cancer-related health behaviors and screening practices among Latino women and men in California. Ethnicity & Health 2006;11(1):1–17.CrossRefGoogle Scholar
  33. 33.
    Winkleby MA, Cubbin C. Changing patterns in health behaviors and risk factors related to chronic diseases, 1990–2000. Am J Health Promot. 2004;19(1):19–27.PubMedGoogle Scholar
  34. 34.
    Bersamin A, Hanni KD, Winkleby MA. Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis. Public Health Nutr. 2008:1–10.Google Scholar
  35. 35.
    Prognosis in hypertension. Br Med J. 1970;4(5737):697–8.Google Scholar
  36. 36.
    Buck C, Baker P, Bass M, Donner A. The prognosis of hypertension according to age at onset. Hypertension 1987;9(2):204–8.PubMedGoogle Scholar
  37. 37.
    Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 2004;164(19):2126–34.CrossRefPubMedGoogle Scholar
  38. 38.
    Qureshi AI, Suri MF, Kirmani JF, Divani AA. Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. Med Sci Monit. 2005;11(9):CR403–9.PubMedGoogle Scholar
  39. 39.
    Kshirsagar AV, Carpenter M, Bang H, Wyatt SB, Colindres RE. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006;119(2):133–41.CrossRefPubMedGoogle Scholar
  40. 40.
    Jimenez-Corona A, Lopez-Ridaura R, Stern MP, Gonzalez-Villalpando C. Risk of progression to hypertension in a low-income mexican population with pre-hypertension and normal blood pressure. Am J Hypertens 2007;20(9):929–36.CrossRefPubMedGoogle Scholar
  41. 41.
    Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanian A. High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension 1991;12(1):22–27.Google Scholar
  42. 42.
    Huttin C, Moeller J, Stafford R. Patterns and costs for hypertension treatment in the United States: clinical, lifestyle and socioeconomic predictors from the 1987 national medical expenditures survey clinical drug investigation 2000;20(3):181–95.Google Scholar
  43. 43.
    Borrell LN, Crawford ND. Disparities in self-reported hypertension in Hispanic subgroups, non-Hispanic black and non-Hispanic white adults: the national health interview survey. Ann Epidemiol. 2008;18(10):803–12.CrossRefPubMedGoogle Scholar
  44. 44.
    Loria CM, Bush TL, Carroll MD, Looker AC, McDowell MA, Johnson CL, et al. Macronutrient intakes among adult Hispanics: a comparison of Mexican Americans, Cuban Americans, and mainland Puerto Ricans. Am J Public Health 1995;85(5):684–9.CrossRefPubMedGoogle Scholar
  45. 45.
    National Center for Chronic Disease Prevetion and Health Promotion. Behavioral Risk Factor Surveillance System. 2008; Available from:
  46. 46.
    Chong Y, Carroll M, Burt V, Montalvan P. NHANES converted refusals: are they different from willing respondents in cardiovascular risk factors? In: American Association For Public Opinion Association; 2009; Miami Beach, FL; 2009.Google Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Andrea Bersamin
    • 1
    • 2
  • Randall S. Stafford
    • 1
  • Marilyn A. Winkleby
    • 1
  1. 1.Stanford Prevention Research CenterStanford UniversityStanfordUSA
  2. 2.Center for Alaska Native Health Research, Institute of Arctic BiologyUniversity of Alaska FairbanksFairbanksUSA

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