Hypertension Among Mexican Americans -- United States, 1982-1984 and 1988-1991

Since 1960, data have been collected on measured blood pressure for non-Hispanic whites and blacks. However, few data have been available about measured blood pressure for Mexican Americans (1). Until the release of data from the National Health and Nutrition Examination III, Phase I (NHANES III), the only source of blood pressure data for most of the Mexican American population in the United States was the Hispanic Health and Nutrition Examination Survey (HHANES). Data on measured blood pressure for other Hispanic subgoups (i.e., Cuban Americans and Puerto Ricans) were available in HHANES but not in NHANES III. To identify trends in prevalence, awareness, treatment, and control of hypertension among Mexican Americans aged 18-74 years, HHANES (conducted during 1982-1984) and NHANES III (conducted during 1988-1991) were analyzed. This report summarizes the results of that analysis.

CDC's HHANES and NHANES III are household interview and examination surveys of the U.S. civilian, noninstitutionalized population (2,3). HHANES sampled Mexican Americans * residing in Arizona, California, Colorado, New Mexico, and Texas; 84% of the total Mexican American population in 1980 resided in these states (2). NHANES III sampled Mexican Americans residing in the United States (3). All interviews were conducted by persons who were bilingual. Hypertension was defined as systolic blood pressure greater than or equal to 140 mm/Hg, and/or diastolic blood pressure greater than or equal to 90 mm/Hg, and/or taking antihypertensive medication (4). Analysis of characteristics of persons with hypertension included awareness status (being told by a health professional of having hypertension), treatment (taking antihypertensive medication), and control (taking antihypertensive medication and/or having blood pressure less than 140/90 mm/Hg). Information about awareness and treatment of hypertension was collected during the household interview. The protocol to measure blood pressure was similar in both surveys and included the use of four cuff sizes, standardized training for examiners, and the performance of quality-control visits during data collection (1). However, HHANES included two blood pressure measures by a physician (2) and NHANES III included three blood pressure measures by a trained interviewer during the home interview, and three blood pressure measures by a physician during the examination (3). To maximize comparability between both surveys, for this report blood pressure was calculated using the average of the two measures taken in HHANES and the first two measures taken by the physician during the examination in NHANES III.

The prevalence of hypertension was calculated using a sample of 1552 men and 1952 women from HHANES and 1282 men and 1223 women from NHANES III. Data were weighted to provide estimates for the sampled populations (Mexican Americans residing in the Southwest {HHANES} and in the United States {NHANES III}). Standard errors were calculated using the Software for Survey Data Analysis. Prevalence estimates were age adjusted by the direct method to the 1980 U.S. population.

The overall age-adjusted prevalence of hypertension among Mexican Americans was similar during 1982-1984 (21.1%) and 1988-1991 (18.0%) Table_1. Estimates also were similar for the sex-specific and age-specific prevalence of hypertension Table_1 and for hypertension awareness, treatment, and control Table_2.

Reported by: Office of Analysis, Epidemiology, and Health Promotion, and Div of Health Examination Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: Although the overall prevalence of hypertension among Mexican Americans was similar during 1982-1984 (HHANES) and 1988-1991 (NHANES III), age- and sex-specific prevalences suggest a slight downward trend (except among men aged 40-49 years) -- a finding consistent with an overall decline in the prevalence of hypertension in the United States (1). In contrast, among Mexican Americans with hypertension (particularly women), levels of awareness, treatment, and control of hypertension did not increase as they did among whites and blacks (1).

Low socioeconomic status and overweight are documented risk factors for hypertension (5). Despite the high prevalence of low socioeconomic status and overweight among Mexican Americans (5), the age-adjusted prevalence of hypertension among Mexican Americans is similar to the prevalence observed among whites (19.2%) and lower than that among blacks (30.2%) (6).

Despite similarities in the age-adjusted prevalences of hypertension among whites and Mexican Americans during 1988-1991, Mexican Americans had lower levels of control of hypertension (21.3%) than whites and blacks (1). One of the national health objectives for the year 2000 is to attain control of hypertension in 50% of Mexican Americans with this condition (objective 15.4b) (7).

The findings in this report are subject to at least two limitations. First, HHANES and NHANES used different sampling frames. However, the similarity of the prevalences of hypertension in both surveys supports the robustsness of the estimates despite the sampling variation. Second, the relatively short period between both surveys may have precluded detection of temporal changes in the prevalences of hypertension and hypertension awareness, treatment, and control.

Although overall rates for Mexican Americans were similar in both surveys, some subgroups may have higher rates. Subsequent analysis of NHANES III, Phase II will provide information to further characterize trends in hypertension among Mexican Americans.

The lack of improvement in awareness, treatment, and control among hypertensive Mexican Americans in combination with a high prevalence of overweight and low educational attainment (5) indicate an increased risk for cardiovascular diseases for persons of Mexican descent as the population ages. This finding underscores the need to improve the awareness and treatment of hypertension among Mexican Americans.

References

1. Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult U.S. population: data from the health and examination surveys, 1960 to 1991. Hypertension 1995;26:60-9.

2. NCHS. Plan and operations of the Hispanic Health and Nutrition Examination Survey, 1982-84. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1985; DHHS publication no. (PHS)85-1321. (Vital and health statistics; series 1, no. 32).

3. NCHS. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994; DHHS publication no. (PHS)94-1308. (Vital and health statistics; series 1, no. 32).

4. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993;153:154-83.

5. Sorel JE, Ragland DR, Syme SL. Blood pressure in Mexican-Americans, whites and blacks: the Second National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey. Am J Epidemiol 1991;134:370-8.

6. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the U.S. adult population: results from the Third National Health and Nutrition Examination Survey, 1988-91. Hypertension 1995;25:305-13.

7. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- midcourse review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service (in press).

• For both surveys, Mexican Americans self-identified by responding to the question, "Which of those groups {specific groups listed} best represents your national origin or ancestry."

  
  

+------------------------------------------------------------------- -----+ |             | | Erratum: Vol. 44, No. 34 | | ======================== | | SOURCE: MMWR 44(35);653 DATE: Sep 08, 1995 | |             | | In the article "Hypertension Among Mexican Americans -- United | | States, 1982-1984 and 1988-1991," the last sentence on page 635 | | should read: "Analysis of characteristics of persons with | | hypertension included awareness (being told by a health | | professional of having hypertension), treatment (taking | | antihypertension medication),and control (taking antihypertension | | medication and having blood pressure less than 140/90 mm/Hg)." | +------------------------------------------------------------------- -----+
Table_1
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TABLE 1. Prevalence of hypertension * among Mexican Americans aged 18-74 years, by age group and sex--United States,
1982-1984 + and 1988-1991 &
=======================================================================================================================

                       Men                               Women                                 Total
          ------------------------------     ---------------------------------   --------------------------------------
Age         1982- 1984        1988-1991        1982-1984         1988-1991         1982-1984         1988-1991
group     ---------------  --------------    ----------------  ---------------   --------------    --------------------
(yrs)       %      (SE @)    %      (SE)       %       (SE)      %      (SE)       %      (SE)       %     (SE)
-----------------------------------------------------------------------------------------------------------------------
18-29      6.0     (1.0)    3.4     (0.9)     1.7      (0.4)    0.9     (0.8)     3.9     (0.5)     2.3    (0.4)
30-39     12.6     (2.3)    7.6     (1.6)     6.4      (1.4)    4.4     (0.8)     9.5     (1.2)     6.0    (0.8)
40-49     18.2     (1.9)   24.8     (2.2)    14.5      (2.1)   10.5     (1.2)    16.2     (1.0)    17.8    (1.3)
50-59     39.9     (4.5)   38.4     (3.9)    32.3      (3.0)   28.8     (6.2)    35.6     (3.2)    33.5    (2.1)
60-74     57.5     (2.8)   44.3     (5.3)    61.4      (2.4)   53.0     (3.0)    59.6     (2.0)    49.0    (3.5)

Total **  23.0     (1.2)   19.7     (1.0)    19.3      (0.7)   16.1     (1.3)    21.1     (0.8)    18.0    (0.9)
-----------------------------------------------------------------------------------------------------------------------
 * Systolic blood pressure >=140 mm/Hg, diastolic blood pressure >=90 mm/Hg, and/or taking
   antihypertensive medication.
 + Data from the Hispanic Health and Nutrition Examination Survey.
 & Data from the Third National Health and Nutrition Examination Survey, Phase I.
 @ Standard error.
** Age-adjusted by the direct method to the 1980 U.S. population.
=======================================================================================================================

TABLE 2. Prevalence of awareness, treatment, and control of hypertension * among Mexican Americans aged 18-74 years with
hypertension, by age group and sex--United States, 1982-1984 + and 1988-1991 &
===================================================================================================================================

                                     Men                              Women                             Total
                      --------------------------------   --------------------------------   --------------------------------
                          1982-1984        1988- 1991        1982-1994       1988-1991       1982-1984         1988-1991
Age group              ---------------  --------------   ---------------   --------------   --------------  ----------------
 (yrs)                    %    (SE @)      %     (SE)       %      (SE)      %     (SE)      %     (SE)       %      (SE)
-----------------------------------------------------------------------------------------------------------------------------------
Awareness **
 18-59                  45.6   (4.6)     42.0    (3.9)    75.4     (3.7)   72.8    (3.6)    57.0   (3.2)     52.8     (3.2)
 60-74                  54.5   (4.8)     57.1    (4.9)    76.4     (3.2)   73.6    (4.8)    66.5   (3.4)     66.7     (2.7)
 Total                  46.8   (4.1)     45.5    (3.0)    75.8     (2.2)   73.1    (2.7)    60.0   (3.0)     57.2     (2.2)

Treatment ++
 18-59                 16.6   (3.2)      19.5    (3.3)    54.1     (3.9)   48.8    (6.3)    32.2    (2.7)      29.6   (4.6)
 60-74                 36.8   (6.7)      46.5    (5.5)    59.7     (4.8)   55.7    (5.6)    49.3    (4.9)      51.9   (3.3)
 Total                 22.0   (3.6)      25.7    (2.8)    56.3     (1.7)   51.8    (4.1)    37.7    (2.6)      36.7   (2.8)

Control &&
 18-59                  6.8   (2.0)      11.9    (2.2)    30.5     (2.8)   29.1    (4.7)    16.7    (2.3)      17.8   (3.1)
 60-74                 19.3   (5.0)      26.6    (6.5)    27.5     (4.3)   30.4    (8.3)    23.8    (4.2)      28.8   (6.5)
 Total                 10.2   (2.5)      15.2    (1.6)    29.4     (2.2)   29.7    (4.8)    19.0    (2.1)      21.3   (2.4)
-----------------------------------------------------------------------------------------------------------------------------------
*  Systolic blood pressure >=140 mm/Hg, diastolic blood pressure >=90 mm/Hg, and/or taking antihypertensive medication.
+  Data from the Hispanic Health and Nutrition Examination Survey.
&  Data from the Third National Health and Nutrition Examination Survey, Phase I.
@  Standard Error.
** Being told by a health professional of having hypertension.
++ Taking antihypertensive medication.
&& Taking antihypertensive medication and having blood pressure <140/90 mm/Hg.
===================================================================================================================================

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