High blood pressure control is often elusive for blacks and Mexican Americans, despite adherence to treatment and lifestyle changes
Research Activities, December 2009, No. 352
Blacks and Mexican Americans struggle with uncontrolled blood pressure, despite adherence to treatment and lifestyle modifications, concludes a new study. Researchers studied ethnic differences in treatment, adherence, and control among 5,392 adults with hypertension who participated in the Third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994. During their participation in NHANES over 7 years, individuals received home-based interviews and received physical examinations at mobile examination centers.
Blacks were 60 percent more likely than non-Hispanic whites to be prescribed medication and 50 percent more likely to be advised to restrict salt intake (probably due to evidence of impaired renal salt excretion among blacks). Both blacks and Mexican Americans were twice as likely as whites to report following advice to exercise, quit smoking, restrict alcohol, and reduce stress. Also, blacks were 50 percent more likely to report salt restriction and 70 percent more likely to report weight loss attempts. Despite adherence to medication (which was similar for all three groups) and lifestyle modification, both blacks and Mexican Americans were 40 percent and 50 percent, respectively, more likely than whites to suffer from uncontrolled hypertension.
The researchers cite several reasons to explain these ethnic differences in blood pressure control. These include higher rates of obesity and diabetes in blacks and Mexican Americans, differences in diet, and the lower responsiveness to certain blood pressure medications among blacks. These findings underscore the point that adherence to treatment alone is not sufficient to adequately control hypertension among blacks and Mexican Americans and highlight the need to monitor blood pressure levels and escalate intensity of treatment in adherent persons to achieve blood pressure control. The study was supported in part by the Agency for Healthcare Research and Quality (HS10871).
See "Effect of treatment and adherence on ethnic differences in blood pressure control among adults with hypertension," by Sundar Natarajan, M.D., M.Sc., Elizabeth J. Santa Ana, M.A., Youlian Liao, M.D., and others, in the March 2009 Annals of Epidemiology 19, pp. 172-179.