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Journal of the American Heart Association
Rapid Access Reports: Hispanics'
hypertension better controlled with equal
access to care
DALLAS, Sept. 12 -- 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.
Co-authors are Linda B. Piller, M.D., M.P.H.; Charles E. Ford, Ph.D.;
Mario A. Henriquez, M.D.; William C.
Cushman, M.D.; Paula T. Einhorn, M.D., M.S.;
Pedro J. Colon Sr., M.D.; Donald G. Vidt,
M.D.; Rudell Christian, M.P.H.; Nathan D.
Wong, Ph.D.; Jackson Wright, M.D., Ph.D.;
and David C.
Goff Jr., M.D., Ph.D.
The ALLHAT study was funded by the National Heart, Lung, and Blood
Institute of the National Institutes of
Health.
Statements and conclusions of study authors that are published in the
American Heart Association scientific
journals are solely those of the study
authors and do not necessarily reflect
association policy or position. The American
Heart Association makes no representation or
warranty as to their accuracy or reliability.
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