Lack of insurance, language barriers might be obstacles to care, expert says
THURSDAY, March 13, 2014 (HealthDay News) -- High blood pressure often is untreated in U.S. Hispanics, putting them at risk for heart disease and stroke, new research finds.
Hispanics are nearly as likely as whites to have high blood pressure, but less likely to have it under control, said study researcher Paul Sorlie, chief of the epidemiology branch of the U.S. National Heart, Lung, and Blood Institute.
The findings, published March 13 in the American Journal of Hypertension, solidify what other research has found and also add valuable information, Sorlie said.
His team evaluated more than 16,000 men and women of Hispanic origin enrolled in a large study that began in 2008. Participants were between 18 and 74 years old and lived in New York City, Chicago, Miami or San Diego.
In terms of high blood pressure prevalence and control, "all Hispanics are not alike," Sorlie said.
Cubans, Puerto Ricans and Dominicans were the most likely to have high blood pressure of the groups studied. Other regions examined in the study were Mexico and Central and South America.
Overall, nearly 26 percent of the participants had high blood pressure. That's comparable to the 27 percent of whites found to have high blood pressure in the National Health and Nutrition Examination Survey.
High blood pressure is a primary or contributing cause of nearly 1,000 deaths a day in the United States, according to the U.S. Centers for Disease Control and Prevention.
In the new study, blood pressure was measured and participants completed questionnaires about high blood pressure and their awareness of it. They also were asked about their education, income and health insurance.
High blood pressure was defined as an average reading of 140/90 millimeters of mercury or higher, or the use of blood pressure medication in the previous four weeks.
The men and women were classified as treated if they reported medication use. They were considered controlled if their blood pressure reading was under 140/90.
Overall, 74 percent of Hispanics knew they had high blood pressure, compared to 81 percent of whites in the National Health and Nutrition Examination Survey. But only 63 percent of Hispanics were treated, compared to 76 percent of whites. And just 38 percent of Hispanics had their blood pressure under control, while more than half of whites did.
What lies behind these disparities?
"Clearly, the most associated item is health insurance," Sorlie said. "If they don't have health insurance, the percent who get treated and controlled is much worse than those who do have health insurance."
Of those under 65, half of the women and 55 percent of the men had no health coverage. (After 65, the numbers of those covered went up as they became eligible for Medicare.)
Of those under 65 years old without health insurance, 22 percent of men and 39 percent of women had their blood pressure controlled. Among the insured, 39 percent of men and 50 percent of women had their blood pressure under control.
The study findings are no surprise, said Dr. Steven Bailey, chairman of the Briscoe division of cardiology at the University of Texas Medicine Health Science Center at San Antonio. He was not involved in the study.
Bailey said his own research has produced similar findings. The new study, he said, adds to the data.
The way the information is communicated to patients is important, he said, noting a language barrier must sometimes be overcome.
The new findings also add much needed detailed information about differences among Hispanics from different areas, he said. "The Hispanic population in terms of care, care delivery and access to care varies so much within the United States that it becomes important to understand what that looks like," he said.
As more research is gathered, Sorlie said, the best advice for those of any ethnicity is to be sure they know if their blood pressure is elevated.
"It's a critical risk factor and you can do something about it that's relatively inexpensive and for the most part effective," he said, referring to medications to normalize blood pressure.
To learn more about blood pressure control, visit the American Heart Association (http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High-Blood-Pressure-or-Hypertension_UCM_002020_SubHomePage.jsp ).
SOURCES: Paul Sorlie, Ph.D., chief of epidemiology branch, U.S. National Heart, Lung, and Blood Institute, Bethesda, Md.; Steven Bailey, M.D., chairman, Briscoe division of cardiology, and professor of medicine and radiology, University of Texas Medical Center Health Science Center at San Antonio; March 13, 2014, American Journal of Hypertension