Posted by danny burstein

The following are pre-publication drafts of articles from the
Morbidity and Mortality Weekly Report dated September 1, 1995.
Late-breaking articles, and final editorial revisions are not
included; therefore, these articles should be considered
preliminary, and not to be released to the public. --CDC

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: 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."

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