Race-based Therapy for Hypertension: Possible Benefits and Potential Pitfalls

Keith C. Ferdinand; Daphne P. Ferdinand

Disclosures

Expert Rev Cardiovasc Ther. 2008;10(6):1357-1366. 

In This Article

Hypertension in Hispanic Individuals

Hispanic is a demographic term denoting a Spanish or Latin family name of any race(s).[70] Mexican-Americans are the largest single US Hispanic group, followed by Central and South Americans, Puerto Ricans and Cuban Americans. In addition, Hispanic Americans are a heterogeneous group, with mixtures of various races, including Blacks, Whites and Native American populations.[70] Among Mexican-Americans, US data note lower rates of hypertension compared with Whites and Blacks.[3,4] Nevertheless, hypertension prevalence rates in Hispanics may vary by gender and country of origin. Hispanic Americans overall have relatively low levels of hypertension, despite elevated levels of diabetes and obesity.[51] Although prevalence of hypertension in Hispanics is not elevated compared with Whites, rates of awareness, treatment and control are worse.[6] The San Antonio Heart Study, one of the few systematic studies of hypertension and related diseases in Hispanics, showed more obesity and markedly higher prevalence of Type 2 diabetes; the prevalence of hypertension was slightly lower in Mexican-Americans than in Whites.[52]

Therefore, despite a greater prevalence of obesity and diabetes, the prevalence of hypertension in Hispanic Americans appears to be somewhat similar to or lower than that seen in the general population. For self-identified Hispanics, there appears to be an increased risk for stroke in Puerto Rican and Mexican-American males.[53] The causes of these differences, based on geographic origin, remain unclear. There appeared to be no difference in antihypertensive regimens based on chlorthalidone, amlodipine or lisinopril in Hispanics versus non-Hispanics in BP lowering and cardiovascular outcomes as confirmed in ALLHAT. Of the total 42,418 patients, 16% were identified as Hispanic.[36,54] Similarly, in the large INVEST trial, a significant proportion of Hispanics were included (4,021, 35.7% of 11,267, in the calcium antagonist cohort and 4,024, 35.6% of 11,309, in the noncalcium antagonist strategy). BP control and clinical outcomes were similar to those in the main cohort. The levels of CVD, specifically CHD and hypertension in US Hispanics will probably increase in future years as this population becomes acculturated and has longer exposure to a lifestyle that includes physical inactivity, high sodium and high saturated-fat intake. The so-called Hispanic 'paradox' of less hypertension and CHD despite high prevalence of obesity and diabetes is expected to reverse as older, less healthy Hispanics become a larger proportion of that population.

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