Epidemiology and management of hypertension in the Hispanic population: a review of the available literature

Abstract

Hispanics are the fastest growing ethnic minority in the USA. Among Hispanics, lack of hypertension awareness and lack of effective blood pressure (BP) control are problematic, as are higher incidence rates of hypertension-related co-morbidities compared with non-Hispanic populations. Moreover, there are currently no hypertension treatment guidelines that address the unique characteristics of this ethnic group. This article discusses ethnic differences in hypertension and cardiovascular risk factors and reviews the literature on the efficacy of antihypertensive agents in Hispanic patients, with a focus on the role of renin-angiotensin-aldosterone system (RAAS) inhibition in the management of hypertension in these patients. Hypertension in Hispanic patients can be challenging to manage, in part because this population has a higher prevalence of obesity, diabetes, and metabolic syndrome compared with non-Hispanic whites. The presence of these co-morbidities suggests that RAAS-inhibitor-based therapies may be particularly beneficial in this population. However, few studies have evaluated the efficacy of antihypertensive treatments in Hispanic patients. Two outcomes studies in hypertensive patients have shown the benefits of treating Hispanic patients with antihypertensive therapy and included RAAS inhibitors as part of the treatment regimen. In addition, BP-lowering trials have shown the antihypertensive efficacy of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and direct renin inhibitors, although data on the latter are more limited. Additional studies are needed to more thoroughly evaluate the effects of RAAS inhibitors (and other drug classes) on outcomes and BP lowering in the Hispanic hypertensive population.

Fig 1.

San Antonio Heart Study: Cox hazard ratio models predicting all-cause, cardiovascular disease, and coronary heart disease mortality in a comparison of Mexican Americans with non-Hispanic Whites, stratified by diabetes mellitus/insulin use. Reprinted from Hunt et al.[25] by permission of Oxford University Press.

Table I

Full trial names of study acronyms used in this article

Table II

Studies reporting on the efficacy of antihypertensive agents in the Hispanic population (PubMed findings)

Table II

Studies reporting on the efficacy of antihypertensive agents in the Hispanic population (PubMed findings)

Table II

Studies reporting on the efficacy of antihypertensive agents in the Hispanic population (PubMed findings)

Table II

Studies reporting on the efficacy of antihypertensive agents in the Hispanic population (PubMed findings)

Table II

Studies reporting on the efficacy of antihypertensive agents in the Hispanic population (PubMed findings)

Fig. 2

INVEST (International Verapamil SR/Trandolapril Study): Kaplan-Meier survival curve of time to primary outcome event (composite of death, non-fatal myocardial infarction, or non-fatal stroke) by Hispanic status. Reprinted from Cooper-DeHoff et al.[29], with permission from Elsevier. = myocardial infarction.