Hypertension Disparities in Immigrant and Refugee Populations: Screening, Treatment Access, and Cultural Barriers

Abstract

Hypertension affects over 120 million Americans, yet immigrant and refugee populations face disproportionate barriers to effective hypertension care. With nearly 48 million immigrants and growing refugee populations in the US, understanding these disparities has become a crucial public health issue. This review synthesizes current evidence on hypertension disparities among immigrant and refugee populations, examining barriers across the hypertension care cascade from screening through control, and discusses promising interventions. Hypertension prevalence varies across immigrant populations. These populations face multiple barriers throughout care: limited screening access, delayed treatment initiation, and poor long-term control. The intersectionality of structural barriers, cultural factors, economic limitations, and healthcare system limitations creates a cumulative cycle of disadvantages. The political threats and "othering" process, discrimination and cultural marginalization, further worsen these challenges, affecting trust, care-seeking behavior, and treatment adherence.Evidence-based interventions show that culturally responsive, community-centered approaches can meaningfully reduce disparities. Community health worker programs achieved remarkable improvements in blood pressure control among immigrant populations. Technology-enhanced interventions, partnerships with faith-based organizations, culturally adapted educational resources, and Clinician cultural humility training often show promising results. However, addressing these disparities requires approaches at the individual, community, healthcare system, and policy levels to be implemented simultaneously. There need to be a sustained commitment to health equity, recognizing that the health of immigrants affects community well-being and the stability of the national and global healthcare system.

Keywords: Cardiovascular health equity; Community health workers; Cultural competency; Health disparities; Hypertension; Immigrants; Refugees.