Prevalence, detection, and control of hypertension in a biethnic community. The San Antonio Heart Study

Predictors of hypertension detection in English general practices: a cross sectional study

BACKGROUND

Worldwide, high systolic blood pressure is the leading risk factor for deaths and disability-adjusted life-years but has been historically under-detected. This study aimed to quantify differences between estimated and practice-detected prevalences of hypertension across English general practices, and to determine how variations in detected prevalence could be explained by population-level and service-level factors.

METHODS

Descriptive statistics, pair wise correlations between the independent variables and a multivariable regression analysis were undertaken. In the regression model, the outcome was detected hypertension prevalence, adjusted for estimated prevalence, person-related and disease-related determinants of illness and characteristics of general practices.

RESULTS

Detected prevalence was substantially lower than estimated prevalence (mean difference 16.23%; standard deviation 2.88%). Higher detected prevalence was associated with increased deprivation, increased non-white ethnicity and urban location. Lower detected prevalence was associated with larger list sizes, more general practitioners and being located in the South outside London. The final multivariable model's adjusted R2 value was 0.75.

CONCLUSIONS

Substantial under-detection of hypertension is widespread across England. Independent of estimated prevalence, factors associated with greater morbidity and population density predicted higher detected prevalence. Identifying patients with undetected hypertension and coordinating care for these patients will require further resources and logistical support in community settings.

Intermediate Outcomes by Race and Ethnicity in Peritoneal Dialysis Patients: Results from the 1997 ESRD Core Indicators Project

Background

Hispanics are the fastest growing minority group in the United States, and approximately 10% of all end-stage renal disease (ESRD) patients are Hispanic. Few data are available, however, regarding dialysis adequacy and anemia management in Hispanic patients receiving peritoneal dialysis in the U.S.

Methods

Data from the Health Care Financing Administration (HCFA) ESRD Core Indicators Project were used to assess racial and ethnic differences in selected intermediate outcomes for peritoneal dialysis patients.

Results

Of the 1219 patients for whom data were available from the 1997 sample, 9% were Hispanic, 24% were non-Hispanic blacks, and 59% were non-Hispanic whites. Hispanics were more likely to have diabetes mellitus as a cause of ESRD compared to blacks or whites, and both Hispanics and blacks were younger than white patients (both p < 0.001). Although whites had higher weekly Kt/V and creatinine clearance values compared to blacks or Hispanics ( p < 0.05), blacks had been dialyzing longer ( p < 0.01) and were more likely to be anuric compared to the other two groups ( p < 0.001). Blacks had significantly lower mean hematocrit values ( p < 0.001) and a greater proportion of patients who had a hematocrit level less than 28% ( p < 0.05) compared to Hispanics or whites, despite receiving significantly larger weekly mean epoetin alfa doses ( p < 0.05) and having significantly higher mean serum ferritin concentrations ( p < 0.01). Multivariate logistic regression analysis revealed significant differences by race/ethnicity for experiencing a weekly Kt/V urea < 2.0 and hypertension, but not for other intermediate outcomes examined (weekly creatinine clearance < 60 L/week/1.73 m2, Hct < 30%, and serum albumin < 3.5/3.2 g/dL).

Conclusion

Hispanics had adequacy values similar to blacks and anemia parameters similar to whites. Additional studies are needed to determine the etiologies of the differences in intermediate outcomes by racial and ethnic groupings in peritoneal dialysis patients.

Issues in achieving compliance with antihypertensive treatment in the Latino population

Latino Americans are the largest growing ethnic minority group in the United States. The level of awareness and control of hypertension among Latino Americans has remained virtually unchanged in the past 20 years. Untreated hypertension often progresses and is a major risk factor for cardiovascular disease. Hypertension control can be achieved with simple and well-tolerated medication regimens that are cost-effective and reduce morbidity and mortality in all populations studied. Clinicians can work to increase compliance by developing a basic understanding of the social, demographic, and historical conditions that affect Latino Americans. Language proficiency, cultural scripts, and health beliefs and attitudes influence patient-clinician communication in specific ways among Latino patients. Health care systems and plans should work on creating culturally competent health care programs to serve the needs of this diverse population.

Hypertension and diabetes in Detroit Hispanics

The purpose of this study was to explore the prevalence of hypertension and diabetes alone and together in a sample of Hispanics. There were 111 participants with a mean age of 51 years. Twenty-six percent of the participants were hypertensive, a proportion well above the Healthy People 2010 target of 16%. The majority of hypertensive participants had isolated systolic hypertension, which is consistently associated with greater cardiovascular risk. Thirty-seven percent of the hypertensives were also diabetic. Diabetics were significantly more likely than non-diabetics to have stage 3 hypertension than either stage 1 or stage 2 (chi(2) [1] = 7.17, p <.01). It is important for nurses to screen Hispanic clients who are 18 years and older for high blood pressure. Early case finding will help nurses increase awareness and control of high blood pressure among Hispanics, which is crucial to avoid the enormous human and financial burdens of cardiovascular morbidity and mortality.

Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension

The association between socio-economic status (SES) and untreated hypertension varies according to a country's level of development and racial/ethnic group. We sought to confirm this variation in women from China and the United States (US) as well as to investigate the impact of SES on several mediating risk factors. We also investigate the extent to which SES explains racial/ethnic differences in untreated hypertension in the US. We used cross-sectional data from 1814 non-pregnant women in China (China Health and Nutrition Survey (CHNS), 1997) and 3266 non-pregnant women in the United States (National Health and Nutrition Examination Survey (NHANES III), 1988-1994) respectively. A variety of statistical modelling techniques was used to predict untreated hypertension as a function of several mediating factors and to simulate the impact of changes in SES. The age-adjusted prevalence of untreated hypertension was significantly higher (p<0.01) for low-income White and Black women compared to Mexican American or Chinese women. Untreated hypertension was not significantly associated with income or education in Mexican Americans or women in China. Obesity and light physical activity had the largest mediating effect on the association between SES and untreated hypertension for all racial/ethnic groups. However, this effect was not as strong as the proxy effect of income and education. SES did not completely explain racial/ethnic differences in hypertension in the US. While SES was more strongly associated with hypertension in Blacks than Whites, Blacks were still 1.97 (95% CI 1.47-2.64) times more likely to have untreated hypertension than Whites after adjusting for SES differences. The association between SES and untreated hypertension varied by country and racial/ethnic group. An important explanation for this variation was the differential effect of SES on mediating risk factors. SES disparities between Whites and Blacks in the US partly explain differences in the prevalence of untreated hypertension between these racial/ethnic groups.

A population perspective on diabetes prevention: whom should we target for preventing weight gain?

OBJECTIVE

To examine the influence of obesity and prevention of weight gain on the incidence of type 2 diabetes.

RESEARCH DESIGN AND METHODS

We examined participants in the San Antonio Heart Study, a prospective population-based study of Mexican Americans and non-Hispanic whites residing in San Antonio, Texas. BMI was stratified into four categories: normal (<25 kg/m(2)), overweight (> or =25 kg/m(2) and <30 kg/m(2)), obese (> or =30 kg/m(2) and <35 kg/m(2)), and very obese (> or =35 kg/m(2)). The number and proportion of incident cases prevented by targeting each BMI category were estimated. In addition, we calculated the decrease in risk of developing type 2 diabetes associated with weight gain prevention across both the BMI and age spectra.

RESULTS

Preventing normal individuals from becoming overweight would result in the greatest reduction in incidence of type 2 diabetes. This would result in a 62 and 74% reduction in the incidence of type 2 diabetes in Mexican Americans and non-Hispanic whites, respectively. Preventing the entire population from gaining, on average, 1 BMI unit would result in a reduction in incidence of type 2 diabetes of 12.4 and 13.0% in Mexican Americans and non-Hispanic whites, respectively.

CONCLUSIONS

The majority of cases of type 2 diabetes were in individuals who were overweight or mildly obese with a family history of type 2 diabetes. Public health resources should be directed toward the prevention of weight gain among normal and overweight individuals in order to prevent the maximum number of cases of type 2 diabetes.

Hypertension and combinations of cardiovascular risk factors. An epidemiologic case-control study in an adult population in Guadeloupe (FWI)

Our aim was to quantify the association between hypertension and four well-known cardiovascular risk factors (obesity, dyslipidemia, high blood glucose, smoking) and to determine the extent of their combinations in hypertensive subjects in an adult population in Guadeloupe (FWI). A case-control study was conducted in 1999. Odds ratios (ORs) and 95% confidence interval (95% CI) of hypertension according to cardiovascular risk factors were calculated by a logistic regression model. In all, 4210 subjects were included in the study: 2105 hypertensives and 2105 age and sex matched non-hypertensive controls. In the hypertensives, obesity (30%) was the most frequent risk factor followed by dyslipidemia (23.2%), current smoking (11.5%) and high blood glucose (8.2%). But, prevalence of current smokers was higher in normotensives (13.9 vs. 11.5%, p < 0.01). Among cases, 44.5% had no risk factor other than hypertension. The proportion of subjects with multiple risks factors (< or = 2) was higher in hypertensives than in controls (55.5 vs. 6.5%,p < 0.001) and higher in women than in men in cases (58.1 vs. 51.8%, p = 0.005). The adjusted ORs (95% CI) of hypertension were 2.41 (2.02-2.88) for obesity, 1.39 (1.16-1.66) for dyslipidemia and 1.67 (1.20-2.32) for high blood glucose. Our study documents the high prevalence of combinations of cardiovascular risk factors in hypertensive subjects in Guadeloupe and confirms the need of a global risk approach in prevention and treatment of hypertension.

Elevated incidence of type 2 diabetes in San Antonio, Texas, compared with that of Mexico City, Mexico

OBJECTIVE

To compare the incidence of type 2 diabetes between low-income Mexican-Americans residing in San Antonio, Texas, and low-income residents in Mexico City, Mexico.

RESEARCH DESIGN AND METHODS

Using data from the San Antonio Heart Study and the Mexico City Diabetes Study, we compared the incidence of type 2 diabetes in 35- to 64-year-old low-income Mexican-American residents of San Antonio with similarly aged low-income residents of Mexico City. Because of the different follow-up times in the two studies, Poisson regression was used to compare the rates of diabetes. Potential risk factors for diabetes were also analyzed to determine whether they explained or contributed to a difference in incidence.

RESULTS

The age- and sex-adjusted incidence of type 2 diabetes was significantly higher in San Antonio (RR 2.01) compared with Mexico City. This difference was seen primarily in the oldest age group (55-64 years of age) and remained statistically significant after adjusting for a number of diabetes risk factors, including demographic, anthropometric, and metabolic variables. Follow-up rates were similar in both cities.

CONCLUSIONS

We conclude that there was a higher incidence of type 2 diabetes in San Antonio than in Mexico City, and that difference occurred primarily in individuals in the oldest age group. The potential mediating factors we examined did not account for this difference. Other factors, such as exercise and diet, which were not available for analysis in this study, in addition to a cohort effect, may have contributed to the difference in incidence of type 2 diabetes in the two cities. In addition, there was no evidence of a higher case fatality among diabetic individuals from Mexico City compared with San Antonio.

Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER

OBJECTIVES

The prevalence rate of diabetes is probably higher in Hispanics than in Caucasians, although there is controversy about differences in the risk of diabetic retinopathy. The purpose of the study is to determine the prevalence rates of diabetes and diabetic retinopathy in a population-based study of Hispanics aged > or = 40 years.

RESEARCH DESIGN AND METHODS

Proyecto VER is a random sample of Hispanic populations aged > or = 40 years in Arizona. A total of 4,774 individuals (71.6% of the eligible sample) completed the examinations. Diabetes was defined as self-report of a physician diagnosis or HbA(1c) value of > or = 7.0%. Diabetic retinopathy was assessed on stereo fundus photographs of fields 1, 2, and 4.

RESULTS

The prevalence rate of diabetes in the Hispanic community (individuals > or = 40 years of age) was 22%. The prevalence rate of diabetic retinopathy (DR) was 48%; 32% had moderate to severe nonproliferative and proliferative retinopathy. DR increased with increasing duration of diabetes and increasing level of HbA(1c). The prevalence rate of DR-like changes in the sample of individuals without diabetic retinopathy was 15% and was not associated with hypertension, systolic blood pressure, or diastolic blood pressure.

CONCLUSIONS

The prevalence rate of diabetes in this population of Hispanics is high, almost twice that of Caucasians. The prevalence rate of DR is high but similar to reports in a Caucasian population. The prevalence rate of 9% moderate to severe retinopathy in the newly diagnosed group suggests that efforts to improve detection and treatment of diabetes in Hispanics may be warranted.

Cardiovascular risk factors in Mexican American adults: a transcultural analysis of NHANES III, 1988-1994

OBJECTIVES

This study examined the extent to which cardiovascular disease risk factors differ among subgroups of Mexican Americans living in the United States.

METHODS

Using data from a national sample (1988-1994) of 1387 Mexican American women and 1404 Mexican American men, aged 25 to 64 years, we examined an estimate of coronary heart disease mortality risk and 5 primary cardiovascular disease risk factors: systolic blood pressure, body mass index, cigarette smoking, non-high-density lipoprotein cholesterol, and type 2 diabetes mellitus. Differences in risk were evaluated by country of birth and primary language spoken.

RESULTS

Estimated 10-year coronary heart disease mortality risk per 1000 persons, adjusted for age and education, was highest for US-born Spanish-speaking men and women (27.5 and 11.4, respectively), intermediate for US-born English-speaking men and women (22.5 and 7.0), and lowest for Mexican-born men and women (20.0 and 6.6). A similar pattern of higher risk among US-born Spanish-speaking men and women was demonstrated for each of the 5 cardiovascular disease risk factors.

CONCLUSIONS

These findings illustrate the heterogeneity of the Mexican American population and identify a new group at substantial risk for cardiovascular disease and in need of effective heart disease prevention programs.

Greater incidence of hospitalized myocardial infarction among Mexican Americans than non-Hispanic whites. The Corpus Christi Heart Project, 1988-1992

BACKGROUND

Since Mexican Americans have adverse patterns of risk factors for myocardial infarction relative to non-Hispanic whites, the incidence of myocardial infarction should be greater among Mexican Americans than among non-Hispanic whites. This expectation conflicts with reports generated from death certificate registries.

METHODS AND RESULTS

Data regarding myocardial infarction attacks and incident events were collected for a 4-year period in the Corpus Christi Heart Project, a population-based surveillance project for hospitalized coronary heart disease events. For both women and men, Mexican Americans experienced greater hospitalization rates for both attacks and incident events than non-Hispanic whites. Age-adjusted attack rate ratios comparing Mexican Americans with non-Hispanic whites were 1.59 (95% CI, 1.05 to 2.41) and 1.31 (95% CI, 1.18 to 1.45) among women and men, respectively. Corresponding incidence ratios were 1.52 (95% CI, 1.28 to 1.80) and 1.25 (95% CI, 1.10 to 1.42).

CONCLUSIONS

This is the first report documenting greater incidence of hospitalized myocardial infarction among Mexican Americans than among non-Hispanic whites, a biologically plausible finding given the risk factor patterns observed in the Mexican-American population. Public health planners and clinicians should be aware of the importance of myocardial infarction as a health problem in the Mexican-American population. Culturally appropriate prevention strategies should be developed for and tested in Mexican-American populations.

Feminist empiricism as a method for inquiry in nursing

Feminist empiricism may provide a valuable approach for the acquisition, evaluation, and integration of biological knowledge in nursing epistemologies. This article discusses feminist empiricism as a method for inquiry in nursing. Proponents of feminist empiricism strive to work within the current political, social, and scientific structures while acknowledging that all three of these structures must change if less distorted epistemologies are to emerge. Hypertension in women is used to illustrate how feminist empiricism could be used to modify the traditional scientific approach. The argument is made that the androcentricism of the traditional scientific approach must be changed in order to include the problematics of women. Moreover, women must have a central role in determining the problematics of both health and illness in women. A philosophical stance embracing holism cannot deny biological phenomena or preclude research on these phenomena. Theorists and scientists in nursing have a unique opportunity to reconceptualize biological phenomena, from a holistic perspective, in the development of epistemologies for nursing. An argument for the use of basic research as a quantitative methodology, from a feminist perspective, is made. The appropriateness, for nursing, of basic research methodologies to generate knowledge about biological processes, which are within nursing's scientific domain, are discussed.

Prevalence of hypertension in Mexico City and San Antonio, Texas

BACKGROUND

Few data are available on the prevalence of hypertension in Mexico.

METHODS AND RESULTS

We compared the prevalence of mild hypertension (systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > or = 90 mm Hg and/or use of antihypertensive medications) in 1500 low-income Mexican Americans who participated in the San Antonio Heart Study and 2280 low-income Mexicans who participated in the Mexico City Diabetes Study. The crude prevalence of mild hypertension was 17.1% in Mexican men versus 24.4% in Mexican American men (P = .001) and 17.4% in Mexican women versus 22.0% in Mexican American women (P = .005). After adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), non-insulin dependent diabetes mellitus (NIDDM), educational attainment, and percent native American genetic admixture (Caucasian and native American), the odds ratio (Mexico City/San Antonio) was 0.55 (95% CI, 0.39, 0.77; P < .001) in men and 0.81 (CI, 0.54, 1.12; P = .201) in women. In a pooled model including both men and women, the odds ratio was 0.67 (95%, CI, 0.53, 0.84; P < .001). In the pooled model, city, age, female sex, NIDDM, BMI, WHR, and low educational attainment were significantly related to the prevalence of hypertension.

CONCLUSIONS

The causes for these differences in hypertension prevalence are not known but may reflect a less modernized lifestyle in Mexico City, including greater physical activity, less obesity, and the consumption of a high-carbohydrate, low-fat diet.

Mortality differences between elderly Mexican Americans and non-Hispanic whites in San Antonio, Texas

OBJECTIVE

To identify differences in causes of death between elderly Mexican Americans (MA) and non-Hispanic whites (NHW).

DESIGN

Retrospective death certificate review.

SUBJECTS

Elderly Mexican Americans and non-Hispanic Whites age 65 and over who died in Bexar County, Texas during 1989.

MEASURES

Data obtained from chart review included age, sex, race/ethnicity, and cause of death. Age-adjusted and cause-specific mortality rates, odds ratios (OR), and 95% confidence intervals (CI) were calculated.

RESULTS

Mexican Americans were at greater risk of dying in nine of the thirty causes of death examined. The mortality rates of MA subjects were higher than those of NHW from death caused by diabetes (OR = 3.19, CI = 2.27-4.49), renal failure (OR = 2.06, CI = 1.44-2.94), congestive heart failure (OR = 1.50, CI = 1.44-2.94), and multiple systemic diseases (OR = 2.59, CI = 1.89-3.57). Among the male subjects, MA had a greater risk than NHW of dying from myocardial infarction (OR = 1.83, CI = 1.15-2.90), coronary disease (OR = 1.37, CI = 1.07-1.75) and septicemia/pyuria (OR = 2.12, CI = 1.09-4.10). Among female subjects, MA had a greater likelihood of dying from cirrhosis (OR = 3.03, CI = 1.00-9.29). For only one of the causes of death was the risk lower among MA than NHW: MA female subjects had a lesser chance of dying from the chronic obstructive pulmonary disease (COPD) than NHW females (OR = 0.36, CI = 0.18-0.72).

CONCLUSION

Mexican American elders have a greater risk of dying from non-insulin dependent diabetes mellitus and renal failure than their NHW counterparts. Elderly MA men have a greater risk of dying from cardiovascular disease than their NHW counterparts. Mexican American women may have a greater risk of dying from cirrhosis, but a lower risk of dying from complications of COPD. Finally, death from ill defined causes, such as multiple systemic diseases, may be a major under-acknowledged cause of death among older MA.

Risk factors and mortality among black, Caucasian, and Latina women with acute myocardial infarction

The purpose of this study was to examine the clinical outcome of acute myocardial infarction among women of three ethnic/racial groups and to determine whether observed differences in outcome are explained by differences in associated risk factors. Nine hundred seventeen (917) consecutive admissions occurred among 810 women, of whom 347 (42.8%) were Caucasian, 258 (31.9%) were black, and 205 (25.3%) were Latina. The overall mortality rate was 13%; the Caucasian rate was significantly higher than the Latina rate (16.9% vs 7%, p < 0.01), as was the black rate (13.8% vs 7%, p < 0.05). Comparing survivors with nonsurvivors among the three groups, hypertension was more common for survivors among blacks, as was a history of angina; in-hospital congestive failure was associated with a higher mortality for blacks and Caucasians, as was in-hospital angina for Caucasians. Univariate and multivariate logistic regression for the outcome variables of congestive failure, in-hospital angina, and mortality, showed race to be a significant factor in the lower mortality rate for Latinas in the univariate analysis. In the multivariate analysis, only in-hospital angina and congestive failure significantly influenced mortality. In this study of myocardial infarction among women of lower socioeconomic status, factors other than race were the primary influences on outcome.

Overweight among Mexican Americans and its relationship to life style behavioral risk factors

The hypothesis positing differences between Mexican Americans and whites regarding attitudes and behaviors concerning obesity and other health issues was tested. A random sample of 1171 whites and 155 Mexican Americans aged 18 to 65 was selected. Two analyses were carried out. First, overweight Mexican Americans were compared with overweight whites. Second, overweight individuals were compared with normal weight counterparts within each ethnic group. Differences between overweight Mexican Americans and overweight whites disappeared after adjusting for the effects of sex, income, educational status, and marital status. Among whites, several factors remained significantly different when comparing overweight with normal weight individuals. Among Mexican Americans, however, all but one of the significant differences between overweight and normal weight individuals disappeared after adjusting for other variables. The implications of these results as they relate to the implementation of public health programs to deal with the prevention and treatment of obesity among Mexican Americans are discussed.

Hospitalization rates for myocardial infarction among Mexican-Americans and non-Hispanic whites. The Corpus Christi Heart Project

The rate of hospitalization for myocardial infarction was examined in the Corpus Christi Heart Project (CCHP), a prospective population-based surveillance program in a biethnic community of Mexican-Americans and non-Hispanic whites. During 12 months of ascertainment, a total of 740 patients hospitalized with definite (217) or possible (523) myocardial infarction were identified. Of the 740 subjects, 334 were Mexican-Americans (150 females and 184 males), 348 were non-Hispanic whites (138 females and 210 males), and 58 were of other ethnic backgrounds. The 1-year age-adjusted rates of hospitalization per 100,000 population were 427.4 and 276.9 among Mexican-American and non-Hispanic white females, respectively, and 721.4 and 502.6 among Mexican-American and non-Hispanic white males, respectively. The age-adjusted hospitalization rate ratios for Mexican-Americans in relation to non-Hispanic whites were 1.55 (95% confidence interval [CI]: 1.23 to 1.95) and 1.40 (95% CI: 1.15 to 1.70) for females and males, respectively. These results suggest that Mexican-Americans may have a greater burden of coronary disease than non-Hispanic whites.

Level of control of hypertension in Mexican Americans and non-Hispanic whites

Compared with non-Hispanic whites, Mexican Americans have a higher prevalence of diabetes, greater adiposity, and an unfavorable body fat distribution. The prevalence of hypertension, however, is similar or lower in Mexican Americans than in non-Hispanic whites. There is little information on the level of blood pressure control in Mexican Americans. We compared the mean blood pressure levels of Mexican American and non-Hispanic white hypertensive subjects in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Hypertension was defined as one or more of a systolic blood pressure > or = 160 mm Hg, a diastolic blood pressure > or = 95 mm Hg, and current use of antihypertensive medications. Three hundred and fifty-eight Mexican Americans and 241 non-Hispanic whites met these criteria. Poor hypertension control was defined as a systolic blood pressure > or = 160, a diastolic blood pressure > or = 95 mm Hg, or both. After adjustment for age, gender, obesity, body fat distribution, and level of educational attainment, Mexican American hypertensive subjects were in significantly poorer control than non-Hispanic white hypertensive subjects. The reasons for their poorer control are unknown, but our findings emphasize the importance of hypertension in this ethnic group.

Hyperdynamic circulation and the insulin resistance syndrome ("syndrome X")

The insulin resistance syndrome ("syndrome X") consists of hyperinsulinemia, glucose intolerance, dyslipidemia, and hypertension, although the inclusion of hypertension has been challenged. Insulin has biological effects that could produce a hyperdynamic circulation. We therefore postulated that an insulin-induced hyperdynamic circulation is an early feature of the insulin resistance syndrome and that this circulatory abnormality leads to later fixed hypertension. The San Antonio Heart Study cohort, a population-based cohort of 3,301 Mexican Americans and 1,857 non-Hispanic whites, was used to define individuals who were hyperdynamic (pulse pressure and heart rate in the upper quartile of their respective distributions), intermediate, and hypodynamic (pulse pressure and heart rate in the bottom quartile). The characteristics of the insulin resistance syndrome were then examined according to these three hemodynamic categories. We also examined the 8-year incidence of hypertension and of type II diabetes according to these hemodynamic categories. A hyperdynamic circulation was associated with statistically significant increases in body mass index (BMI) (p < 0.001), subscapular-to-triceps skinfold ratio (p = 0.042), triglyceride (p = 0.002), 2-hour glucose (p = 0.002), and fasting and 2-hour insulin (p = 0.019 and 0.006). When hemodynamic status was examined separately in lean (BMI < 27 kg/m2) and obese (BMI > or = 27 kg/m2) individuals, the above effects persisted, although they were somewhat attenuated. The odds ratio for the hyperdynamic state as a predictor of future hypertension was 1.66, although this was not statistically significant (p = 0.304). The odds ratio for predicting future type II diabetes was 3.97, which was statistically significant (p = 0.047).(ABSTRACT TRUNCATED AT 250 WORDS)

End-stage renal disease in US minority groups

Medicare's End-Stage Renal Disease (ESRD) Program makes renal replacement services accessible for the majority of Americans with renal failure. National data from Medicare demonstrate complex and variable patterns of use of renal replacement services among US racial and ethnic groups. The black population has consistently suffered from a greater than 3.5-fold higher rate of treated ESRD than has the white population. The rates of hypertensive, diabetic, and glomerulopathic ESRD are all substantially greater in blacks than in whites, and hypertension has accounted for a far greater proportion of ESRD in blacks than any other diagnosis. There is a paucity of national data on the occurrence of ESRD in Hispanic Americans. However, data from Texas strongly suggest that the incidence rate of treated ESRD is much higher in Mexican Americans than in non-Hispanic whites. Higher rates are apparent for each of the three most important causes of ESRD: hypertension, diabetes, and glomerulonephritis. Native Americans experience ESRD at a rate intermediate between those of whites and blacks, but their rate of diabetic ESRD is higher than in either blacks or whites. However, considerable diversity exists among Native American tribal groups. Significant barriers to the acquisition of preventive care have been identified, especially for blacks. While these barriers to preventive care are accompanied by a significantly impaired health status of the black American population, a specific causal relationship between impaired access to care for blacks and their predisposition to ESRD has not been established.

Epidemiology of isolated systolic hypertension in Pu-Li, Taiwan

The clinical significance of isolated systolic hypertension (systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg) has long been recognized, but its prevalence and correlates have not been well characterized. A community-based study was carried out by the Yang-Ming Crusade in 1987-1988 in Pu-Li Town, Taiwan. Of the 2573 registered residents over 30 years old, 1738 were interviewed, and their fasting blood samples were drawn and tested. The prevalence of isolated systolic hypertension was 2.1%. Age-specific prevalence increased with age. No significant difference was found between men and women. No trend was found at the urbanizational level. To study the significant correlates of isolated systolic hypertension, univariate analyses were applied first. Stratified analyses by age and by sex were used for interaction assessment. Based on the above findings as well as from the clinical point of view, logistic regression was used for multivariate analyses. Logistic regression analysis showed that after controlling the covariates simultaneously, four variables were significantly correlated with isolated systolic hypertension: age (greater than or equal to 50 vs. less than 50 years, OR = 3.4, 95% CI = 1.6-7.2); diabetes (yes vs. no, OR = 2.4, 95% CI = 1.2-4.7); blood urea nitrogen (greater than or equal to 25 vs. less than 25 mg/dl, OR = 2.1, 95% CI = 1.2-3.9); and physical activity (frequent vs. infrequent, OR = 1.8, 95% CI = 1.0-3.1). In comparison with definite (greater than or equal than 160/95 mmHg) and borderline (140/90-160/95 mmHg) hypertension as defined by WHO, the different sets of predictors and the possible adverse effect of frequent physical activity on isolated systolic hypertension were found and discussed.

Coronary artery disease in Hispanic Americans. How does ethnic background affect risk factors and mortality rates?

A concerted national effort has reduced cardiovascular mortality rates in the general US population. Unfortunately, not all ethnic groups have benefited equally from these improvements in our national health. The author presents insights into social and clinical factors that affect cardiovascular disease among Hispanic Americans.

Lipoprotein and apolipoprotein levels among Mexican-Americans in Starr County, Texas

Mexican-Americans represent the single largest component of the US Hispanic population and have been shown to bear a disproportionate burden of chronic disease. A representative sample of 1,004 Mexican-Americans aged 15-74 years from Starr County, Tex., was recruited for this study. Each subject was provided a detailed physical evaluation that included measurement of fasting levels of cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol and its subfractions (HDL2 and HDL3) alpha- and beta-lipoprotein cholesterol, and low density lipoprotein cholesterol. Apolipoproteins A-I, A-II, B, C-II, C-III, and E were determined for approximately 550 of these individuals. Age- and sex-specific mean levels and percentile cut points are presented. The distributions of lipoproteins are quite similar to those of the general population except for consistently higher triglycerides in males and females and lower HDL cholesterol levels in females. These findings are consistent with the high frequency of obesity. Comparative age- and sex-specific data for the apolipoproteins are not widely available. Where such data exist, apolipoprotein levels observed in the Mexican-American population tend to be similar to or lower than the comparative data.

Hypertension prevalence and the status of awareness, treatment, and control in the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-84

The prevalence rates of hypertension among adult (ages 18-74) Mexican Americans, Cuban Americans, and Puerto Ricans were estimated using data from the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES). Hypertension is defined as diastolic greater than or equal to 90 mm Hg, or systolic greater than or equal to 140 mm Hg, or currently taking antihypertensive medication. Among Mexican Americans in the Southwestern United States, 16.8 percent of the males and 14.1 percent of the females were found to be hypertensive. Among Cuban Americans in Dade County, Florida 22.8 percent of the males and 15.5 percent of the females were hypertensive. Among Puerto Ricans in the New York City area 15.6 percent of the males and 11.5 percent of the females were hypertensive. The age-adjusted rates are significantly lower than comparable rates for Whites and Blacks as measured in the second National Health and Nutrition Examination Survey (NHANES II), 1976-80. Control of hypertension in the HHANES populations fall short of the 1990 Objectives for the Nation established by the US Public Health Service 60 percent (34 percent controlled Mexican American hypertensives, 27.8 percent controlled Cuban American hypertensives, and 29 percent controlled Puerto Rican hypertensives.

A note on the measurement of hypertension in HHANES

Using data from the HHANES, we found the rates of elevated blood pressure readings on clinical examination to be extremely low for a sample of Mexican American and Puerto Rican women. The prevalence rates were one-fourth to one-fifth the rates found for a comparable sample of White women from NHANESII. These findings are discrepant with the little that is known about hypertension prevalence among Hispanics and with estimates of hypertension prevalence for Mexican Americans and Puerto Ricans drawn from NHANESII. While our HHANES samples women had much lower rates of clinical high blood pressure than Whites, they reported hypertension histories in excess of Whites. Rates of medicine usage among Hispanics were insufficiently large for effective treatment to explain the disparity. The prevalence estimates increased, but the relative discrepancies remained when we altered our sample specifications and clinical high blood pressure measure. A possible explanation for these discrepancies is that few physicians performed the majority of blood pressure readings in our HHANES sample. This may have been statistically inefficient. The discrepancies noted suggest that HHANES may not be a reliable source of information on hypertension among Hispanic women.

Decreased prevalence of hypertension in Mexican-Americans

Relatively few studies of hypertension have been carried out in Mexican-Americans, a population characterized by high rates of obesity and non-insulin-dependent diabetes mellitus. We therefore compared the prevalence of hypertension according to four different definitions in 3,297 Mexican-Americans and in 1,873 non-Hispanic whites from the San Antonio Heart Study, a population-based study of cardiovascular disease and diabetes. By all four definitions, the crude prevalence of hypertension in both sexes was lower in Mexican-Americans than in non-Hispanic whites, although only two of the eight pairwise comparisons were statistically significant. However, after adjusting for the potentially confounding effects of age, body mass index, and non-insulin-dependent diabetes mellitus, Mexican-Americans did have a statistically significant lower prevalence of both systolic and diastolic hypertension than did non-Hispanic whites in both sexes (odds ratios ranging from 0.66 to 0.71 depending on the definition of hypertension). The cause of this lower prevalence is unknown, but study of this ethnic group with elevated levels of risk factors for hypertension (obesity, hyperinsulinemia, and diabetes) may provide additional insights into the etiology of hypertension.

Slowdown in the decline of stroke mortality in the United States, 1978-1986

The gradual decline in stroke mortality rates observed in the United States since 1900 accelerated markedly around 1973 for whites and around 1968 for blacks. During the next decade stroke mortality rates decreased by almost 50% so that the United States now experiences one of the lowest stroke mortality rates in the world. Beginning in 1979, however the annual rate of decline in stroke mortality began to slow considerably. Comparing the period 1979-1986 with the previous decade, a 57% slowing in the absolute rate of decline (as estimated by the slope of the linear portion of the mortality curve) was observed for white men; the corresponding slowdowns in the rate of decline were 58% for white women, 44% for black men, and 62% for black women. If the decline during the 1980s had continued at the rate observed for the period 1968/73-1978, there would have been 131,000 fewer stroke deaths during the period 1979-1986, 28,000 fewer in 1986 alone. This slowdown in the rate of decline in stroke mortality is occurring while mortality rates for both coronary heart disease and all causes are leveling off. The reasons for this change in the mortality trend remain unknown, and corresponding trends in the treatment and control of hypertension do not provide an entirely satisfactory explanation.

Hypertension in the Hispanic-American population

According to the 1988 census, there are 19.4 million Hispanics living in the United States. They represent 8.1 percent of the nation's population, and that percentage is expected to rise significantly in the next 25 years. Demographic projections indicate that Hispanics will become the largest minority group in the United States by the year 2000, yet they remain a seriously understudied population. This article examines available clinical data, epidemiologic findings, and sociologic observations regarding the incidence of hypertension in this minority group and summarizes what is known about the detection, evaluation, treatment, and control of high blood pressure in Hispanics. In addition, the preliminary results of a multi-center, placebo-controlled trial comparing the efficacy and safety of a potassium-sparing diuretic (Dyazide; Smith Kline & French Laboratories) in Hispanic-American patients with mild-to-moderate hypertension are presented.

Test characteristics of self-reported hypertension among the Hispanic population: findings from the Hispanic Health and Nutrition Examination Survey

Data from the Hispanic Health and Nutrition Examination Survey conducted from 1982 to 1984 were analyzed for the sensitivity, specificity, and positive and negative predictive value of self-reported hypertension in 5195 Hispanics of both sexes between the ages of 18 and 74 years. On the basis of a hypertension definition of 140/90 mmHg or of the use of antihypertensive medications, overall sensitivity of self-reported hypertension was 56% for Mexican-Americans, 71% for Cuban-Americans and 72% for Puerto Ricans. Sensitivity was higher among women, among the obese, and among those with access to a regular place for medical care; increased with increasing age; and decreased with education and the time interval since last medical visit. Independent associations for sensitivity were noted for sex, body mass index (BMI), and time interval since last medical visit among Mexican-Americans; and for time interval since last medical visit and for being divorced or separated for Cuban-Americans. Overall positive predictive value reached 49% among Mexican-Americans, 53% among Cuban-Americans, and 39% among Puerto Ricans. Raising the hypertension-threshold to 160/95 mmHg tended to increase the sensitivity but reduced the positive predictive value.

Ischemic heart disease mortality in Hispanics, American Indians, and non-Hispanic whites in New Mexico, 1958-1982

To describe trends in mortality from ischemic heart disease in New Mexico's Hispanic, American Indian, and non-Hispanic white populations, we used vital records data collected from 1958 through 1982. We calculated age-adjusted and age-specific mortality rates for ischemic heart disease for each of the state's principal ethnic groups. Death certificate data were used in combination with population estimates based on the censuses of 1960, 1970, and 1980. Age-adjusted mortality rates for ischemic heart disease among Hispanics, American Indians, and non-Hispanic white men were consistent with nationwide patterns of rising mortality rates during the 1960s followed by declining rates. Mortality rates from ischemic heart disease in all three ethnic groups in New Mexico were lower than national rates for whites. Rates for Hispanics in New Mexico were lower than for non-Hispanic whites; rates for American Indians were the lowest among the three groups. These data support previous observations that Hispanics and American Indians in the Southwest are at decreased risk for mortality from ischemic heart disease in comparison with U.S. whites.