Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern California 2010-2012.

Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) with a prevalence of 33% in the United States.1 HTN greatly contributes to cardiovascular morbidity and mortality with an increased risk of developing myocardial infarction, stroke, and heart failure.2 Effective HTN treatment prevents or delays its complications.3 Despite public health efforts to promote HTN evaluation and management, HTN remains under-recognized and undertreated; only half (47%) of all hypertensive patients have successfully controlled their blood pressure (BP).4 Due to its high prevalence and significance in CVD prevention, Healthy People 2020 includes HTN control and prevention as one of the most critical public health goals of the current decade.5 The prevalence of HTN and morbidity due to HTN differs by racial/ethnic subgroup. The majority of observational studies examining racial differences in HTN in the United States have focused on the non-Hispanic White (NHW) and non-Hispanic Black (NHB) populations.6 The National Health and Examination Survey is the primary data source for national prevalence rates of HTN in the United States.7 Although the most recent National Health and Examination Survey report includes NHWs, NHBs, non-Hispanic Asians, and Hispanics, it does not currently contain information to study differences in HTN across Asian American subgroups.8 Hispanics and Asian Americans are the two most rapidly growing racial/ethnic minority groups in the United States, with populations that are projected to reach 110 and 30 million by 2050, respectively.9,10 The six largest Asian American subgroups in the United States are Asian Indians, Chinese, Filipinos, Japanese, Koreans, and Vietnamese; these six subgroups make up 84% of the Asians in the United States based on 2010 Census data.11 Variation in CVD burden among Asian American subgroups is well-established.1,12–14 Asian Indians and Filipinos have higher rates of coronary heart disease, while Filipinos, Chinese, and Japanese have higher stroke rates, compared with NHWs and other racial/ethnic groups.15–19 Studies examining HTN for Asians have been primarily conducted in their countries of origin, not in the United States. The White House, the American Heart Association, the Agency for Healthcare Research and Quality, and the National Heart, Lung and Blood Institute have all recently acknowledged the lack of data on Asian subgroups and the need to disaggregate Asian American subgroups to better understand diverse populations.20–23 Despite heterogeneity in HTN and CVD risk among minority groups, the current HTN guidelines released by American Society of Hypertension and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure (JNC7 and JNC8) do not provide specific recommendations to minority groups such as Asian Americans and Hispanics, citing lack of evidence.24–26 Our goal with this study is to help fill this knowledge gap in order to help guide detection, treatment, and prevention efforts in HTN among minority populations who have access to ambulatory care.