Hypertension in minority populations. Access to care

Data from multiple sources confirm the greater risk of morbidity and mortality from cardiovascular disease that is seen in some minority segments of the population of the United States, when those segments are compared with the population as a whole. In most studies, blacks are shown to have the highest overall mortality rate from cardiovascular disease--higher than the rate for Hispanics, and substantially higher than the rate for whites and Asians. In some of these studies, blacks also have higher rates of both hypertension-related stroke and coronary artery disease. In some of the major clinical trials, Hispanic patients have the next-highest death rate from high blood pressure and ischemic heart disease. In other, smaller studies, however, non-Hispanic whites have had comparable or higher age-adjusted death rates. Asians, by contrast, have significantly lower death rates from cardiovascular disease, irrespective of national origin, and they also have correspondingly lower mortality from stroke and other hypertension-related diseases. As in coronary artery disease, issues related to access to care may be implicated in the disproportionate morbidity and mortality rates noted in black and Hispanic patients, as well as among some lower-class segments of the non-Hispanic white population. Access to care may depend upon a number of factors, among them cultural isolation, public awareness, individual and group attitudes, perception of resource availability, actual resources, socioeconomic status, educational level, and peer behavior.