title: Is the association of diabetes with uncontrolled blood pressure stronger in Mexican Americans and blacks than in whites among diagnosed hypertensive patients?
abstract: BACKGROUND
  Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated.
  
  
  METHODS
  A total of 6,134 diagnosed hypertensive subjects aged ≥ 20 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models.
  
  
  RESULTS
  Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37-0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35-0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40-0.96). Mexican Americans have a stronger association of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks.
  
  
  CONCLUSIONS
  The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee; lix01@etsu.edu.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. lix01@etsu.edu.
authors.forename: Ping
authors.initials: P
authors.lastname: Song
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000208:ethnology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008875:Middle Aged; D009749:Nutrition Surveys; D014481:United States / Q000453:epidemiology
keywords: blood pressure; diabetes; diagnosed hypertension; hypertension; isolated uncontrolled diastolic blood pressure; isolated uncontrolled systolic blood pressure; racial disparity; uncontrolled blood pressure.