Evolving patterns of prevalence and management of hypertension phenotypes in Mexico: A two-decade analysis of nationally representative surveys

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ABSTRACT BACKGROUND Systemic arterial hypertension is a public health concern, and timely diagnosis and management are critical to mitigate long-term effects. Here, we evaluated prevalence trends and determinants of hypertension and its phenotypes in Mexican population over the last two decades. METHODS We analyzed cross-sectional Mexican Health and Nutrition Surveys (2000-2023), including 141,668 adults aged ≥20 years. Hypertension was defined as self-reported diagnosis or blood pressure (BP) ≥140/90 mmHg; undiagnosed hypertension (UDH) as BP ≥140/90 mmHg without prior diagnosis; and untreated hypertension (UTH) as prior diagnosis without treatment. UDH was classified as isolated systolic (ISH), isolated diastolic (IDH), or systolic-diastolic hypertension (SDH). We assessed prevalence trends with Poisson models, and determinants of UDH and UTH with logistic models. RESULTS We observed an overall decrease in hypertension prevalence from 2000 to 2023, driven by increases in diagnosed (12.3% to 19.3%) and decreases in undiagnosed (20.7% to 11%) hypertension. IDH and SDH declined over time, while ISH increased, particularly among older adults. Among diagnosed cases, UTH decreased (31% to 19.5%) and BP control improved (40.5% to 69.5%). Despite these trends, by 2023 approximately 8.2 million Mexican adults still had UDH (36.3% of all hypertension cases), 2.8 million remained untreated, and 4.4 million uncontrolled. Lack of diagnosis and treatment were more likely among men, individuals with unhealthy lifestyles, and social disadvantage. CONCLUSIONS Results highlight evolving trends in hypertension diagnosis, treatment, and control in Mexico, with persistent challenges in UDH and UTH. Strengthening screening, treatment access, and equity is crucial to reduce hypertension-related cardiovascular risk.

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