Journal of Human Hypertension (2000) 14, 555±559
Ó 2000 Macmillan Publishers Ltd All rights reserved 0950-9240/00 $15.00
ORIGINAL ARTICLE
Prevalence of hypertension in indigenous
inhabitants of traditional communities
from the north of Mexico
F Guerrero-Romero1,2, M RodrõÂguez-MoraÂn1,2, F Sandoval-Herrrera3 and R Alvarado-Ruiz2,4
1
Medical Research Unit in Clinical Epidemiology, Mexican Social Security Institute, Mexico; 2Research Group on
Diabetes and Chronic Illnesses, Mexico; 3Solidarity Program Health Care, Mexican Social Security Institute, Mexico;
4
General Hospital, Institute of Worker's Social Security, Durango, Mexico
The purpose of this study was to estimate the prevalence
and risk factors of hypertension in adults indigenous to
their traditional communities from the north of Mexico. The
study was based on a cross-sectional survey of
inhabitants from Mexicaneros, Huicholes and Tepehuanos
communities, which have not been in¯uenced by a western
lifestyle. A home inter-view and clinical examination that
included blood press-ure and anthropometric
measurements of 217 men and 598 non-pregnant women
aged between 35 to 64 years was carried out. Eligible
indigenous subjects must have had no migratory history
to partially or totally urbanised areas. Target population
represented approximately 100% of the indigenous people
who have spent all their life time in the community of
birthplace. Age and body mass index average was 48.9 ±
12.9 years and 25.6 ± 5.1 kg/m2. Hypertension was
identi®ed in 56 indi-
Keywords: prevalence; traditional communities; indigenous; Mexico
Introduction
Hypertension is a common ®nding in the general
population, with a prevalence that varies widely
worldwide. Populations of developing countries now face
the greatest risk for hypertension. Twenty-four percent of
the US adult population had hyper-tension,1 whereas in the
urban areas of Mexico the prevalence of hypertension
reaches 25%,2 and in the partly westernised Mexican rural
communities it varies from 15% to 21%.3,4
There is plenty of evidence to the fact that hypertension
differs among racial groups.1,5±7 Many studies have
suggested that African Americans, non-Hispanic black,
non-Hispanic white and Mexican American populations,
have a higher prevalence of hypertension than whites. 6±8
The prevalence of hypertension among indigenous
inhabitants of tra-ditional Latin American communities has
not been
Correspondence: Dr Fernando Guerrero-Romero, Siqueiros 225 esq
c/castanÄeda, 34000 Durango, Dgo., Mexico.
E-mail: guerreroKomanet.com.mx
Received 24 January 2000; revised 27 March 2000; accepted 9 May 2000
Hypertension in traditional communities of Mexico
F Guerrero-Romero et al
556
www.nature.com/jhh
viduals, 45 women and 11 men (prevalence 6.87%, 95%
con®dence interval (CI) 5.1±8.6). Forty-one percent of
the hypertensive subjects were aware of being hyper-
tensive. Hypertensive subjects had a higher intake of
saturated fats than non-hypertensives. Salt consump-
tion was lower than 6 g per day in subjects with and
without hypertension. High intake of saturated fats
(odds ratio 6.4, 95% CI 2.1±12.3; P _ 0.01) was an inde-
pendent predictor for hypertension. This study
presents, for the ®rst time, data concerning hyperten-
sion in adults who are indigenous to and living in
traditional communities from Mexico. Prevalence of
hypertension was lower than in the partly urbanised
rural communities with a westernised lifestyle and the
urban areas of Mexico.
Journal of Human Hypertension (2000) 14, 555±559
well studied. Although the `exposure' to race is an inherent
trait dif®cult to measure or even to de®ne, 9 the available
reports show that populations of indigenous ancestry,
without racial admixture, exhi-bit a lower prevalence of
arterial hypertension.10
The study of hypertension on inhabitants from
traditional communities offers the opportunity to evaluate
the essential attributes or causal role of the known
cardiovascular risk factors on the rise of blood pressure,
among populations with low preva-lence of hypertension
risk factors.
The purpose of this study was to estimate the prevalence
and associated risk factors of hyperten-sion in adult
indigenous to their traditional com-munities from the north
of Mexico.
Materials and methods
Previously approved by the Mexican Social Security
Institute Research Committee, and after obtaining the
patient informed consent, an epidemiological survey was
conducted among men and women inhabitants of
traditional indigenous communities of Durango State in the
north of Mexico (Figure 1). Design and setting has
been previously

Figure 1 Map of Mexico showing the localisation of Durango
State. Shaded area represent the localisation of indigenous com-
munities surveyed on the north-western Mexican mountains.
described.11 In brief, the sample to be studied was
determined according to two-stage cluster sampling.
In the ®rst stage of sampling, the geographical areas
were divided into clusters of traditional indigenous
communities. In the second stage, a random sample of
households was selected from each community. From
each household, men and women between 35 and 64
years age were invited to participate. Eligible women
for the study would not be pregnant. An in-home
interview and clinical examination was car-ried out. 11
All the interviewers were physicians working in the
Solidarity Program health care of the Mexican Social
Security Institute. Prior to the start of study a training
course was conducted to stan-dardise both techniques
of blood pressure and anthropometric measurements.
Thirty-seven (12 Tepehuanas, 13 Huicholes, and 12
Mexicaneras) indigenous communities were selected,
this ®gure represents approximately 100% of the
traditional communities in the selected geo-graphical
area which are in the north western Mex-ican
mountains (Figure 1). These communities are
dif®cult to get to, so are not in¯uenced by a western
lifestyle, and the majority are of less than 100
inhabitants.
The selected communities have no racial admix-
ture. Indigenous inhabitants of these communities that
were invited to participate in the study have no
migratory history to partially or totally urbanised
towns, so they have spent their life time in their
original indigenous community of birthplace.
Questionnaires were completed on age, smoking
habits and alcohol consumption. A semiquantitative
food frequency questionnaire to obtain information
about individual nutrient intake in the customary diet
was applied. This questionnaire collected quan-
titative data about the type of food consumed in the
previous 3 days. Dietary records were analysed for
total calories, carbohydrates, proteins, fats and sodium
chloride.
To provide a demographic comparison between the
hypertensive indigenous subjects vs the hyper-tensive
subjects of urban communities, we selected 670
women and 305 men from our database of indi-
viduals who have participated in various research
studies over the past 4 years. To be included in this
sample, subjects from urban areas must have been
selected in a random way from the urban popu-lation.
Using a mercury sphygmomanometer, the tech-
nique of blood pressure measurement, and the
hypertension diagnoses criteria assumed were those
recommended in the Sixth Report of the Joint National
Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure. 12 Furthermore,
subjects who self-reported to be hyper-tensive and
were currently taking antihypertensive drugs were also
considered as hypertensives irres-pective of their
systolic/diastolic values. Subjects that self-reported not
being hypertensive and had blood pressure values that
de®ned hypertension, were considered as newly
diagnosed cases.
In the standing position weight and height were
measured with the subjects in light clothing and
without shoes. Body mass index (BMI) was calcu-
lated as weight (in kilograms) divided by height (in
meters) squared. Waist circumference was taken as the
minimum circumference at umbilicus level. Hip
circumference was taken as the maximum circum-
ference around the buttocks posteriorly and the
symphysis pubis anteriorly. Waist-to-hip ratio was
calculated as waist circumference divided by hip
circumference. Obesity was de®ned as BMI _30
kg/m2 and abdominal obesity as waist-to-hip ratio _0.8
in women and _0.9 in men.
Statistical analysis
Differences between the urban and indigenous men
and women, with and without hypertension, were
assessed using the unpaired Student's t-test. To
determine which factors were independently asso-
ciated to hypertension, multivariate logistic regression
analyses was used to compute the odds ratio (OR) to
the development of hypertension. It was considered a
95% con®dence interval (CI). Data were analysed by
using the Statistical package SPSS V 8.0.
Results
We included 815 indigenous subjects (598 women and
217 men), a ®gure that represents approximately 97%
of the indigenous people that have spent all their life
time in the community of birthplace. Age ranged from
37 to 63 years (48.9 ± 12.9 years). The average BMI
was 25.6 ± 5.1 kg/m2.
Hypertension was identi®ed in 56 individuals, this
is for a prevalence of 6.87%, 95% CI 5.1±8.6 (45
women, 7.52%, 95% CI 5.4 ±9.7; and 11 men, 5.06%,
95% CI 2.5±8.8), for a female/male ratio = 1.43:1.
Forty-one percent of the hypertensive subjects were
aware of being hypertensive, among these sub-jects
the average systolic and diastolic blood press-ure was
137.2 ± 26.9 mm Hg and 87.8 ± 16.9 mm Hg,
respectively. The duration of hypertension varied from
1.5 to 16 years. Eighty-four percent were non-
controlled. Thirty-three subjects were newly diag-
nosed as hypertensive (58.9%, 95% CI 44.9±71.9),
Journal of Human Hypertension
with an average systolic and diastolic blood press-ure
of 153.9 ± 7.5 mm Hg and 90.6 ± 5.6 mm Hg.
Hypertension among subjects in urban communi-
ties had a prevalence of 26.5% (95% CI 23.8±29.4).
We identi®ed 177 hypertensive women (26.4%, 95%
CI 23.1±29.8) and 82 hypertensive men (26.9%, 95%
CI 22.0±32.0) (Table 1).
Hypertensive indigenous subjects were older than
non-hypertensive (51.2 ± 13.8 years vs 42.6 ± 13.9
years, P _ 0.000), and had higher BMI (27.8 ± 5.2
kg/m2 vs 25.5 ± 4.5 kg/m2, P = 0.007) and waist-to-hip
ratio (0.83 ± 0.2 vs 0.75 ± 0.2, P _ 0.000) than
subjects without hypertension. Nevertheless, only six
hypertensive women (13.3%), four hyper-tensive men
(36.3%), and eight (1.05%) of the non-hypertensive
subjects were obese, P _ 0.000. On the other hand,
obesity prevalence in the urban com-munity was 31%
(95% CI 28.2±34.0).
Among subjects in the indigenous communities
surveyed, the alcohol consumption was widely dis-
tributed. Indigenous men and women, with and
without hypertension, had higher alcohol consump-
tion than inhabitants of urban communities. Smok-ing
was also signi®cant, it was higher among indigenous
men and men of urban communities, whereas urban
women showed higher tobacco con-sumption than
indigenous women (Table 1).
Hypertensive men and women of urban communi-
ties had higher BMI, waist-to-hip ratio, age and blood
pressure values than the hypertensive indigenous
(Table 1).
Hypertensive and non-hypertensive indigenous
women had higher parity rate than the correspon-dent
urban women (Table 1).
Among the indigenous community, a greater intake
of saturated fats characterised the customary diet of
the hypertensive subjects. Salt consumption was not as
much as 6 g per day in subjects with and without
hypertension, however hypertensive sub-jects had a
higher consumption of salt than non-
Hypertension in traditional communities of Mexico
F Guerrero-Romero et al
557
hypertensive (Table 2). In the hypertensive subjects in
urban communities, average salt consumption was of
9.2 ± 2.8 g per day (Table 2).
High intake of saturated fats (OR 6.4, 95% CI 2.1±
12.3; P _ 0.01) was an independent predictor for
hypertension in the hypertensive indigenous sub-jects,
whereas in the subjects of urban communities salt
consumption was OR 7.1 (95% CI 5.4 ±11.3, P _
0.001).
Discussion
The results of this study present for the ®rst time data
concerned with hypertension in a population-based
survey of adults' who are indigenous to and living in
traditional communities from Mexico.
Prevalence of hypertension in the traditional
communities that we studied is lower than in the
Durango urban communities with a westernised life-
style, and the urban areas of Mexico.2 In these
indigenous communities there was a signi®cant
female predominance because a large proportion of
young males had occupational migration so, com-
parative to urban areas, the indigenous communities
have a modi®ed population structure.11,13
There are few reports about the prevalence of
hypertension and its association with cardiovascu-lar
risk factors in ethnic minority groups of tra-ditional
communities,10,14±17 and is virtually unknown in Latin
American traditional-living populations. The
epidemiological pattern of the car-diovascular risk
pro®le in the indigenous people of traditional
communities differs from that among inhabitants of
partly westernised or westernised urban societies,14
and thus provide an attractive population for
examining the natural history of hypertensive
disease.9
Low total calorie intake at the expense of high
saturated fats and low protein intake characterised the
customary diet pattern in the traditional com-

Table 1 Clinical and anthropometric characteristics by gender of indigenous and urban subjects with and without hypertension

Women Men

Hypertensive Non-hypertensive Hypertensive Non-hypertensive

Urban Indigenous Urban Indigenous Urban Indigenous Urban Indigenous

n 177 45 493 553 82 11 223 206

Age (years) 52.5 ± 8.9 49.4 ± 10.6 50.4 ± 8.1 41.3 ± 13.8* 56.7 ± 15.6 58.8 ± 13.2 49.5 ± 6.1 46.0 ± 14.2²
Weight (kg) 82.1 ± 8.0 69.6 ± 16.7* 72.1 ± 5.0 64.4 ± 11.4* 96.5 ± 9.8 68.9 ± 10.2* 85.4 ± 10.2 68.0 ± 9.1*
Height (m) 1.64 ± 0.08 1.57 ± 0.09* 1.63 ± 0.08 1.58 ± 0.08* 1.72 ± 0.09 1.62 ± 0.08* 1.71 ± 0.09 1.66 ± 0.07*
Body mass index (kg/m2) 31.4 ± 3.1 28.2 ± 5.1* 29.9 ± 3.4 25.8 ± 4.4* 33.6 ± 7.0 26.3 ± 5.8* 29.7 ± 5.1 24.7 ± 4.7*
Waist-to-hip ratio 0.95 ± 0.06 0.81 ± 0.02* 0.81 ± 0.05 0.75 ± 0.08* 0.98 ± 0.03 0.94 ± 0.04² 0.85 ± 0.07 0.76 ± 0.09
Parity 3.2 ± 1.4 7.8 ± 4.2* 3.1 ± 1.1 5.9 ± 3.8* Ð Ð Ð Ð
Fasting glucose (mmol/L) 108.4 ± 25.4 102.9 ± 32.8 99.4 ± 6.1 103.0 ± 16.4 105.9 ± 24.1 100.3 ± 23.5 98.4 ± 5.4 100.6 ± 8.5²
Systolic blood pressure 151.2 ± 21.5 136.0 ± 22.4* 105.4 ± 11.2 103.3 ± 15.4 165.2 ± 10.8 132.3 ± 10.3* 112.8 ± 9.7 113.2 ± 10.5
(mm Hg)
Diastolic blood pressure 95.1 ± 4.2 88.2 ± 12.9* 71.2 ± 8.4 72.6 ± 9.9 95.6 ± 7.1 94.6 ± 8.9 71.4 ± 10.1 72.3 ± 9.2
(mm Hg)
Alcohol consumption 11.2 ± 5.4 25.4 ± 5.2* 9.1 ± 3.1 18.7 ± 6.1* 21.4 ± 3.5 35.2 ± 6.7* 19.8 ± 3.4 29.7 ± 8.1*
(g/day)
Smoking (cigarettes per 8.6 ± 3.5 7.8 ± 3.0 9.1 ± 5.1 8.1 ± 4.7² 10.7 ± 2.1 14.1 ± 5.4* 9.8 ± 1.4 11.8 ± 4.6²
day)

*P _ 0.0000; ²P _ 0.05.

Journal of Human
Hypertension
 Hypertension in traditional communities of Mexico
F Guerrero-Romero et al

558 Table 2 Characteristics of the customary diet of indigenous and urban subjects with and without hypertension

Women Men

Hypertensive Non-hypertensive Hypertensive Non-hypertensive

Urban Indigenous Urban Indigenous Urban Indigenous Urban Indigenou

177 45 493 553 82 11 223 206

Total kcal per day 3800 2300 3400 2200 3600 2150 3200 2000
Carbohydrates (% of total kcal) 60 45 51 42 55 44 50 43
Fat (% of total kcal) 20 49 27 48 25 48 20 46
Saturated (% of total Fat kcal) 28 42 20 31 26 41 18 25
Protein (% of total kcal) 20 6 22 10 20 8 30 11
Sodium chloride (g/day) 9.8 5.5 8.0 5.2 10.2 5.7 7.5 5.6

munities that we studied. These diet patterns deter-mine a
population with obesity practically absent. With regard to
this it should be noted the low aver-age of BMI and waist-
to-hip ratio in the indigenous population studied. Only 10
(17.8%) hypertensive patients were obese. The low
prevalence of obesity and hypertension that we found
among indigenous subjects could be evidence of the
signi®cant role of obesity on the increase of blood pressure
risk. In this regard, the high frequency of hypertension in
the urban communities was not surprising taking into
account that urban subjects showed the highest fre-quency
of obesity.
Current data support that hypertension is determ-ined in
part by genetic factors and arises from the interaction of
environmental risk factors, 18 of which dietary salt intake is
one of the most important.16,18,19 The indigenous subjects
that we studied had an average salt intake that ranged from
4.2 g/day to 5.9 g/day, whereas in the subjects from urban
communities it was 6.5 g/day to 10.2 g/day. This ®nding
con®rms previous reports that in a population with a low
salt intake there is little or no hypertension.16
Although we did not measure the lipid pro®le, the
higher saturated fat intake in these indigenous com-
munities was strongly associated with hypertension. On
this concern, saturated fat intake is directly related to
cardiovascular risk but not with the devel-opment of type 2
diabetes,20 which is in agreement with our previous reports
concerning the absence of type 2 diabetes in these
indigenous communities.11 Cardiovascular risk associated
with intake of satu-rated fats may be related to an increase
in total and low-density lipoprotein-cholesterol serum
levels.
Further research is required in order to clearly de®ne the
role of saturated fats on the pathogenesis of hypertension in
the absence of other cardiovascu-lar risk factors.
ditional-living populations is lower than the preva-lence in
ethnic minorities living in developing com-
munities,1,2,6,10,14,15,17,21 suggesting that socio-cultural
changes related with a westernised lifestyle increase the
prevalence of hypertension.14 Although the number of
hypertensive indigenous that we identi®ed was small, it is
necessary to take into account that we included
approximately all the sub-jects living in the indigenous
communities. So, inferences on prevalence and
epidemiologic charac-teristics are representative for such
indigenous com-munities.
The best that can be inferred from this evidence is that
hypertension is a `disease of civilization' resulting from an
interaction between a modern life-style pattern that
promotes a lack of physical activity, a high prevalence of
obesity, with high salt consumption, and genetic factors.9,18
With respect to the role of race, there are no con-sistent
conclusions,16 and it is likely a source of bias to draw a
etiologic inferences of racial differences in the prevalence
of hypertension. What would be expected if these shared
indigenous groups had equal developing conditions and
diet with subjects in westernised communities? Further
research will be required to understand the role of race on
hyper-tension.
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