Evolving Patterns of Prevalence and Management of Hypertension Phenotypes in Mexico: A 2-Decade Analysis of Nationally Representative Surveys

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 phenotypes in the Mexican population over 2 decades. METHODS: We analyzed cross-sectional Mexican Health and Nutrition Surveys (2000-2024), including 146 904 adults aged ≥20 years. Hypertension was defined as self-reported diagnosis or blood pressure ≥140/90 mm Hg; undiagnosed hypertension (UDH) as blood pressure ≥140/90 mm Hg without prior diagnosis; and untreated hypertension as a prior diagnosis without treatment. UDH was classified as isolated systolic, isolated diastolic, or systolic-diastolic hypertension. We assessed trends with Poisson models and determinants of UDH and untreated hypertension with logistic models. RESULTS: We observed an overall decrease in hypertension prevalence from 33.1% in 2000 to 26.0% in 2024, concurrently with increases in diagnosed (12.3%-19.3%) and decreases in undiagnosed (20.7%-6.7%) hypertension. Isolated diastolic hypertension and systolic-diastolic hypertension declined over time, while isolated systolic hypertension increased, particularly among older adults. Among diagnosed cases, treatment percentage increased (69%-80%) and blood pressure control improved (40.5%-81.1%). Despite these trends, by 2024, ≈5 million Mexican adults still had UDH (25.9% of all hypertension cases), 2.9 million remained untreated, and 2.7 million were uncontrolled. Lack of diagnosis and treatment were more likely among men, individuals with unhealthy lifestyles, and those with social disadvantage. CONCLUSIONS: Results highlight evolving trends in hypertension diagnosis, treatment, and control in Mexico, with persistent challenges in UDH and untreated hypertension. Strengthening screening, treatment access, and equity is crucial to reduce hypertension-related cardiovascular risk.