IMPORTANCE: Among US Hispanic or Latino adults, the burden of hypertension is high, with substantial variation by heritage group. The long-term incidence of hypertension and prevalence of blood pressure (BP) control in this population have not been well characterized.

OBJECTIVE: To estimate the 12-year incidence of hypertension and prevalence of BP control in a diverse cohort of US Hispanic or Latino adults.

DESIGN, SETTING, AND PARTICIPANTS: This population-based prospective cohort study used data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), which is a longitudinal cohort of 16 415 Hispanic or Latino adults examined at visit 1 (V1, 2008-2011), V2 (2014-2017), and V3 (2020-2024). The participants were community-dwelling Hispanic or Latino adults aged 18 to 74 years at V1 who also participated in person at V3 (n = 9061) from 4 urban centers in the US (Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California). Data were analyzed from April 1, 2025, to May 29, 2026.

EXPOSURES: Self-identified Hispanic or Latino heritage (Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American).

MAIN OUTCOMES AND MEASURES: Hypertension was defined as measured systolic BP (SBP) 130 mm Hg or higher, diastolic BP (DBP) 80 mm Hg or higher, or self-reported use of antihypertensive medication. BP control was defined as SBP lower than 130 mm Hg and DBP lower than 80 mm Hg.

RESULTS: Among 9061 participants, the mean age was 41.1 years (95% CI, 40.5-41.7 years), and 5274 (52.8% [95% CI 51.3%-54.3%]) were female. Among 5082 participants without hypertension at V1, 50.5% (95% CI, 47.6%-53.4%) developed hypertension over a mean of 12.4 years (95% CI, 12.4-12.5 years), corresponding to an age-adjusted incidence rate of 36.4 (95% CI, 34.2-38.8) per 1000 person-years. Compared with South American adults, Central American adults (incidence rate ratio [IRR], 1.47 [95% CI, 1.13-1.91]), Cuban adults (IRR, 1.72 [95% CI, 1.36-2.17]), and Dominican adults (IRR, 1.43 [95% CI, 1.07-1.91]) had higher rates of incident hypertension. Among individuals treated for hypertension, the prevalence of BP control decreased from 40.2% (95% CI, 32.7%-48.3%) at V1 to 34.7% (95% CI, 30.9%-38.8%) at V3.

CONCLUSIONS AND RELEVANCE: In this cohort study of diverse Hispanic or Latino adults, approximately half developed hypertension over 12 years, with low rates of BP control and marked disparities by heritage group. Findings emphasized the need for tailored prevention and treatment strategies within the diverse US Hispanic or Latino population.