Hypertension represents the most important modifiable contributor to cardiovascular morbidity and mortality worldwide. Persistent failures in identifying, treating, and controlling elevated blood pressure reflect missed opportunities to reduce avoidable deaths. This study sought to quantify the prevalence of long-term undiagnosed, untreated, and uncontrolled hypertension among older adults in Mexico, to examine their socioeconomic distribution, and to estimate the likelihood of transitioning from these states to diagnosis, treatment, and sustained control over a five-year period. We used longitudinal data from Mexican adults aged 50 years and older participating in two survey waves (2009 and 2014) of the WHO Study on Global AGEing and Adult Health (SAGE). Hypertension was defined using objectively measured blood pressure, while information on prior diagnosis and treatment was obtained through self-report. We calculated five-year prevalence and transition probabilities and assessed socioeconomic inequality using concentration indices derived from a household wealth index. Multivariable probit models were applied to identify population groups facing the greatest obstacles to effective hypertension care. Among respondents with complete information (N = 945), more than three-fifths met the criteria for hypertension. A substantial proportion experienced persistent gaps in care: over one-third of those initially unaware of their condition remained undiagnosed after five years; more than 40% of untreated individuals continued without pharmacological management; and nearly two-thirds of those with uncontrolled blood pressure at baseline failed to achieve lasting control. While hypertension prevalence was higher among individuals in higher wealth groups, deficiencies in diagnosis, treatment, and control were disproportionately concentrated among socioeconomically disadvantaged populations. Persistent unmet need was more common among men, individuals not living with a partner, rural residents, those lacking health insurance coverage, and individuals with overweight. These results underscore significant weaknesses in Mexico’s hypertension care continuum. Improvements are needed not only in early detection and initiation of treatment but also in maintaining long-term blood pressure control. To reduce socioeconomic disparities and strengthen cardiovascular disease prevention, policies and interventions should prioritize sustained hypertension care for men, single adults, uninsured populations, and those with overweight.
