The effect of acculturation with cardiovascular disease (CVD) risk factors is poorly understood. We assessed the association of three acculturation measures (English language, US country of birth and a combination of the two) with CVD risk factors and co-morbid medical and behavioral conditions in a registry of 6,793 Latinos with hypertension. Greater acculturation was associated with higher adherence to medication (P < 0.05) and a higher prevalence of behavioral conditions (P < 0.01) but not with differences in prevalence of CVD risk factors, greater levels of CVD risk factor control or outcomes. Our study demonstrates that our proxies for acculturation were associated with behavioral risk factors, but not with the level of control of biomedical CVD risk factors. While more work is needed to develop proxies that can predict risk factor control and CVD outcomes, our simple measures can facilitate regular assessment of the cultural component of behavioral risk.