Adverse SDOH may partially explain link between race and treatment-resistant hypertension
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Key takeaways:
- Social determinants of health such as education, income and socialization were tied to risk for treatment-resistant hypertension.
- This effect was disparately strong among Black adults compared with white adults.
Social determinants of health mediate the risk for treatment-resistant hypertension, especially among Black adults who may be disproportionately affected by barriers to equitable education and income, researchers reported.
A subanalysis of the population-based REGARDS study evaluating the effect of social determinants of health (SDOH) and risk for apparent treatment-resistant hypertension was published in the Journal of the American Heart Association.
“Fundamentally, race is a social rather than a biological construct. Black individuals in the U.S. are disproportionately affected by adverse SDOH. ... The 2018 resistant hypertension scientific statement noted SDOH as possible contributors to the higher prevalence of apparent treatment-resistant hypertension among Black adults,” Oluwasegun P. Akinyelure, MD, PhD, of the department of epidemiology at the University of Alabama at Birmingham, and colleagues wrote. “We used data from the prospective REGARDS study to estimate the association between SDOH at multiple levels (individual, ZIP code, county and state) and incident apparent treatment-resistant hypertension among white and Black adults.”
The NIH-funded REGARDS study is a population-based, longitudinal study of more than 30,000 white and Black adults aged 45 years or older from the contiguous U.S.
The present subanalysis of the REGARDS cohort was restricted to 5,031 participants who completed the baseline visit, had systolic BP and diastolic BP measurements and had self-reported antihypertensive use confirmed at baseline visit (mean age, 64 years; 41% men; 45% Black).
Participants with apparent treatment-resistant hypertension at baseline were excluded from the analysis.
Apparent treatment-resistant hypertension was defined as having systolic BP of at least 140 mm Hg or diastolic BP of at least 90 mm Hg, or systolic BP of at least 130 mm Hg or diastolic BP of at least 80 mm Hg for participants with diabetes or chronic kidney disease while on three or more classes of antihypertensive drugs or taking four or more classes of antihypertensive medication regardless of BP.
Five domains from the Healthy People 2030 framework were used to assess SDOH: education, economic stability, social context, neighborhood environment and health care access.
During a median follow-up of 9.5 years, 15.9% of white participants and 24% of Black participants developed apparent treatment-resistant hypertension.
SDOH domains and treatment-resistant hypertension risk
The researchers reported that risk for apparent treatment-resistant hypertension was higher among participants with more adverse SDOH in both white and Black adults.
After adjustment for age and sex, Akinyelure and colleagues reported that Black participants had a 59% (HR = 1.59; 95% CI, 1.39-1.82) higher total effect risk for apparent treatment-resistant hypertension compared with white participants.
The 59% excess risk for apparent treatment-resistant hypertension among Black participant was primarily mediated:
- 14.2% with less than a high school education (95% CI, 5.1-24.8);
- 16% with annual household income less than $35,000 (95% CI, 6.3-28.4);
- 8.1% if not seeing a friend or relative in the past month (95% CI, 1.7-15.1);
- 7.6% if not having someone to care for them if ill or disabled (95% CI, 0.9-14.2);
- 18% if living in a disadvantaged neighborhood (95% CI, 5.5-36.9);
- 10.6% with lack of health insurance (95% CI, 3.8-17.9); and
- 6% if residing in states with low public health infrastructure (95% CI, 0.1-13.1).
Address ‘barriers to equitable education and income’
“Addressing adverse SDOH, a product of structural racism that contributes to disparities in cardiovascular disease risk factors between white and Black adults, may address the root causes of hypertension disparities,” the researchers wrote. “Patient educational and income levels have been previously shown to be related to health behaviors, health literacy and medication adherence, which are particularly important among individuals with apparent treatment-resistant hypertension. Addressing structural barriers to equitable education and income attainment among Black compared with White adults may reduce racial disparities in apparent treatment-resistant hypertension risk.”
Reference:
- Adverse social determinants of health linked to treatment-resistant hypertension in Black Americans. https://www.nih.gov/news-events/news-releases/adverse-social-determinants-health-linked-treatment-resistant-hypertension-black-americans. Published May 16, 2024. Accessed May 20, 2024.
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