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REFLECTIONS
Hypertension
Hypertension Global Newsletter #5 2023

The authors of the 2023 guideline state that they contain
several conceptual elements of novelty supported by research
Hypertension
performed after the 2018 guidelines and deal more in-depth with
topics that were only briefly considered in the past, including
specific conditions that frequently coexist with hypertension
and warrant tailored approaches to BP lowering, including
pregnancy, peripheral artery disease, chronic inflammatory
diseases, and hypertension in oncology. In addition, whilst
the principal focus remains on hypertension in adults, the
updated guidelines include for the first time recommendations
on managing hypertension in children, adolescents, and young
adults.
WATCH
A WEBINAR SERIES BY THE CO-
CHAIRS AND OTHER AUTHORS OF CLICK HERE
THE UPDATED 2023 GUIDELINES. FOR THE LINK TO FULL ARTICLE

EPIDEMIOLOGY

Social determinants of health and uncontrolled blood pressure in a national

cohort of black and white US Adults: The REGARDS Study.
Akinyelure OP, et al. Hypertension. 2023 Jul;80(7):1403-1413.

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study examined data from 7306 White and 7497 Black
US adults taking antihypertensive medications between 2003 and 2007 with a focus on determining the contribution of social
determinants of health (SDOH) on uncontrolled BP. SDOH were defined using the Healthy People 2030 domains of education,
economic stability, social context, neighbourhood environment, and healthcare access. Uncontrolled BP was defined as SBP ≥140
mmHg or DBP ≥90 mmHg.

Among participants taking antihypertensive medication, 25.4% of Social Determinants of Health
White and 33.7% of Black participants had uncontrolled BP. The
SDOH included in the current analysis mediated the Black–White Education
difference in uncontrolled BP by 33.0% (95% CI, 22.1%–46.8%). Annual household income
Social determinants of health mediating Black:White differences in # of friends or relatives seen monthly
uncontrolled BP (≥140/90 mmHg) included low annual household Nobody to care for if ill
income (15.8%), low education (10.5%), living in a disadvantaged
neighborhood (11.0%), living in a health professional shortage Neighbourhood socioeconomic score
area (10.4%), and high-poverty zip code (9.7%). The likelihood of High poverty zip code
uncontrolled BP also increased with the number of SDOH. Rural area
Lack of health insurance
The authors suggest that interventions addressing SDOH at the Health professional shortage area
public policy, environmental, organizational, and individual levels Lack of public health infrastructure
may improve BP control and reduce Black:White disparities in
cardiovascular disease mortality.

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