Blood Pressure Control and Maintenance in U.S. Veterans: Roles of Sex, Race, Ethnicity, and Deprivation

U.S. Veterans have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. Thus, blood pressure (BP) control is particularly beneficial for younger Veterans, discharged after October 1, 2001 (ie, post-9/11).

The objective of the study was to assess BP control and maintenance by sociodemographic characteristics among post-9/11-era Veterans with new-onset hypertension.

This retrospective cohort study included data from all post-9/11 Veterans who received care in U.S. Veterans Affairs medical centers, October 1, 2001-September 30, 2023 (n = 1,280,441). Hypertension was defined as the first diagnosis, antihypertensive fill, or ≥2 outpatient BP ≥140/90 mm Hg. Exposures were sex, race, and ethnicity. The Social Deprivation Index was calculated from zip codes. Logistic regression tested associations between sociodemographic variables and BP control (<140/90 mm Hg), 1, 2, and 5 years after hypertension onset, while covarying demographics, behavioral, and clinical factors.

Overall, 31% of patients met the hypertension criteria and had adequate follow-up (n = 398,732; median age: 37 years, 10% women, 63% non-Hispanic [NH] White). One year after onset, 43% of men and 60% of women achieved BP control, improving to 59% and 67% by 5 years. After adjustment, women had greater odds of control at 1 year (OR: 1.85; 95% CI: 1.81-1.90), which remained at 5 years (OR: 1.39; 95% CI: 1.34-1.44). Relative to NH White patients, Hispanic patients had 23% to 17% greater control odds, and NH Black patients had 10% to 23% lower odds through 5 years. Inclusion of the social Deprivation Index did not change these results.

The first year of hypertension management portends future differences in BP control. Earlier strategies are needed to improve BP control in a population at high-risk for cardiovascular disease.