Neighborhood level social determinants of health and loss of blood pressure control

A deeper understanding of the association between blood pressure (BP) control and neighborhood-level social determinants of health (SDOH) may help elucidate nonclinical factors that contribute to hypertension disparities. We sought to evaluate patterns of BP elevations by neighborhood-level SDOH domains.

In this single-center retrospective cohort study at Cedars-Sinai Medical Center, adults with ≥2 outpatient visits/year in at least 2 consecutive years (each consecutive 2-year period forms a dyad) from 2018 to 2023 were linked to the Healthy Places Index (HPI), a measure of neighborhood SDOH. Among patients with normotensive BP (BP <130/80 mm Hg) in the first year of at least 1 dyad, we assessed for the development of high BP (systolic BP ≥ 130 or diastolic BP ≥ 80 mm Hg) in the following year.

A total of 94,276 adults (median age 56.4 ± 18.8 years; 37.2% male) with BP <130/80 mm Hg, of whom 38,719 (41.1%) developed high BP. In analyses adjusting for demographic, clinical, and SDOH factors, risk of developing high BP was associated with living in a neighborhood with a HPI score in the lowest vs highest quartile (prevalence ratio [PR] 1.07, 95% CI: 1.05-1.10). This finding was primarily associated with the economic (1.04, 1.00-1.07) and educational attainment (1.05, 1.02-1.08) domains, captured as part of the HPI score.

In a cohort of >94,000 adults starting with BP <130/80 mm Hg, an increase in BP above this threshold in the following year was associated with neighborhood-level SDOH status, particularly variations in economic and educational attainment.