NIH Study Finds Link between Treatment-Resistant Hypertension and SDoH

NIH Study Finds Link between Treatment-Resistant Hypertension and SDoH

A recent study published in the Journal of the American Medical Association (JAMA) and funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH), has found that adverse economic and social conditions significantly increase the likelihood of developing treatment-resistant hypertension.

Such hypertension is defined as blood pressure that remains above 140/90 mmHg despite optimal use of three antihypertensive medications of different classes, including a diuretic. This condition significantly raises the risk of stroke, coronary heart disease, heart failure, and all-cause mortality.

The study analyzed data from 2,257 Black and 2,774 white adults participating in a larger study that includes over 30,000 Americans. Approximately half of these participants reside in the “Stroke Belt” in the southeastern United States, where stroke mortality rates are higher than the national average.

The social determinants of health (SDoH) factors in the study examined education level, income, social support, health insurance status, and neighborhood conditions. The study identified that several of these factors were linked to an increased risk of developing treatment-resistant hypertension, such as having less than a high-school education, a household income under $35,000, lack of social interactions, absence of someone to provide care during illness, lack of health insurance, residing in a disadvantaged neighborhood, and living in states with poor public health infrastructure.

Over a span of 9.5 years, the study observed that 24 percent of Black adults developed apparent treatment-resistant hypertension, compared to 15.9 percent of white adults. While adverse SDoH increased the risk for both groups, Black adults were disproportionately affected by these adverse conditions, leading to a higher incidence of the condition.

The researchers suggest that addressing the SDoH could mitigate the racial disparities observed and subsequently reduce the higher risks of stroke and heart attack among Black Americans. Effective interventions suggested included improving access to education, increasing household income, enhancing social support networks, expanding health insurance coverage, improving neighborhood conditions, and bolstering public health infrastructure.

In response to these findings, the NINDS Office of Global Health and Health Disparities is developing strategies to promote health equity. In August 2023, a supplement featuring 10 manuscripts was published, providing recommendations for addressing SDoH.

Furthermore, the NINDS’s Mind Your Risks® campaign, launched in 2016, highlights the link between high blood pressure and dementia, particularly targeting Black men ages 28-45. This campaign offers strategies for preventing and managing high blood pressure to improve brain and cardiovascular health.

Although the SDoH risk factors will take more than publications, manuscripts, and educational campaigns to change, this research is significant in acknowledging these disparities for future opportunities of targeted funding to high-risk communities.

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Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

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