Hypertension is a modifiable risk factor for cardiovascular disease (CVD) and its prevalence is high in the United States and worldwide. Adequate characterization of blood pressure (BP) is essential for the diagnosis and management of hypertension. However, BP assessment can be challenging because of the unique influences across the lifespan, disease conditions, and physical environmental context. Moreover, complex uncertainties in BP assessment may contribute to underdiagnosis, undertreatment, and preventable morbidity and mortality. Recent advances in BP measurement devices have enabled comprehensive characterization of BP that could dramatically change how hypertension is managed to optimize CVD risk reduction, avoid complications of low BP, and improve hypertension control rates. To address the rapidly evolving landscape in BP assessment, the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a 2-day workshop of clinicians and researchers in December 2024. The present report summarizes the topics presented and discussed during the meeting, which focused on the latest evidence on BP assessment as well as obstacles and knowledge gaps to be addressed to advance BP assessment in clinical practice and research.

Guidelines recommend adults with diabetes should know their hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL)-cholesterol levels and goals. Determine the proportions of US adults with diabetes who report knowing their HbA1c, BP, and LDL-cholesterol levels and goals as recommended by their doctor or healthcare provider. A cross-sectional analysis of the US adults with self-reported diabetes from 2011–2020 in the National Health and Nutrition Examination Surveys (NHANES). US adults in NHANES with self-reported diabetes. Sociodemographic characteristics including age, sex, race and ethnicity, education, and health insurance coverage were assessed using standardized questionnaires. The outcomes were self-report of knowing HbA1c, BP, and LDL-cholesterol levels and goals. Age-sex-adjusted Poisson regression models with robust variance estimation were used to estimate associations of participant characteristics with each of these outcomes. Among US adults with diabetes included in the analysis (N = 3,464), 58.3

Background: In rural Bangladesh, there are several challenges to improving hypertension treatment coverage and control, particularly the scarcity of physicians and centralized delivery of hypertension care, which requires patients to travel a long distance to healthcare facilities (Upazila Health Complexes [UHC]). Aim: To assess the feasibility of implementing a community-based (CB) WHO HEARTS package involving non-physician health workers (Community Healthcare Providers [CHCP]) to diagnose and treat patients with hypertension in Community Clinics (CC) under telemedicine supervision and guidance of a UHC physician. Methods: This single-arm pilot study was conducted in four CCs in rural Bangladesh among adults with untreated hypertension [blood pressure (BP) 140-180/90-110 mmHg]. The CB-HEARTS package intervention components were 1) simplified treatment protocol, 2) reliable medication supply, 3) team-based care, 4) standardized follow-up, and 5) an information system to track patients’ BP control. Through teleconsultancy, CHCPs communicated with designated UHC physicians to confirm the diagnosis of hypertension and initiate treatment with amlodipine 5 or 10 mg/day in the CC. Patients with controlled BP (<140/90 mmHg) during follow-up were provided a 3-month medication refill. Patients with complications or uncontrolled BP after medication titration according to the treatment protocol were referred to the UHC. Enrollment and retention rates were primary outcomes, and BP change and hypertension control were secondary. Results: Of 244 who were eligible, 220 (90.2%) individuals with hypertension were enrolled (mean age 56±13.8 years, 76% female). Overall, 97% of enrolled participants started medication treatment. Retention rates at the CC were 88%, 88%, and 85% at 3, 6-12, and 12-18 months, respectively ( Table ). Mean systolic/diastolic BP was 153/92 mmHg at enrollment. BP was lowered by ~35 mmHg systolic and ~18 mmHg diastolic ( Figure ) over 18 months of follow-up. The hypertension control rate was ~98% during the follow-up among patients retained in the program. Conclusions: This pilot study indicates decentralized hypertension care delivered by non-physician health workers through remote supervision of physicians is feasible to implement and may considerably improve hypertension control in rural Bangladesh. A randomized trial to test the safety, effectiveness, and acceptability is warranted.

Background: Black adults in rural areas have higher obesity prevalence (48.3%), lower socioeconomic status, and decreased access to health services contributors to poor cardiovascular health. Further, stress among Black adults have been associated with higher BMI. This work examines whether psychosocial stress is associated with higher BMI among Black adults in rural communities. Methods: Baseline data from 344 Black adults, ≥19 years older from the Black Belt area in Alabama fromthe EPIPHANY study (a multilevel lifestyle intervention trial to reduce systolic blood pressure [SBP]). Psychosocial stress was assessed using the Perceived Stress Scale (PSS-4). Total PSS-4 score was calculated, and participants were grouped into low (scores [0-5]) and moderate/high (scores 6-10 and 11-16, respectively) by sex. Weight and height were measured to calculate BMI. BMI was categorized as <25 kg/m 2 (under-/normal weight) or > 25 kg/m 2 (overweight/obese). Adjusted prevalence ratios (PR) were calculated to evaluate the association between stress and overweight/obesity, by sex, adjusting for social determinants of health (Model 1), health behaviors (Model 2) and initial systolic and diastolic blood pressure (Model 3). Results: The mean age of participants was 41.4 (13.1) years and 68.0% were women. Men and women reporting higher stress were more likely to earn <$30,000 annually and reported higher levels of depression (15%, p=0.003 and 35.2%, p<0.001, respectively). Among women, those reporting higher stress were more likely to be younger (39.6 vs 43.9 years, p=0.014) and delay healthcare due to cost (29.7% vs 6.4%, p < 0.001) vs those reporting lower stress. Men reporting higher stress were significantly more likely to be current smokers (40.0%, p=0.022) vs those reporting low stress. Men had higher prevalence of obesity in lower and moderate/high stress (76.9% and 84.4%, respectively (Figure 1). Multivariable adjusted PR found men with higher stress scores were 12% (Model 1) to 15% (Models 2 and 3) more likely to have overweight/obesity vs those with lower stress scores, yet not statistically significant. There was no evidence of an association among women (Table 1). Conclusion: Over 80% of both women and men reporting higher stress had overweight/obesity vs those with lower stress score, though not statistically significant. These findings support opportunities to address health behaviors, depression, and psychosocial stress among Black adults in rural communities.

Background Hypertension is the leading preventable risk factor for premature death worldwide. Accurate estimates of prevalence and control are critical for developing public health priorities. Objective This study sought to examine global variations in hypertension prevalence, awareness, treatment, and control by world economic region and compare secular changes from 2000 to 2020. Methods A systematic search of MEDLINE from January 1995 to November 2024 was supplemented with manual searches of article references. Population-based cross-sectional surveys reporting age- and sex-specific hypertension prevalence and using standardized blood pressure measurement methods were included. Sex- and age-specific prevalence by country was applied to population counts to calculate the number with hypertension regionally and worldwide. Country-specific percentages of awareness, treatment, and control were applied to numbers of adults with hypertension to obtain regional and global estimates. Hypertension was defined as mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication. Results We included 287 studies conducted in 6,060,567 adults from 119 countries. In 2020, 33.0% (95% CI: 32.5%-33.5%), or 1.71 (95% CI: 1.65-1.77) billion, of the world’s adults had hypertension: 30.1% (95% CI: 29.4%-30.9%), or 395 (95% CI: 394-396) million, in high-income countries and 33.4% (95% CI: 32.8%-33.9%), or 1.32 (95% CI: 1.26-1.38) billion, in low- and middle-income countries. From 2000 to 2020, age-standardized prevalence decreased by 2.7% and absolute burden increased by 76 million in high-income countries compared with increases of 5.8% in prevalence and 651 million in absolute burden in low- and middle-income countries. From 2000 to 2020 in high-income countries, awareness increased from 57.7% to 69.2%, treatment from 42.9% to 66.3%, and control from 16.4% to 40.2%. More modest increases were observed in low- and middle-income countries: awareness from 29.1% to 46.1%, treatment from 20.7% to 30.8%, and control from 6.4% to 13.6%. Conclusions The burden of hypertension is increasing, as are disparities between high-income countries and low- and middle-income countries. Urgent efforts are needed to address hypertension worldwide, particularly in low- and middle-income countries.

Background: Lifestyle modification is central to hypertension prevention and control. Despite its recognized importance, few community-based clinical trials have evaluated short-term behavioral change within multicomponent interventions. Objective: To examine six-month changes in diet, sleep, and physical activity, among adults in a hypertension prevention trial [Home Blood Pressure Telemonitoring LINKED with CHWs to Improve Blood Pressure(LINKED-BP) Program (NCT05719647)] randomized to a multilevel intervention versus enhanced usual care. We hypothesized that participants in the intervention arm would have greater improvements in these lifestyle behaviors than those in the control arm. Methods: Participants were adults aged ≥18 years at risk for stage 2 hypertension who were enrolled in the LINKED-BP Program. This cluster randomized clinical trial was conducted across health systems in Maryland and the Washington, DC metropolitan area. Participants were randomized to a multi-level intervention with community health workers providing education and lifestyle modification support or enhanced usual care over a 12-month period. For this analysis, we included participants with baseline and 6-month survey data. We assessed six-month changes in diet (Mediterranean Eating Pattern for Americans score), nightly sleep duration (hours), and physical activity (International Physical Activity Questionnaire). Descriptive statistics and multivariable linear regression were used to analyze the association between study arm and changes in lifestyle behaviors. Results: Participants (N=335) had a mean age of 43.1 (± 12.2) years and 69% were female ( Table 1 ). Between baseline and 6 months, physical activity increased modestly across both groups (602 to 834 MET-min/week overall), but the change was not statistically significant (Table 2 ) . Other lifestyle behaviors remained largely unchanged. Multi-variable adjusted models comparing the intervention with enhanced usual care showed no significant between-group differences in the changes in diet (0.28 [–0.20, 0.75]), sleep (–0.03 [–0.30, 0.25]), or physical activity (51.4 [–206.9, 309.7]) (Table 3 ). Conclusions: Preliminary data from this cluster-randomized trial showed non-significant within-group improvements in physical activity over 6 months. Achieving meaningful behavioral change in real-world hypertension management may require more intensive, sustained, and equity-focused interventions.

Background: Hypertension guidelines recommend the use of automated BP devices over manual devices to reduce observer bias, such as terminal digit preference. We aimed to evaluate systematic differences in BP readings and the association with incident stroke according to type of measurement. Methods: Using de-identified electronic health record data from Optum Labs Data Warehouse from primary care visits in 2024, we classified providers' BP measurement method using proportion of odd terminal digit preference as a proxy for manual devices (defined as <0.5% odd digits) and automated devices (defined as 45-55% odd digits). Results: Among 336,634 matched patients, mean SBP in the automated group was 131.7 (19.3) mmHg and 125.9 (14.8) mmHg in the manual group. The absolute percentage of patients meeting BP clinical thresholds differed substantially (<130/80: automated 33.2% vs. manual 38.8%; <140/90: automated 61.2% vs. manual 70.9%). Among 686,482 matched patients in the 2019 cohort, the manual group had a 1.16-fold (1.10-1.22) higher risk of stroke at any given BP compared to the automated group. Conclusion: Manual BP measurement was associated with lower mean BP, BP control, and potential underestimation of stroke risk. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by National Heart, Lung, and Blood Institute (K24HL155861) and National Institute of Diabetes and Digestive and Kidney Diseases (R01DK115534). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the institutional review board at New York University Grossman School of Medicine. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Under agreement with the OLDW we cannot share individual data with third parties.

Background The rate of hypertension hospitalizations is increasing among US adults. Individuals with low socioeconomic position are more likely to have high blood pressure (BP), which may increase their risk of hypertension hospitalization and adverse post-discharge outcomes. Methods We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which enrolled 5115 adults aged 18 to 30 years from 4 urban US communities in 1985-1986. Hospitalizations were identified by self-report during study exams and annual interviews, with hypertension hospitalizations determined through medical record review, through August 2020. Socioeconomic position included education, family income, having private health insurance, and neighborhood deprivation assessed at the last study visit prior to the hypertension hospitalization. Uncontrolled BP (≥140/90 mmHg) was determined at the first CARDIA study visit after hypertension hospitalization. Results Overall, 67 CARDIA participants were hospitalized for hypertension. The hazard ratio of hypertension hospitalization among participants who had less than high school vs high school or more education was 3.12 [95% CI, 1.78-5.48], whose family income was <$25,000 vs ≥$25,000 was 2.43 [95% CI, 1.44-4.11], who had no private vs private insurance was 2.58 [95% CI, 1.56-4.28] and those in tertile 3 vs tertile 1 of neighborhood deprivation index (most vs least deprived) was 3.06 [95% CI, 1.23-7.58]. Among 46 participants who attended a CARDIA study visit following hospital discharge, 23 (50%) had uncontrolled BP. Conclusion Adults with low socioeconomic position were more likely to be hospitalized for hypertension. Uncontrolled BP was common following hypertension hospitalization.

Background The Ethiopian government is considering implementation of a front-of-package label policy to address the rising prevalence and burden of diet-related, non-communicable disease. The objective of this study was to determine the most effective labels to discourage purchase of less healthy packaged foods in Ethiopia. Methods This study was a randomized controlled trial with four arms (no label and three labels) among adults in Addis Ababa, Ethiopia (n = 1200). The primary outcome was mean intent to purchase on a 7-point Likert scale across four products. A secondary outcome was the proportion of participants correctly identifying excess sugar or sodium. Results The mean intent to purchase score among participants randomized to the Nutrient Warning Labels arm was 4.37 (95% CI: 4.16, 4.59), which was significantly lower (p ≤ 0.003) than no label, Multiple Traffic Light Label, or Nutri-Score Label arms. 62% of participants in the Nutrient Warning Labels arm correctly identified that either sugar or sodium was in excess across all four products, which was significantly higher than other study arms. Participants reported that Nutrient Warning Labels and the Multiple Traffic Light Label aided in making purchasing decisions, drew attention, were trustworthy, and were easy to understand. Participants were significantly more worried about children consuming food and drink displaying Nutrient Warning Labels compared to other labels (p < 0.001). Conclusions Nutrient Warning Labels were the only label that significantly reduced intent to purchase packaged foods containing excess levels of sugar or sodium among consumers in Ethiopia. Implementation of a mandatory policy requiring packaged foods to display Nutrient Warning Labels is recommended in Ethiopia. Trial Registration This trial was registered at https://www.clinicaltrials.gov on September 9, 2022 (NCT05549388).

Introduction: Perceived risk of hypertension may influence health behaviors, but data are limited among Black adults, a population with a high prevalence of hypertension and low preventive healthcare engagement. We examined associations between perceived hypertension risk and healthcare use in Black adults with elevated blood pressure (BP) or untreated stage 1 hypertension. Methods: Data were from two community-based trials in the AHA Health Equity Research Network on Hypertension Prevention (RESTORE), the EPIPHANY (Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity) trial, which included Black adults from rural Alabama, and CLIP (Community-to-Clinic Linkage Implementation Program in Barbershops), which included Black men from New York City. All participants had systolic BP 120-139 mmHg and/or diastolic BP 80-89 mmHg. Perceived hypertension risk was assessed by asking participants what they thought their chances of developing hypertension were “below average”, “average”, or “above average” compared to adults of the same age and sex. Healthcare use outcomes were having: 1) a usual place of care and 2) a recent healthcare visit (in the last 12 months). We estimated prevalence ratios for associations between perceived risk and healthcare use, overall and by site and sex. Results: The analysis included 761 participants (mean age 39.5 years, 30.0% women). Overall, 51.9% reported a “below average” hypertension risk ( Figure 1 ). A higher proportion of participants with perceived “below average” risk than with higher perceived risk was insured and reported having a high school education or less ( Table 1 ). In EPIPHANY participants, perceived risk was not associated with healthcare use. Among CLIP participants, those with “average” or “above average” risk were more likely to have a usual place of care than those with “below average” risk but were less likely to have had a recent healthcare visit ( Table 2 ). Conclusion: In the current study of Black adults with elevated BP or stage 1 hypertension, over half of participants perceived themselves to be at a “below average” risk for hypertension. Associations between perceived risk and healthcare use differed by site. Higher perceived hypertension risk among urban Black men was associated with having a usual place of care but with lower likelihood of having a recent healthcare visit, underscoring the need to convert risk awareness into ongoing preventive care.

Importance:There are disparities in blood pressure (BP) levels by race in the US. Objective:To estimate the number of cardiovascular disease (CVD) events and deaths that could be prevented among non-Hispanic Black adults by achieving the same mean systolic BP (SBP) as non-Hispanic White adults 45 years or older. Design, Setting, and Participants:In this modeling study, the difference in mean SBP between non-Hispanic Black and non-Hispanic White US adults was calculated from the 2015-2020 cycles of the National Health and Nutrition Examination Survey (NHANES). The 10-year cumulative incidence of CVD, including stroke, coronary heart disease, and heart failure, and CVD mortality for non-Hispanic Black adults were calculated using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The relative risk reduction for CVD events and mortality with initiation and intensification of antihypertensive medication treatment was applied from the Blood Pressure Lowering Treatment Trialists Collaboration (BPLTTC), calibrated to reflect the SBP reduction for non-Hispanic Black adults to have the same SBP as non-Hispanic White adults. Data were analyzed from June 22, 2022, to August 13, 2025. Exposure:Systolic blood pressure. Main Outcomes and Measures:Number of CVD events and deaths. Using data from NHANES, REGARDS, and BPLTCC, the cumulative incidence of CVD events and deaths expected over the next 10 years with current SBP levels and with SBP equity was estimated. Results:Among 82.3 million US adults included in the study, 37.2 million (45.3%) were men, 45.0 million (54.7%) were women, 10.1 million (12.2%) were non-Hispanic Black, and 72.2 million (87.8%) were non-Hispanic White. The mean (SD) age was 60.8 (0.3) years. The mean SBP was 130.7 (95% CI, 129.0-132.5) mm Hg among non-Hispanic Black adults and 124.2 (95% CI, 123.1-125.3) mm Hg among non-Hispanic White adults for those not taking antihypertensive medication (difference, 6.5 [95% CI, 4.5-8.5] mm Hg), and 137.8 (95% CI, 135.8-139.8) mm Hg among non-Hispanic Black adults and 131.2 (95% CI, 129.7-132.7) mm Hg among non-Hispanic White adults for those taking antihypertensive medication (difference, 6.5 [95% CI, 4.0-9.1] mm Hg). Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD events during 10 years by 50 434 (95% CI, 33 985-71 137) among non-Hispanic Black US adults not taking antihypertensive medication and 122 881 (95% CI, 83 220-176 826) among non-Hispanic Black adults taking antihypertensive medication. Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD deaths during 10 years by 21 703 (95% CI, 7313-40 278) among non-Hispanic Black US adults not taking antihypertensive medication and 55 055 (95% CI, 19 823-99 693) among non-Hispanic Black adults taking antihypertensive medication. The largest proportion of CVD events and deaths prevented were among those aged 45 to 64 years. For example, more than half of CVD events prevented among non-Hispanic Black adults not taking antihypertensive medication (55%) were in that age group. Conclusions and Relevance:The findings of this modeling study suggest that achieving SBP equity between non-Hispanic Black and White adults could substantially reduce the number of CVD events and deaths experienced by non-Hispanic Black US adults. Initiatives to maintain normal BP and achieve BP control for individuals with hypertension could have a substantial impact on health equity in the US.

Background: Hypertension is leading risk factor for cardiovascular disease, which disproportionately affects racial and ethnic minority populations. These groups are often underrepresented in studies of hypertension prevention strategies due to persistent recruitment and engagement challenges including lack of trust in medical research. The LINKED-BP trial—a pragmatic, multi-level intervention combining home blood pressure telemonitoring and support from community health workers—was designed to address these disparities. Understanding how best to recruit these populations and demographic or clinical differences among those who do and do not enroll in hypertension prevention trials are essential to improving equitable participation. Objectives: To evaluate which recruitment strategies were most effective and examine the demographic and clinical differences—including age, ethnicity, and gender—that distinguish individuals who were eligible but did not enroll from those who successfully enrolled in the LINKED-BP trial. Methods: We conducted a cluster-randomized trial across 20 primary care practices in Maryland and Washington, DC. Eligible adults (ages 18–65 years) had elevated blood pressure (120–129/<80 mm Hg) or untreated stage 1 hypertension (130–139/80–89 mm Hg) without diabetes or cardiovascular disease. Using a HIPAA waiver, we identified potential participants via electronic records and recruited them through mailed letters, email, MyChart, calls, and SMS. We evaluated recruitment effectiveness by method of first contact and compared demographic characteristics of individuals who were eligible who did and did not enroll. Results: We sent invitations to 921 potentially eligible participants, including 180 invitations via snail mail, 97 via email, 439 via SMS, 205 via MyChart. Of those, 704 were eligible, 499 consented, and 451 were enrolled. The outreach strategies with the highest recruitment yield were MyChart and email. Among participants who were eligible for the study, no significant differences in enrollment by age or gender. A higher proportion of those who did not enroll versus those who did enroll were Non-Hispanic Black individuals. Conclusions: The most effective recruitment strategies were email and electronic patient portal (My Chart) outreach. However, demographic differences by race/ethnicity between enrolled and non-enrolled participants underscore the need for targeted strategies to ensure equity in hypertension prevention trial participation.

Introduction: Digital health literacy (DHL) reflects one's ability to navigate electronic health resources, while patient activation measures an individual's knowledge, skills, and confidence in managing their health. Both are essential for mitigating hypertension. Disparities in DHL across non-rural and rural health systems, as well as social determinants of health (SDoH), may pose barriers to effective patient care. Objective: To examine the association between DHL and patient activation among adults at risk for stage 2 hypertension, adjusting for health system types and SDoH. Methods: We conducted a cross-sectional analysis using baseline survey data from adults at risk for stage 2 hypertension enrolled in the “Home Blood Pressure Telemonitoring LINKED with CHWs to Improve Blood Pressure” (LINKED-BP) Program, a randomized clinical trial in health systems in Maryland and the Washington, DC metro area. Patient activation was assessed using the 13-item Patient Activation Measure (PAM-13, range 0-100). DHL was measured using the 8-item eHealth Literacy Scale (eHEALS, range 8–40; eHEALS < 26: low DHL; eHEALS ≥26: high DHL). Health system rurality was defined by the Federal Office of Rural Health Policy. Covariates included SDoH: age, sex, income, education, insurance, and race/ethnicity. We used descriptive statistics and multivariable linear regression to assess the association between DHL (both continuous and categorical) and patient activation, adjusted for covariates. Results: Among 264 participants, 121 received care from a rural and 143 from a non-rural health system. A greater proportion of participants with low DHL vs high DHL were from the rural health system (70.3% vs 41.9%, P=0.001) (Table 1). Rural participants were more likely than non-rural to have a high school education or less (24.0% vs 1.4%, P<0.001) (Table 2). Each one-point increase in eHEALS was associated with a 0.86 higher patient activation score (95% CI: 0.59-1.13) (Table 3) in the fully adjusted model. Participants with high DHL had patient activation scores that were 7.58 points higher (95% CI: 2.68-12.47) compared to those with low DHL (Table 3) in the fully adjusted model. Conclusions: Higher DHL was associated with greater patient activation among adults at risk for stage 2 hypertension after adjusting for health system type and SDoH. Future studies should explore how tailored digital resources for underserved and rural areas may reduce disparities in chronic disease outcomes.

Social determinants of health (SDoH), health care use, and cardiovascular disease (CVD) risk perception are understudied among men who identify as Black and Hispanic. In this study we sought to describe these factors among a cohort of urban-residing Black men, participants in a community-engaged trial on hypertension prevention. We focused on presenting intermediary SDoH, including material circumstances, health behaviors, and psychosocial factors, which allow for a more robust understanding of health inequities but are underexplored. We analyzed baseline trial data (N=430) and compared subgroups (44% of participants self-identified as having Hispanic ethnicity and a Black racial identity). Average age was 38 years, with mean blood pressure of 129/83 mmHg. Hispanic Black (HB) men reported higher unemployment (21.4% versus 11.1%, P=.02) and more housing instability (28.7% versus 18.6%, P=.01) than did non-Hispanic Black (NHB) men. Overall, HB men reported worse household conditions compared with NHB men. Approximately half of both groups reported high stress, 45% (HB) and 51% (NHB), respectively. Both groups had low perception of personal CVD risk and underutilized health care. Hispanic Black men were less likely to have a primary care provider than were NHB men (17.6% versus 29.3%, P<.001). Non-Hispanic Black men reported lower physical activity than did HB men (median, 2655 vs 2547 metabolic equivalent minutes/week, P=.03). Recognizing heterogeneity among Black populations, including in social drivers of CVD disparities, will allow for more precision in designing CVD health promotion interventions. Findings also suggest that perception of personal CVD risk and health care utilization may be important targets for CVD prevention in Black men.

Background: Terminal digit preference (TDP) is an overrepresentation of blood pressure (BP) measurements ending in certain end digits, most often 0 or 5, which may result in misclassification of hypertension status and suboptimal treatment decisions. We evaluated whether use of oscillometric devices and BP measurement training for healthcare professionals impacted TDP in primary care settings. Methods: We analyzed data from 14 clinics in Maryland and DC participating in the Home Blood Pressure Telemonitoring LINKED with Community Health Workers to Improve B lood P ressure (LINKED-BP) Program, a randomized clinical trial of a home BP telemonitoring intervention for adults at risk for stage 2 hypertension. Clinic systolic BP (SBP) and diastolic BP (DBP) measurements were recorded before and after clinical training on proper BP measurement techniques, including positioning, cuff selection, measurement protocols, and TDP. BP measurements from 262 participants pre-training and measurements from 143 participants post-training were included. We examined the distributions of SBP and DBP pre- and post-training and calculated the percent of measurements ending in each end digit 0-9. We used chi-square tests to compare the observed terminal digit distributions to the expected uniform distribution. Results: At baseline, there was no visual evidence of TDP in the distributions of SBP or DBP measurements. Pre-training, 10.3% of SBP measurements and 8.8% of DBP measurements ended in 0. There was no evidence of a difference in the observed terminal digit distributions for SBP (p=0.978, Figure 1) or DBP (p=0.749) compared to the expected uniform distribution. After BP measurement training, 9.8% of SBP and 8.4% of DBP measurements ended in 0 and there was no evidence of TDP for either SBP (p=0.993, Figure 2) or DBP (p=0.951). Conclusions: We found no evidence of TDP at pre- or post-training. The results suggest that participating clinics were already employing appropriate BP measurement recording practices, possibly due to annual education, prior participation in research, and widespread use of oscillometric devices. These findings highlight the importance of evaluating BP measurement quality in hypertension prevention and management studies to tailor BP measurement training. Future research could explore the impact of training on other aspects of the BP measurement procedure and factors contributing to high-quality BP measurements in primary care.