Abstract
Background: Patients from underrepresented backgrounds, including women of color, in the US have a higher prevalence of hypertension and may experience worse outcomes. Although there has been increased awareness regarding the importance of representation in cardiovascular studies, a substantial disparity in study populations persists. Objective: This study aimed to assess the inclusion and reporting of race-sex groups in studies conducted in the US between 2012-2022 that focused on primary hypertension as an outcome. Methods: We conducted a systematic search using Covidence to extract original peer-reviewed studies from PubMed and Embase. After removing duplicates, two investigators performed a title and abstract review to select studies. The studies that met the criteria underwent full-text screening and were downloaded to a shared spreadsheet. Additionally, studies with analyses by race-sex groups were identified and reviewed for theme extraction. Results: Out of 157 studies on hypertension, 20 studies (12.7%) reported results stratified by race-sex. Within these studies, women accounted for an average of 56.5 ± 14.7% of the overall study population, and the primary focus was on the prevalence of hypertension (N=17). However, some reported hypertension control (N=6), treatment (N=5), and trends (N=5). While all these studies included Non-Hispanic (NH) White and NH Black subgroups, only nine (45%) included Hispanic/Latinx, six (30%) included Asian American and Pacific Islander, and none included Native American/American Indian. Among the studies that reported demographic breakdowns (N=14), NH White individuals consisted of more than 50% of the study population in nine studies, whereas NH Black individuals comprised ≥20% of the study population in six studies. Conclusion: There is still a lack of studies on primary hypertension in the US that include and analyze - but most importantly - report their results by race-sex groups. Additionally, a significant gap persists in the inclusion of individuals from underrepresented backgrounds, especially Asian American and Pacific Islanders and Native American/American Indians. Future studies could benefit from incorporating race-sex analyses and results to address these disparities.
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