Analysis of Blood Pressure Readings Among the Unsheltered Population of Miami-Dade County

Abstract

Title: Analysis of Blood Pressure Readings Among the Unsheltered Population of Miami-Dade County Background: Hypertension (HTN) can lead to adverse cardiovascular sequelae without appropriate management. People experiencing homelessness (PEH) are at increased risk of acute and chronic diseases, yet have poor access to HTN monitoring. Little is known about prevalence of HTN among unsheltered PEH. Our objective is to assess baseline HTN characteristics in the unsheltered PEH population of Miami-Dade County. Methods: Blood Pressure (BP) measurements were obtained by in-person clinic “street runs” where medical providers meet with unsheltered PEH in non-clinical environments such as overpasses and encampments. Vitals were recorded in RedCap electronic medical record system. Centers for Disease Control National Health and Nutrition Examination Survey (NHANES) 2017 – 2020 pre-pandemic data set represented the general population. Descriptive statistics and independent sample t-test comparisons were performed using SPSS v26. Results: BP was reported in 145 interactions – participant mean age 56.2 years (SD 10.5), 79.8% Male. The total average systolic BP (SBP) 140.14 (SD 22.28), diastolic BP (DBP) 87.99 (SD 12.74). Average visit 1 (N = 94) SBP 141.10 (SD 22.82), DBP 88.46 (SD 13.24). Average visit 2 (N= 22) SBP 145.45 (SD 21.69), DBP 89.82 (SD 12.45). No significant difference was found between visits 1 and 2. Elevated BP at two visits established formal HTN diagnosis, as defined by American College of Cardiology criteria. NHANES average SBP 119.81 (SD 19.38), DBP 71.61 (SD 12.02). NHANES data compared to average Visit 1 BP showed PEH to have significantly higher SBP (p<0.0001), DBP (p<0.0001). Age and gender stratification furthered internal validation. The average BP measurements of unsheltered PEH at clinic was in American Heart Association’s HTN Stage 2 category. Conclusion: BP of the PEH surveyed were higher than in the general population and within pathological staging criteria for HTN. Steady results from multiple visits suggest compounding factors beyond access to care: polysubstance use disorder, smoking, poor and unbalanced nutrition, chronic stress of being unsheltered. Future studies comparing unsheltered vs sheltered PEH could elucidate more information on risks and management of this deadly and preventable disease.