P035 SOCIAL DETERMINANTS OF HEALTH AND CONTROL OF HYPERTENSION

Abstract

Background and Objectives: Recent national blood pressure (BP) survey data of adults in Canada and United States show a troubling decline in the control of hypertension, particularly in women, the elderly and those with low income, less education and under-using health services. Social determinants of health (SDH) can be important barriers to controlling hypertension. Studies assessing associations of BP control and SDH have focused on one or a few domains. Objectives of this study are to screen treated hypertensive patients for a wide range of SDH, test for correlations and assess the effects of high-quality treatment on SDH and BP control relationship. Method: We created and applied a screening tool to gather personal information on 14 SDH from consecutive consenting eligible patients attending a complex hypertension care clinic. Logistic regression was used to assess association of each SDH domain with BP control. Results: Of 90 patients enrolled, 88 completed the 6-month study. At baseline, mean age (standard deviation) was 64 (14) years, 64% male, 69% white, 25% experiencing financial hardship, mean BMI 30.4 kg/m2 (5.9), mean automated office BP 138/78 (23/14), mean number of co-morbid conditions 4.2 (2.0) and 55% had treatment-resistant hypertension. From baseline to exit, BP fell to 127/73 (17/12), p<0.001, mean number of antihypertensive drug classes increased from 3.06 (1.43) to 3.23 (1.30), p=0.049 but BMI remained unchanged. There were no associations between uncontrolled hypertension and any of the 14 SDOH domains at baseline. However, at exit financial status was associated with uncontrolled hypertension on univariate analysis (p=0.022) and on multivariate analysis. Stress (p=0.063) and optimism status (p=0.085] showed a similar trend. These analyzes indicated better BP control among those with poorer financial status, higher stress levels or more pessimistic outlook. Conclusion: None of the SDOH were associated with uncontrolled hypertension at baseline. However good medical care and follow-up appeared to have improved BP control, noticeably in those experiencing financial hardship. Explanation of findings requires further study.