DOI: 10.1161/circ.148.suppl_1.12012 ISSN: 0009-7322

Abstract 12012: Adverse Social Determinants of Health Are Associated With Increased Risk of Uncontrolled Hypertension Among Cancer Patients in Rural Georgia: A Prospective Cohort Study

Priyanshu Nain, Nickolas Stabellini, Sandeep Yerraguntla, Gaurav Gopu, Aditya Bhave, Lakshya Seth, Vraj Patel, Stephanie Jiang, Sarah Malik, Neal L Weintraub, Alberto J Montero, Alusine Fofanah, Jennifer Cullen, Neeraj Agarwal, Xiaoling Wang, Bonnie Ky, Lauren A Baldassarre, Ryan A Harris, Avirup Guha
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: The role of social determinants of health (SDOH) in the short-term control of hypertension (HTN) in cancer patients is unknown. Understanding the role of SDOH is important for equitable care of cancer patients, especially in the rural US.

Hypothesis: High SDOH scores are associated with uncontrolled HTN in hypertensive cancer patients.

Methods: We performed a prospective observational study at a tertiary care cancer center cardio-oncology clinic. Patients with cancer and HTN were asked to complete the Protocol for Responding to & Assessing Patients' Assets, Risks & Experiences (PRAPARE) questionnaire on their first visit. Blood pressure (BP) readings were taken at 2 follow-up visits. Uncontrolled HTN was defined as SBP≥130 mmHg and/or DBP≥80 mmHg with corroborated home blood pressure readings. Patients who did not perform home readings but had elevated BP at 2 nd visit were considered uncontrolled. The goals were the same regardless of cancer treatment. The SDOH score was calculated using PRAPARE SDH Risk Tally Score. We performed Cox proportional hazards regression adjusting for age, gender, and metastasis to identify the role of SDOH on short-term HTN control. The adversity cutoff for the SDOH score was informed by spline regressions.

Results: In the cohort of 175 patients, median age was 66 (IQR 58-75) years, 55% were females, 42.2% were Non-Hispanic Black patients and 20.5% had breast cancer. Mean SDOH score was 6±3. The median duration of follow-up was 91 days (55-139). Uncontrolled HTN was noted in 59.4% of patients at their 2nd visit. For each 1-point increase in the SDOH score, uncontrolled hypertension increased by 9% (HR=1.09, 95% CI=1.03-1.15, p=0.002).

Conclusions: Rural cardio-oncology patients with HTN have a high burden of SDOH. These study findings help identify contributors of SDOH that limit optimal HTN control in this population, allowing for better risk stratification and preventive intervention in clinical practice.

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