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BACKGROUND: Determining the contribution of social determinants of health (SDOH) to the higher proportion of Black adults with uncontrolled blood pressure (BP) could inform interventions to improve BP control and reduce cardiovascular disease. METHODS: We analyzed data from 7306 White and 7497 Black US adults taking antihypertensive medication from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003–2007). SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Uncontrolled BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. RESULTS: Among participants taking antihypertensive medication, 25.4% of White and 33.7% of Black participants had uncontrolled BP. The SDOH included in the current analysis mediated the Black-White difference in uncontrolled BP by 33.0% (95% CI, 22.1%–46.8%). SDOH that contributed to excess uncontrolled BP among Black compared with White adults included low annual household income (percent-mediated 15.8% [95% CI, 10.8%–22.8%]), low education (10.5% [5.6%–15.4%]), living in a health professional shortage area (10.4% [6.5%–14.7%]), disadvantaged neighborhood (11.0% [4.4%–18.0%]), and high-poverty zip code (9.7% [3.8%–15.5%]). Together, the neighborhood-domain accounted for 14.1% (95% CI, 5.9%–22.9%), the health care domain accounted for 12.7% (95% CI, 8.4%–17.3%), and the social-context-domain accounted for 3.8% (95% CI, 1.2%–6.6%) of the excess likelihood of uncontrolled BP among Black compared with White adults, respectively. CONCLUSIONS: SDOH including low education, low income, living in a health professional shortage area, disadvantaged neighborhood, and high-poverty zip code contributed to the excess likelihood of uncontrolled BP among Black compared with White adults.

Background: Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office, but few data are available on the association of chronic stress with BP measured outside of the office setting. Methods: We analyzed data from 473 African-American adults enrolled in the Jackson Heart Study with office BP < 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress related to jobs, relationships, neighborhoods, caregiving, legal problems, medical problems, racism and discrimination, and meeting basic needs experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). We grouped participants by tertile of the composite GPSS score. Any MHT was defined as awake BP ≥ 130/80 mm Hg, asleep BP ≥ 110/65 mm Hg, or 24-hour BP ≥ 125/75 mm Hg. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication (mean age 53 years), the prevalence of any MHT was 59.0%, 75.0% and 61.8% for the low (GPSS score ≤ 3), middle (GPSS score 4 - 6), and upper tertiles of the GPSS score (GPSS score > 6), respectively. Among those taking antihypertensive medication (mean age 61 years), the prevalence of any MHT was 77.4%, 80.7%, and 77.9% for participants in the low, middle, and upper tertile of the GPSS score, respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low tertile of the GPSS score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication (Table). Conclusion: No association was present between chronic stress and MHT among African Americans in the Jackson Heart Study.

Background: Identifying social determinants of health (SDOH) associated with incident apparent treatment resistant hypertension (aTRH) may guide interventions to reduce the incidence of aTRH and its associated cardiovascular disease risk. Methods: We analyzed data from 2,769 White and 2,254 Black US adults from the REasons for Geographic and Racial Differences in Stroke study taking antihypertensive medication with controlled blood pressure (BP) at baseline to estimate the association of SDOH with incident aTRH. SDOH were guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment and healthcare access. Incident aTRH was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease, while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication regardless of BP level, at a follow-up visit. Results: Over a median 9.5 years of follow-up, 16.1% of White versus 23.7% of Black adults developed aTRH. After age and sex adjustment, the SDOH associated with incident aTRH (hazard ratio; 95% CI) included having less than a high school education (1.51; 1.22 - 1.87), being a high school graduate (1.30; 1.10 - 1.53), and attending some college (1.29; 1.10 - 1.52) versus college graduate; annual household income Conclusion: SDOH were associated with transitioning from controlled BP to incident aTRH among White and Black adults.

Background: Most adults with hypertension have other chronic conditions. As obesity and diabetes are increasing among US adults, the prevalence of multimorbidity may have increased among US adults with hypertension. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) to assess the trend in multimorbidity among US adults (ages ≥ 20 years) with (n = 24,646) and without (n = 24,189) hypertension from 1999-2000 through 2017-March 2020. Hypertension was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or use of antihypertensive medication. Multimorbidity was defined as the co-occurrence of ≥ 3 chronic conditions, not including hypertension. Chronic conditions were selected based on a framework from a US Health and Human Services report and data available in NHANES and included dyslipidemia, coronary heart disease, stroke, heart failure, diabetes, obesity, liver fibrosis, chronic kidney disease, asthma, lung disease (chronic obstructive pulmonary disease, emphysema, or chronic bronchitis), arthritis, hepatitis-C, cancer, and depression. Results: From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased from 2.4 to 3.0 among US adults with hypertension and from 1.9 to 2.2 among US adults without hypertension (Figure, top panel). During this period, the age-adjusted prevalence of multimorbidity increased from 42% to 56% among US adults with hypertension and from 32% to 34% among US adults without hypertension (Figure, bottom panel). In 2017-2020, after age, race/ethnicity, and sex adjustment, the mean difference in the number of chronic conditions among US adults with versus without hypertension was 0.70 (95% CI: 0.56 - 0.84). Multimorbidity was 1.50 (95% CI: 1.34 - 1.68) times more common among US adults with versus without hypertension. Conclusion: Multimorbidity has increased among US adults, and its prevalence is higher among adults with versus without hypertension.

Reduced growth and delayed maturation have been described in children with sickle cell disease (SCD). This study investigated growth and hemolysis in children with SCD in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) cohort. The database includes 5287 children, of which, 3305 had at least 2 growth measurements over a 5-year period. Body mass index was converted to z-scores (zBMI), and 19.8%, 66.1%, 14.2% of children were classified as underweight, normal, and overweight/obese, respectively. Multivariable analysis of growth was conducted and included variables: age, sex, blood pressure, hemoglobin, reticulocyte count, treatment with chronic red cell transfusion therapy (CRCT), or hydroxyurea therapy. Baseline hemoglobin levels were associated with the lower odds of being underweight (odds ratio [OR]=0.93, 95% confidence interval [CI]: 0.86-0.99), and higher odds of being overweight/obese (OR: 1.26, 95% CI: 1.17-1.36) compared with normal zBMI. CRCT was associated with being overweight/obese at baseline (OR: 1.85, 95% CI: 1.31-2.60). Overall, results showed that children who were underweight improved regardless of therapy over the 2-year time period. However, children on CRCT are at higher risk for being overweight and should be monitored closely.

Background The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline recommends using 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk to guide decisions to initiate antihypertensive medication. Methods We included adults aged 40-79 years from the National Health and Nutrition Examination Survey 2013-2018 (n = 8803). We computed 10-year predicted ASCVD risk using the Pooled Cohort risk equations. Clinical CVD was self-reported. Analyses were conducted overall and among those with stage 1 hypertension, defined by a mean SBP of 130-139 mmHg or DBP of 80-89 mmHg. In subgroups defined by diabetes, chronic kidney disease (CKD), and age at least 65 years, we estimated the proportion of United States adults with high ASCVD risk (i.e. 10-year predicted ASCVD risk ≥10% or clinical CVD) and estimated age-adjusted probability of having high ASCVD risk. Results Among United States adults, an estimated 72.3, 64.5, and 83.9 of those with diabetes, CKD, and age at least 65 years had high ASCVD risk, respectively. Among United States adults with stage 1 hypertension, an estimated 55, 36.7, and 72.6% of those with diabetes, CKD, and age at least 65 years had high ASCVD risk, respectively. The probability of having high ASCVD risk increased with age and exceeded 50% for United States adults with diabetes and CKD at ages 52 and 57 years, respectively. For those with stage 1 hypertension, these ages were 55 and 64 years, respectively. Conclusion Most United States adults with diabetes, CKD, or age at least 65 years had high ASCVD risk. However, many with stage 1 hypertension did not.

Although mean blood pressure (BP) increases with age, there may be a subset of individuals whose BP does not increase with age. Characterizing the population that maintains normal BP could inform hypertension prevention efforts. We determined the proportion of Jackson Heart Study participants that maintained normal BP at 3 visits over a median of 8 years. Normal BP was defined as systolic BP

Background: Hypertension and uncontrolled blood pressure (BP) are the largest contributors to racial disparities in life expectancy. Determining the contribution of social determinants of health (SDOH) to racial differences in uncontrolled BP could help identify ways to achieve the American Heart Association’s 2030 impact goal of equitably improving healthy life expectancy. Methods: We analyzed data from 7,497 Black and 7,306 White US adults taking antihypertensive medication from the REasons for Geographic and Racial Differences in Stroke study to determine the association between SDOH and uncontrolled BP. SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment and healthcare access. Uncontrolled BP was defined as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg. Results: Among participants taking antihypertensive medication (mean age 66.3 years, 50.7% Black, 57.1% female), 68.0% of Black and 59.0% of White participants had uncontrolled BP. After multivariable adjustment, uncontrolled BP (prevalence ratio; 95% CI) was more common among those with less than a high school education (1.06; 1.02 – 1.09), annual household income Conclusion: SDOH were associated with uncontrolled BP among both Black and White adults taking antihypertensive medication.

Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index 2 ) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease–related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.

OBJECTIVE: Nocturnal hypertension and non-dipping systolic blood pressure (SBP) are associated with increased cardiovascular disease (CVD) risk. Short and long sleep duration (SSD and LSD) are also associated with increased CVD risk and may be risk factors for nocturnal hypertension and non-dipping SBP. We examined the association between SSD and LSD with sleep BP, nocturnal hypertension, and non-dipping SBP among 647 white and African American Coronary Artery Risk Development in Young Adults (CARDIA) study participants who completed 24-hour ambulatory BP monitoring, wrist actigraphy, and sleep diaries in 2015-2016. METHODS: The times when participants were asleep and awake were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as sleep BP ≥120/70 mmHg and non-dipping SBP as mean sleep-to-awake SBP ratio >0.90. Sleep duration was categorized as SSD (

The authors examined the proportion of US adults that would have their high blood pressure (BP) status changed if systolic BP (SBP) and diastolic BP (DBP) were measured with systematic bias and/or random error versus following a standardized protocol. Data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES; n = 5176) were analyzed. BP was measured up to three times using a mercury sphygmomanometer by a trained physician following a standardized protocol and averaged. High BP was defined as SBP ≥130 mm Hg or DBP ≥80 mm Hg. Among US adults not taking antihypertensive medication, 32.0% (95%CI: 29.6%,34.4%) had high BP. If SBP and DBP were measured with systematic bias, 5 mm Hg for SBP and 3.5 mm Hg for DBP higher and lower than in NHANES, the proportion with high BP was estimated to be 44.4% (95%CI: 42.6%,46.2%) and 21.9% (95%CI 19.5%,24.4%). Among US adults taking antihypertensive medication, 60.6% (95%CI: 57.2%,63.9%) had high BP. If SBP and DBP were measured 5 and 3.5 mm Hg higher and lower than in NHANES, the proportion with high BP was estimated to be 71.8% (95%CI: 68.3%,75.0%) and 48.4% (95%CI: 44.6%,52.2%), respectively. If BP was measured with random error, with standard deviations of 15 mm Hg for SBP and 7 mm Hg for DBP, 21.4% (95%CI: 19.8%,23.0%) of US adults not taking antihypertensive medication and 20.5% (95%CI: 17.7%,23.3%) taking antihypertensive medication had their high BP status re-categorized. In conclusions, measuring BP with systematic or random errors may result in the misclassification of high BP for a substantial proportion of US adults.

Introduction: Inflammation biomarkers have been individually associated with increased risk of coronary heart disease (CHD). However, little is known of the association between multiple inflammation biomarker counts in the high-risk category and incident CHD risk. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke study, an ongoing national cohort of 30,239 Black and White US adults aged ≥45 years recruited in 2003-2007. Baseline levels of C-reactive protein (hsCRP), white blood cell count (WBC) and serum albumin were divided into tertiles. High-risk categories of hsCRP and WBC were defined as levels above the 3 rd tertile (3.75 mg/dL and 6.31 x 10 9 cells/L, respectively) and albumin levels below the 1 st tertile (4.0 g/dL). Four mutually exclusive groups were derived corresponding to having 0, 1, 2 or 3 biomarkers in the high-risk category. Outcome was a composite of incident non-fatal myocardial infarction and fatal CHD. Results: Of 15,738 participants free of CHD at baseline (mean age 63.1 years, 65.3% female, 40.8% black), 38.9% (n = 6,121) had 0, 36.6% (n = 5,765) had 1, 19.7% (n = 3,107) had 2, 4.7% (n = 745) had 3 inflammation biomarkers in the elevated levels. With median follow-up of 10.5 years, 902 (5.7%) participants had incident CHD. The rates of incident CHD and 95% confidence intervals (CI) per 1000 person years increased progressively for individuals with 0, 1, 2, and 3 inflammation biomarkers in the high-risk category: 4.4 (95% CI: 3.9-5.0), 6.3 (95% CI: 5.7-7.0), 8.9 (95% CI: 7.8-10.0), and 10.3 (95% CI: 7.7-12.8), respectively. The fully adjusted hazard ratios (95% CI) for incident CHD associated with 1, 2 and 3 versus no inflammation biomarker in the high-risk category were 1.28 (1.08-1.51), 1.71 (1.42-2.06), and 1.90 (1.43-2.54), respectively (P trend < 0.001) (Table). Conclusions: The count of inflammation biomarkers in the high-risk category is associated with increased risk of CHD independent of traditional risk factors.

Identifying subgroups of the population with different reasons for uncontrolled blood pressure (BP) can inform where to direct interventions to increase hypertension control. We determined characteristics associated with not being aware of having hypertension and being aware but not treated with antihypertensive medication among US adults with uncontrolled BP using the 2015 to 2018 National Health and Nutrition Examination Surveys (N=2282). Among US adults with uncontrolled BP, systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, 38.0% were not aware they had hypertension, 15.6% were aware but not treated and 46.4% were aware and treated with antihypertensive medication. After multivariable adjustment, US adults who were 18-39 versus ≥70 years old were more likely (prevalence ratio, 1.49 [95% CI, 1.11–1.99]) and those who had a health care visit in the past year were less likely (prevalence ratio, 0.61 [95% CI, 0.48–0.77]) to be unaware they had hypertension. Among US adults with uncontrolled BP who were aware they had hypertension, those 18 to 39, 40 to 49, 50 to 59, and 60 to 69 versus ≥70 years old were more likely to not be treated versus being treated with antihypertensive medication. Not being treated with antihypertensive medication versus being treated and having uncontrolled BP was less common among those with versus without a usual source of health care (prevalence ratio, 0.69 [95% CI, 0.51–0.94]) and who reported having versus not having a health care visit in past year (prevalence ratio, 0.46 [95% CI, 0.35–0.61]). In conclusion, to increase BP control, interventions should be directed towards populations in which hypertension awareness is low and uncontrolled BP is common despite antihypertensive medication use.

Background Not having a healthcare visit in the past year has been associated with a higher likelihood of uncontrolled blood pressure (BP) among individuals with hypertension. Methods We examined factors associated with not having a healthcare visit in the past year among US adults with hypertension using data from the US National Health and Nutrition Examination Survey 2013–2018 (n = 5,985). Hypertension was defined as systolic BP (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, or antihypertensive medication use. Having a healthcare visit in the past year was self-reported. Results Overall, 7.0% of US adults with hypertension reported not having a healthcare visit in the past year. Those without vs. with a healthcare visit in the past year were less likely to be aware they had hypertension (45.0% vs. 83.9%), to be taking antihypertensive medication (36.7% vs. 91.4%, among those who were aware they had hypertension), and to have controlled BP (SBP/DBP Conclusions Interventions should be considered to ensure all adults with hypertension have annual healthcare visits.

Background and Purpose: In the general population, Black adults are less likely than White adults to have controlled blood pressure (BP), and when not controlled, they are at greater risk for stroke compared with White adults. High BP is a major modifiable risk factor for recurrent stroke, but few studies have examined racial differences in BP control among stroke survivors. Methods: We used data from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) to examine disparities in BP control between Black and White adults, with and without a history of stroke. We studied participants taking antihypertensive medication who did and did not experience an adjudicated stroke (n=306 and 7693 participants, respectively) between baseline (2003–2007) and a second study visit (2013–2016). BP control at the second study visit was defined as systolic BP Results: Among participants with a history of stroke, 50.3% of White compared with 39.3% of Black participants had controlled BP. Among participants without a history of stroke, 56.0% of White compared with 50.2% of Black participants had controlled BP. After multivariable adjustment, there was a tendency for Black participants to be less likely than White participants to have controlled BP (prevalence ratio, 0.77 [95% CI, 0.59–1.02] for those with a history of stroke and 0.92 [95% CI, 0.88–0.97] for those without a history of stroke). Conclusions: There was a lower proportion of controlled BP among Black compared with White adults with or without stroke, with no statistically significant differences after multivariable adjustment.

Introduction: In October 2020, the US Surgeon General issued a Call to Action on hypertension control. We investigated the contribution of lack of awareness, not taking antihypertensive medication and an inadequate antihypertensive medication regimen to uncontrolled blood pressure (BP) among US adults. Methods: We analyzed data for 2,282 participants ≥18 years of age with uncontrolled BP from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). BP was measured three times by a trained physician following a standardized protocol. Uncontrolled BP was defined by systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Being aware of having hypertension and antihypertensive medication use were defined by self-report. An inadequate antihypertensive medication regimen was defined as taking antihypertensive medication with uncontrolled BP. Data were weighted to represent the non-institutionalized US population. Results: Among US adults with uncontrolled BP, 34.8% were not aware they had hypertension, 13.8% were aware but not taking antihypertensive medication and 51.4% were aware but taking inadequate antihypertensive medication regimen. US adults 18-39 and 40-49 years of age were more likely to be unaware they had hypertension compared to their counterparts ≥70 years of age (multivariable-adjusted prevalence ratios [PR]: 1.62 [95% CI: 1.26-2.07] and 1.41 [95% CI: 1.02-1.95], respectively). Participants who had a healthcare visit in the past year (PR: 0.60 [95% CI: 0.47-0.77]) and who were obese (PR: 0.69 [95% CI: 0.56-0.85]), had diabetes (PR: 0.56 [95% CI: 0.42-0.76]), chronic kidney disease (PR: 0.59 [95% CI: 0.46-0.75]) and a history of cardiovascular disease (PR: 0.41 [95% CI: 0.27-0.61]) were less likely to be unaware they had hypertension. Among those who were aware they had hypertension, US adults who were 18-39 and 40-49 years of age as compared to those ≥70 years of age were more likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen (multivariable-adjusted PR: 5.48 [95% CI: 3.17-9.48] and 5.14 [95% CI: 2.28-10.26], respectively). In contrast, non-Hispanic blacks and Hispanics as compared to non-Hispanic whites (PR: 0.71 [95% CI: 0.53-0.94] and 0.72 [95% CI: 0.54-0.96], respectively) and those without a usual place to receive healthcare (PR: 0.70 [95% CI 0.51-0.96]) and who had a healthcare visit in past year (PR: 0.47 [95% CI: 0.35-0.62]) were less likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen. Conclusion: The majority of US adults with uncontrolled BP were either unaware they had hypertension or were taking an inadequate antihypertensive medication regimen. Interventions are needed to increase hypertension awareness and assess and titrate patients’ antihypertensive medication regimen.

Ambulatory blood pressure (BP) monitoring (ABPM) may cause sleep disturbances. Some home BP monitoring (HBPM) devices obtain a limited number of BP readings during sleep and may be preferred to ABPM. It is unclear how closely a few BP readings approximate a full night of ABPM. We used data from the Jackson Heart (N = 621) and Coronary Artery Risk Development in Young Adults (N = 458) studies to evaluate 74 sampling approaches to estimate BP during sleep. We sampled two to four BP measurements at specific times from a full night of ABPM and computed chance-corrected agreement (i.e., kappa) of nocturnal hypertension (i.e., mean asleep systolic BP ≥ 120 mmHg or diastolic BP ≥ 70 mmHg) defined using the full night of ABPM and subsets of BP readings. Measuring BP at 2, 3, and 4 h after falling asleep, an approach applied by some HBPM devices obtained a kappa of 0.81 (95% confidence interval [CI]: 0.78, 0.85). The highest kappa was obtained by measuring BP at 1, 2, 4, and 5 h after falling asleep: 0.84 (95% CI: 0.81, 0.87). In conclusion, measuring BP three or four times during sleep may have high agreement with nocturnal hypertension status based on a full night of ABPM.

Almost 1 in 5 US adults with hypertension has apparent treatment resistant hypertension (aTRH). Identifying modifiable risk factors for incident aTRH may guide interventions to reduce the need for additional antihypertensive medication. We evaluated the association between cardiovascular health and incident aTRH among participants with hypertension and controlled blood pressure (BP) at baseline in the Jackson Heart Study (N=800) and the Reasons for Geographic and Racial Differences in Stroke study (N=2316). Body mass index, smoking, physical activity, diet, BP, cholesterol and glucose, categorized as ideal, intermediate, or poor according to the American Heart Association’s Life’s Simple 7 were assessed at baseline and used to define cardiovascular health. Incident aTRH was defined by uncontrolled BP, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg, while taking ≥3 classes of antihypertensive medication or controlled BP, systolic BP

Introduction Reduced growth and delayed maturation have been previously described in children with sickle cell disease (SCD) due to multifactorial causes including chronic anemia and increased hemolysis. Interventions that decrease anemia and inflammation may have a beneficial effect on growth in children with SCD. Previous studies have demonstrated that children with SCD treated with hydroxyurea (HU) and chronic red cell transfusion therapy (CRCT) experience linear growth and increase in body mass index (BMI) compared to their counterparts not on therapy. Unfortunately, most of these studies were limited due to small sample size, cross-sectional study design or were conducted from single or a few center(s). DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) is a large, NHLBI (National Heart, Lung, and Blood Institute) funded consortium to improve stroke prevention implementation in SCD. DISPLACE includes the largest database of children with SCD from 28 different centers in the US. These data allow for an optimal assessment of growth in children with SCD on different disease modifying therapies. Using the DISPLACE database, we conducted a cross-sectional sub-study to evaluate how HU and CRCT affect growth in children over time. Methods The DISPLACE study collected data on 5,247 children aged 2-19 years with SCD from 28 centers in the US between 2012-2016. The majority of children have data collected from at least five years of continuous care. At baseline and annually thereafter, all children had routine standard of care anthropometric measurements including height and weight, vital signs, laboratory tests including complete blood count and chemistries and SCD-related therapies including chronic blood transfusion therapy and hydroxyurea therapy. Body mass index was converted to z-scores (zBMI) based on the Centers for Disease Control guide for age and sex. Children were categorized based on the zBMI score as underweight, normal, and overweight/obese. Our inclusion criteria included children with documented results of weight, height, vital signs, clinical and laboratory tests at baseline. Children who do not have sufficient data for evaluation (at least one missing anthropometric measurement or laboratory value) were excluded. Results Of the 3,305 children included in the study, 19.8%, 66.1%, 14.2% were underweight, normal, and overweight/obese at their initial (baseline) visit respectively. Children who were overweight/obese had a significantly higher hemoglobin level (p Conclusion In our US-based study, the majority of children with SCD (70%) had normal zBMI. As baseline hemoglobin is associated with zBMI, that may predict who is at risk for being underweight or overweight. In addition, patients treated with CRCT are more likely to be overweight and have higher blood pressure. These findings suggest that individuals on CRCT should be monitored and may need lower calories than those not on disease modifying therapies. Disclosures Kanter: bluebird bio, inc: Consultancy, Honoraria; Novartis: Consultancy; Sanofi: Consultancy; Medscape: Honoraria; Guidepoint Global: Honoraria; GLG: Honoraria; Jeffries: Honoraria; Cowen: Honoraria; Wells Fargo: Honoraria; NHLBI Sickle Cell Advisory Board: Membership on an entity's Board of Directors or advisory committees; SCDAA Medical and Research Advisory Board: Membership on an entity's Board of Directors or advisory committees; AGIOS: Membership on an entity's Board of Directors or advisory committees; BEAM: Membership on an entity's Board of Directors or advisory committees.