ANTIHYPERTENSIVE PRESCRIBING PATTERNS AND BLOOD PRESSURE CONTROL IN ADULTS WITH FOOD INSECURITY: A HEALTH EQUITY ANALYSIS
Author(s)
Amy M. Austin, MHI, Ekaterina A. Khlystova, PhD, Claire Edwards Campbell, PhD, Sarah Eng, MPH, Jeffrey Ratto, PhD, Katherine Kendrick, MPH, Sunny Guin, PhD, Vidya Venkataraman, MPH, PhD.
Truveta, Bellevue, WA, USA.
Truveta, Bellevue, WA, USA.
OBJECTIVES: To examine whether food insecurity is associated with differences in antihypertensive drug class selection and 12-month blood pressure (BP) control among adults with hypertension, with attention to racial variation in these patterns.
METHODS: This retrospective cohort study utilized de-identified electronic health record (EHR) data from Truveta, a national US health system network, with index food insecurity screening dates spanning January 2022 to April 2025 and follow-up extending through April 2026. Eligible adults had a diagnosis of hypertension, an active antihypertensive prescription, and a food insecurity screen (N=333,182). Food insecurity was classified using the Hunger Vital Sign (HVS) supplemented by the U.S. Food Security Survey (USFSS). Baseline antihypertensive drug class was derived from dispense records using ingredient-level classification across eight classes. BP control was defined as systolic BP <130 mmHg at 12 months post-index. Descriptive analyses and chi-square tests compared drug class selection and BP control by food insecurity status, stratified by race.
RESULTS: Food-insecure patients were more frequently prescribed thiazide diuretics than food-secure patients (32.8% vs 28.0%; p<0.0001). Among thiazide-treated patients, medication adherence was similar across food insecurity groups (80.9% vs 82.4%); however, 12-month BP control remained lower among food-insecure patients (45.7% vs 47.2%; p<0.0001), raising the possibility of differences in treatment intensity or clinical complexity. Equity-relevant differences were most pronounced among Black patients: food-insecure Black patients had higher thiazide prescribing rates (45.6% vs 37.6%; p<0.0001) and lower BP control (41.6% vs 44.6%; p<0.0001). Smaller differences were observed among White patients for thiazide prescribing (29.2% vs 26.3%; p<0.0001) and BP control (49.3% vs 50.3%).
CONCLUSIONS: Thiazide diuretics, while guideline-recommended and low-cost, were more commonly prescribed among food-insecure patients yet associated with lower BP control, raising questions about treatment optimization across socially vulnerable populations. These findings highlight the value of examining prescribing patterns and outcomes alongside social needs screening in hypertension management.
METHODS: This retrospective cohort study utilized de-identified electronic health record (EHR) data from Truveta, a national US health system network, with index food insecurity screening dates spanning January 2022 to April 2025 and follow-up extending through April 2026. Eligible adults had a diagnosis of hypertension, an active antihypertensive prescription, and a food insecurity screen (N=333,182). Food insecurity was classified using the Hunger Vital Sign (HVS) supplemented by the U.S. Food Security Survey (USFSS). Baseline antihypertensive drug class was derived from dispense records using ingredient-level classification across eight classes. BP control was defined as systolic BP <130 mmHg at 12 months post-index. Descriptive analyses and chi-square tests compared drug class selection and BP control by food insecurity status, stratified by race.
RESULTS: Food-insecure patients were more frequently prescribed thiazide diuretics than food-secure patients (32.8% vs 28.0%; p<0.0001). Among thiazide-treated patients, medication adherence was similar across food insecurity groups (80.9% vs 82.4%); however, 12-month BP control remained lower among food-insecure patients (45.7% vs 47.2%; p<0.0001), raising the possibility of differences in treatment intensity or clinical complexity. Equity-relevant differences were most pronounced among Black patients: food-insecure Black patients had higher thiazide prescribing rates (45.6% vs 37.6%; p<0.0001) and lower BP control (41.6% vs 44.6%; p<0.0001). Smaller differences were observed among White patients for thiazide prescribing (29.2% vs 26.3%; p<0.0001) and BP control (49.3% vs 50.3%).
CONCLUSIONS: Thiazide diuretics, while guideline-recommended and low-cost, were more commonly prescribed among food-insecure patients yet associated with lower BP control, raising questions about treatment optimization across socially vulnerable populations. These findings highlight the value of examining prescribing patterns and outcomes alongside social needs screening in hypertension management.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PCR158
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas