Abstract 13346: Sociobehavioral and Clinical Risk Factors Associated With Severe Asymptomatic Hypertension: A 1999-2018 National Health and Nutrition Examination Survey Analysis

Introduction: Individuals with severe asymptomatic hypertension (SAH) are at high risk of CVD. It is unclear which risk factors are associated with SAH and whether they are different in patients with & without awareness of hypertension (HTN). We hypothesized self-reported HTN status would significantly modify the effect of factors associated with SAH. Methods: We included adults ≥20 years from the 1999-2018 National Health and Nutrition Examination Surveys. Mean BP was calculated as the average of 3 consecutive BP readings 30 seconds apart. SAH was defined as mean SBP≥180 or DBP≥120. We used survey design-adjusted multivariable logistic regression to identify demographic, behavioral, comorbid, and medication-related factors for SAH. We then determined the modifying effect of self-reported HTN on the independent associations between covariates and SAH. Results: Among the 44,622 participants (mean age 47, 51% female, 69% White, and 30% HTN), 0.9% had SAH. Nearly 26% with SAH did not report HTN diagnosis and 62% were taking ≤1 BP medication. SAH individuals were more likely to be older, female, non-Hispanic Black, of lower socioeconomic status, have CVD, and report lower alcohol and salt intake than those without SAH (Table). The significant associations between Black race, female sex, lower income, & BMI and SAH were not different by self-reported HTN (Table). Self-reported HTN significantly modified the effect of older age (OR [95% CI]; HTN: 1.07 [1.06, 1.08], No HTN: 1.10 [1.08, 1.13]), lower education (HTN: 1.04 [0.77, 1.42], No HTN: 2.26 [1.15, 4.44]), lack of insurance (HTN: 2.82 [1.86, 4.28], No HTN: 1.01 [0.52, 1.96]), and CKD (HTN: 1.49 [1.12, 1.98], No HTN: 2.24 [1.25, 4.03]) on SAH. Conclusions: Regardless of self-reported HTN status, non-Hispanic Blacks, females, and lower socioeconomic individuals were independently associated with SAH in the U.S. Older age, low education level, and CKD may confer greater risk of SAH in patients lacking HTN awareness.