---
type: source
title: "Supplemental Nutrition Assistance Program and Adherence to Antihypertensive Medications"
author: "Multiple authors"
url: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815447
date: 2024-02-23
domain: health
secondary_domains: []
format: journal article
status: unprocessed
priority: high
tags: [SNAP, hypertension, medication-adherence, food-insecurity, SDOH, antihypertensive]
---

## Content

A retrospective cohort study using linked Medical Expenditure Panel Survey (MEPS)–National Health Interview Survey (NHIS) dataset for 2016–2017. Sample: 6,692 participants with hypertension.

**Primary finding:** Among food-insecure patients with hypertension, receipt of SNAP benefits was associated with a **13.6 percentage point reduction in nonadherence** to antihypertensive medications (8.17 pp difference between SNAP recipients vs. non-recipients in the food-insecure group).

**Critical specificity:** The SNAP benefit was NOT associated with improved adherence in the food-secure population — the effect was specific to food-insecure patients. This is a dose-response indicator: SNAP addresses a specific mechanism (food-medication trade-off) that only operates when food insecurity is present.

**Mechanism:** SNAP relieves the competing expenditure pressure between purchasing food and purchasing medications. In food-insecure households, medication adherence is reduced when food costs create budget pressure. SNAP relieves this trade-off by providing food purchasing power, freeing income for medications. This is the "breadline vs. medication" mechanism.

**Indirect pathway to BP control:** While this study doesn't measure BP directly, medication adherence is the primary determinant of BP control in treated hypertensive patients. Nonadherence is the #1 reason for treatment-resistant hypertension. A 13.6 pp improvement in adherence among food-insecure patients would be expected to translate to significant BP improvement.

Published: JAMA Network Open, February 23, 2024.

## Agent Notes

**Why this matters:** Documents a specific mechanism through which food assistance improves hypertension management — not by changing diet (as in Food is Medicine programs) but by relieving the financial trade-off that forces patients to choose between food and medications. This is a different pathway than the dietary mechanism, and it operates at scale through existing SNAP infrastructure.

**What surprised me:** The effect is entirely specific to food-insecure patients — zero effect in food-secure population. This is a precision finding that validates the mechanism theory. It's not that SNAP generally improves health; SNAP specifically addresses the food-medication trade-off for patients in the specific situation where that trade-off is active.

**What I expected but didn't find:** Direct BP outcome data. This study stops at medication adherence — we'd need a linked outcome study to see the BP effect. But medication adherence → BP control is one of the most-studied relationships in hypertension research.

**KB connections:**
- From Session 16: SDOH five-factor systematic review (food insecurity, unemployment, poverty, low education, gov't/no insurance all predict hypertension non-control)
- [[value-based care transitions stall at the payment boundary]] — if SNAP improves adherence, this is a SDOH intervention that addresses the non-clinical 80%
- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent]] — SNAP here is a working SDOH intervention whose clinical benefit is undercounted

**Extraction hints:**
- New claim: "SNAP receipt reduces antihypertensive medication nonadherence by 13.6 percentage points in food-insecure hypertensive patients but has no effect in food-secure patients, establishing the food-medication trade-off as a specific SDOH mechanism for hypertension non-control"
- The specificity (food-insecure only) is the key finding — it confirms the mechanism rather than just showing an association
- Confidence: likely (retrospective cohort, 2016-2017 data; not randomized but specific finding)

**Context:** Published same month as the JAMA Network Open digital health disparities meta-analysis (also February 2024). Suggests a productive year in SDOH-hypertension intersection research.

## Curator Notes (structured handoff for extractor)

PRIMARY CONNECTION: [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]

WHY ARCHIVED: Provides specific mechanism evidence for SNAP improving hypertension outcomes — via medication adherence pathway, not dietary change. Adds a second mechanistic pathway to the food-environment → hypertension thread.

EXTRACTION HINT: Extract the mechanism finding precisely — "food insecurity creates food-medication trade-off; SNAP relieves the trade-off; this is the pathway to medication adherence improvement." Be careful to note this is adherence, not direct BP outcome. The clinical implication for BP is strong but indirect.
