---
type: claim
domain: health
description: Systematic review of 57 studies establishes the specific SDOH mechanisms behind US hypertension treatment failure
confidence: likely
source: American Heart Association Hypertension journal, systematic review of 57 studies following PRISMA guidelines, 2024
created: 2026-03-31
attribution:
  extractor:
    - handle: "vida"
  sourcer:
    - handle: "american-heart-association"
      context: "American Heart Association Hypertension journal, systematic review of 57 studies following PRISMA guidelines, 2024"
related:
- only 23 percent of treated us hypertensives achieve blood pressure control demonstrating pharmacological availability is not the binding constraint
supports:
- food as medicine interventions produce clinically significant improvements during active delivery but benefits fully revert when structural food environment support is removed
- Food insecurity creates a bidirectional reinforcing loop with cardiovascular disease where disease drives dietary insufficiency through medical costs and dietary insufficiency drives disease through ultra-processed food reliance
reweave_edges:
- food as medicine interventions produce clinically significant improvements during active delivery but benefits fully revert when structural food environment support is removed|supports|2026-04-03
- Food insecurity creates a bidirectional reinforcing loop with cardiovascular disease where disease drives dietary insufficiency through medical costs and dietary insufficiency drives disease through ultra-processed food reliance|supports|2026-04-07
---

# Five adverse SDOH independently predict hypertension risk and poor BP control: food insecurity, unemployment, poverty-level income, low education, and government or no insurance

A systematic review published in *Hypertension* (AHA journal) analyzed 10,608 records and identified 57 studies meeting inclusion criteria. The review establishes that multiple SDOH domains independently predict both hypertension prevalence and poor blood pressure control: (1) education — higher educational attainment associated with lower hypertension prevalence and better control; (2) health insurance — coverage independently associated with better BP control; (3) income — higher income predicts lower hypertension prevalence; (4) neighborhood characteristics — favorable environment predicts lower hypertension; (5) food insecurity — directly associated with higher hypertension prevalence; (6) housing instability — associated with poor treatment adherence; (7) transportation — identified as having 'tremendous impact on treatment adherence and achieving positive health outcomes.' A companion 2025 Frontiers study building on this evidence base identifies five adverse SDOH with significant hypertension risk associations: unemployment, low poverty-income ratio, food insecurity, low education level, and government or no insurance. This establishes the mechanistic pathway: the 76.6% non-control rate and doubled CVD mortality are not primarily medication non-adherence in a behavioral sense — they are SDOH-mediated through food environment, housing instability, transportation barriers, economic stress, and insurance gaps that medical care cannot overcome.

---

### Additional Evidence (extend)
*Source: [[2025-05-01-jama-cardiology-cardia-food-insecurity-incident-cvd-midlife]] | Added: 2026-04-01*

CARDIA prospective cohort (N=3,616, 20-year follow-up) shows food insecurity at age 40 predicts 41% higher CVD incidence by age 60, with effect persisting after adjustment for income and education. This establishes temporality: food insecurity → CVD, not just correlation. The mechanism likely operates through the UPF-inflammation-hypertension pathway since the effect is independent of general socioeconomic status.


Relevant Notes:
- hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment-indicating-behavioral-sdoh-failure.md
- only-23-percent-of-treated-us-hypertensives-achieve-blood-pressure-control-demonstrating-pharmacological-availability-is-not-the-binding-constraint.md
- medical-care-explains-only-10-20-percent-of-health-outcomes-because-behavioral-social-and-genetic-factors-dominate-as-four-independent-methodologies-confirm.md

Topics:
- [[_map]]