Abstract Body: Introduction: Young adults are at risk for long-term cardiovascular complications if hypertension (HTN) remains unmanaged. There is limited exploration of how specific social determinants of health (SDoH), particularly in young adults, influence HTN control.

Methods: HTN control was assessed among young adult patients (20 to 44 years) who completed SDoH screening in the Northwestern Medicine Health System. Exposures included 6 SDoH: no usual source of care, difficulty affording medication, mental health concerns, housing instability, transportation needs, and food insecurity. Sample included participants with SDoH measures and HTN as defined per 2017 ACC/AHA guidelines or ICD-10 code between 2018 and 2024 (N=36,377). Control was defined as blood pressure (BP) <140/<90 mmHg. Multivariable regression estimated the association between specific SDoH with HTN control, adjusted for age, sex, and race/ethnicity.

Results: BP control at one year was 81.7% among hypertensive young adults. Hypertensive young adults with difficulty affording medication (OR 0.74; 95% CI 0.60-0.94; P=0.011) and housing instability (OR 0.63; 95% CI 0.43-0.96; P=0.027) were less likely to be controlled compared to those without these SDoH. Non-Hispanic Black young adults with HTN were less likely to be controlled compared to Non-Hispanic White young adults (OR 0.69; 95% CI 0.56-0.86; P<0.001). Hypertensive young adults on Medicaid were less likely to be controlled than those with a commercial health plan (OR 0.79; 95% CI 0.63-1.01; P=0.053).

Conclusions: Improving medication accessibility and housing stability for young adults could improve HTN control. Future research should explore strategies to integrate SDoH screening into routine hypertension care.