Abstract Body: Introduction
Hypertension (HT) remains a leading driver of cardiovascular disease in the US, but its burden is unevenly distributed across regions. The prevalence of HT varies significantly across US regions, including Puerto Rico (PR) and Hawaii (HI), despite shared geography and governance. However, limited research has examined how geographic context interacts with physical activity (PA) levels to influence HT risk. The aim of the study is to examine the association between HT and the intersection of geographic location (PR, HI, and mainland US) and PA levels.
Hypothesis
There will be a significant interaction effect between geographic location and PA levels on HT.
Methods
A total of 265,930 adults from the 2023 Behavioral Risk Factor Surveillance System were included. Participants self-reported whether they had ever been diagnosed with HT, which served as the dependent variable. Geographic location was categorized as PR, HI, or the mainland US. Two PA variables were analyzed: meeting aerobic PA guidelines (≥150 min/week) and weekly PA levels (0, 1–299, or ≥300 min/week). Multiple logistic regressions were conducted for each PA variable, with HT regressed on geographic location, PA, and their interaction, adjusting for demographic covariates.
Results
Among the participants (49.7% female; 97.1% mainland, 2.0% HI, 0.9% PR), 41.3% reported HT. Prevalence differed by region (χ2=122.58, p <.05): 41.3% in the mainland U.S., 35.9% in HI, and 48.9% in PR. Participants meeting aerobic PA guidelines had lower HT prevalence (37.98%) than those who did not (χ2=1854.20, p <.05). In logistic regression, living in HI was associated with lower odds of HT (OR=0.82, 95% CI [0.74, 0.92]), while living in PR was associated with higher odds (OR=1.58, 95% CI [1.42, 1.76]). Meeting PA guidelines was associated with lower odds of HT (OR=0.84, 95% CI [0.82, 0.85]), and the interaction between region and PA was not significant (p >.05). Similar results were found with the regression of weekly PA, PA remained independently associated with lower odds of HT (OR=0.79-0.85, p<.05), and PR remained at higher risk (OR=1.55, 95% CI [1.39, 1.73]) with no interaction effect observed.
Conclusions
Despite the benefits of PA, regional differences in HT, especially the higher prevalence in PR, indicate that the contextual and structural factors play a significant role. Tailored interventions addressing both lifestyle and social determinants may be needed to mitigate these disparities.