Abstract Body: Introduction: Hypertension (HTN) is the leading modifiable risk factor for CVD and a major cause of preventable deaths in the US. Social determinants of health (SDoH) impact HTN management.

Methods: HTN prevalence, awareness, treatment, and control were assessed in NHANES 2017-2020 among young (18-39 years), middle-aged (40-64 years), and older adults (≥65 years). Exposures included 5 social needs: low education, low income, no health insurance, food insecurity, and no/limited employment. Sample included participants with SDoH measures and HTN as defined per 2017 ACC/AHA guidelines or use of BP lowering medications (N=3720, representing 89 million adults). Multinomial regression estimated the association of number of social needs (0, 1, or ≥2) with HTN status including aware, treated (among aware) and controlled (among treated), adjusted for age, sex, and race/ethnicity. NHANES weights were used in analyses.

Results: HTN prevalence was 22.7% among young adults. Young adults were more likely than middle-aged and older adults to be unaware or untreated compared to controlled for HTN (P<0.001). Young adults with HTN were more likely to be uninsured, food insecure, and low income compared to older adults (Figure). Adults with HTN and ≥2 social needs were more likely than adults with no social needs to be untreated (OR 1.79; 95% CI 1.15- 2.78; P=0.009) or uncontrolled (OR 1.71; 95% CI 1.27-2.32; P<0.001) compared to having controlled HTN.

Conclusions: SDoH strongly associate with HTN screening and management. Treatment and control are less common among adults with multiple social needs, particularly for younger individuals. Improving insurance coverage, employment, and food security for young adults could improve HTN management.