Abstract Body: Introduction: Hypertension affects nearly half of U.S. adults, yet control rates remain low, particularly among racial and ethnic minorities. The 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines offer individualized, evidence-based treatment recommendations, but real-world adherence varies. The ongoing LINKED-HEARTS Program is a multi-level intervention targeting disparities in hypertension management among underserved populations with multiple chronic conditions.

Objective: To evaluate baseline antihypertensive medication prescription patterns in the LINKED-HEARTS Program and assess adherence to the guidelines stratified by race and comorbid subgroups.

Method: We conducted a cross-sectional analysis of baseline data from eighty-five adults in the intervention arm with uncontrolled hypertension (SBP >140 mm Hg) and comorbid diabetes (DM), chronic kidney disease (CKD), or both. Medication history was collected by the study pharmacist. Adherence was defined as the proportion of patients prescribed guideline-recommended therapies for their comorbidities. Prescription patterns were stratified by race (Black vs. White) and comorbidity. Chi-square tests assessed differences in antihypertensive class distribution across racial groups.

Results: Participants had a mean age of 64.3 ± 12.9 years; 52.9% were female and 57.7% were Black. Among Black adults, adherence to AHA-recommended therapy was 85.2% (DM), 83.8% (CKD), and 78.6% (both). Among White adults, adherence was 78.6% (DM), 85.3% (CKD), and 66.6% (both). Overall, 25% were on fixed-dose combinations, and 68.2% received combination therapy. Black patients were more frequently prescribed calcium channel blockers (CCBs), diuretics, mineralocorticoid receptor antagonists (MRAs), and aldosterone antagonists (AAs), while White patients more often received beta-blockers and Angiotensin Converting Enzyme Inhibitor/ Angiotensin Receptor Blocker (ACEI/ARBs) (Figure 1).

Conclusion: While adherence to AHA guidelines was generally strong, it varied by race and comorbidity. Underutilization of fixed-dose and combination therapies highlights opportunities for optimizing treatment. These gaps may reflect clinical decisions and patient-specific factors such as side effects, socioeconomic status, and access to care. Team-based strategies, including pharmacist involvement and telehealth, may help address these disparities.