Abstract Body: Background: Hypertension (HTN) is an inflammatory disease associated with high-sensitivity C-reactive protein (CRP); however, the magnitude of the association with different types of HTN is unclear. We aim to examine the association of CRP with systolic and diastolic HTN (SHTN and DHTN).

Method: A retrospective cross-sectional study utilizing data from the 2017 - 2020 NHANES included adult participants with available CRP. The association of the tertile (T) of CRP with SHTN and DHTN defined by SBP and DBP ≥130 and ≥80 mmHg, respectively were examined by multiple logistic regression.

Results: Of 9,693 adult participants, the mean age±SD was 50 years and 51% were female. The median level (IQR) of CRP was 1.94 mg/L (0.83, 4.45) (Figure 1A and 1B). Participants with diabetes accounted for 15% of the study population with a median HbA1c of 5.6% (5.3, 6.0). Mean SBP and DBP were 124±19 and 74±12 mmHg, respectively (Figure 2A, 2B, 3A, and 3B). Compared to participants with CRP in T1, those with CRP in T2 and T3 had significantly higher odds of having SHTN and DHTN (OR_{SHTN T2} (95%CI) 1.39 (1.23, 1.56), P <0.0001; OR_{SHTN T3} 1.29 (1.14, 1.46), P <0.0001; OR_{DHTN T2} 1.51 (1.33, 1.71), P <0.0001; OR_{DHTN T3} 1.86 (1.64, 2.11), P <0.0001). After adjusting for age (< vs. ≥65), gender, race (non-Black vs. Black), BMI, HbA1c, mean SBP or DBP, total cholesterol, serum albumin, serum ferritin, level of education, and the ratio of family income to poverty, only participants in T3 had greater odds of having DHTN (aOR_{DHTN T3} 1.39 (1.14, 1.69), P 0.001). With stratified subgroup analyses, only participants ≥65 years old with diabetes in T3 had lower odds of having SHTN (aOR_{SHTN T3} 0.428 (0.21, 0.88), P 0.021), whereas, participants <65 years old without diabetes in T3 and with diabetes in T2 and T3 had higher odds of having DHTN (DM: aOR_{DHTN T3} 1.31 (1.01, 1.71), P 0.042 and Non-DM: aOR_{DHTN T2} 3.26 (1.51, 7.03), P 0.003; aOR_{DHTN T3} 3.94 (1.76, 8.83), P 0.001). There was no effect modifier of CRP – HTN association among all covariates.

Conclusions: CRP is associated with a lower likelihood of SHTN in individuals 65 years old with diabetes, while it is related to the likelihood of DHTN, particularly in <65 years old participants regardless of diabetes status. The inflammatory state may be related to pathophysiologic changes for SBP in older diabetics and DBP in younger populations.