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. 2025 Oct 24;4(11 Pt 1):102267.
doi: 10.1016/j.jacadv.2025.102267. Online ahead of print.

Blood Pressure Control and Maintenance in U.S. Veterans: Roles of Sex, Race, Ethnicity, and Deprivation

Allison E Gaffey  1 , Tiffany E Chang  2 , Sanket S Dhruva  3 , Matthew M Burg  4 , Sally G Haskell  5 , Lori A Bastian  5 , Erica S Spatz  6 , Allison Levine  7 , Melissa Skanderson  7 , Cynthia A Brandt  8
Affiliations
Free article

Blood Pressure Control and Maintenance in U.S. Veterans: Roles of Sex, Race, Ethnicity, and Deprivation

Allison E Gaffey et al. JACC Adv. .
Free article

Abstract

Background: U.S. Veterans have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. Thus, blood pressure (BP) control is particularly beneficial for younger Veterans, discharged after October 1, 2001 (ie, post-9/11).

Objectives: The objective of the study was to assess BP control and maintenance by sociodemographic characteristics among post-9/11-era Veterans with new-onset hypertension.

Methods: This retrospective cohort study included data from all post-9/11 Veterans who received care in U.S. Veterans Affairs medical centers, October 1, 2001-September 30, 2023 (n = 1,280,441). Hypertension was defined as the first diagnosis, antihypertensive fill, or ≥2 outpatient BP ≥140/90 mm Hg. Exposures were sex, race, and ethnicity. The Social Deprivation Index was calculated from zip codes. Logistic regression tested associations between sociodemographic variables and BP control (<140/90 mm Hg), 1, 2, and 5 years after hypertension onset, while covarying demographics, behavioral, and clinical factors.

Results: Overall, 31% of patients met the hypertension criteria and had adequate follow-up (n = 398,732; median age: 37 years, 10% women, 63% non-Hispanic [NH] White). One year after onset, 43% of men and 60% of women achieved BP control, improving to 59% and 67% by 5 years. After adjustment, women had greater odds of control at 1 year (OR: 1.85; 95% CI: 1.81-1.90), which remained at 5 years (OR: 1.39; 95% CI: 1.34-1.44). Relative to NH White patients, Hispanic patients had 23% to 17% greater control odds, and NH Black patients had 10% to 23% lower odds through 5 years. Inclusion of the social Deprivation Index did not change these results.

Conclusions: The first year of hypertension management portends future differences in BP control. Earlier strategies are needed to improve BP control in a population at high-risk for cardiovascular disease.

Keywords: blood pressure; hypertension; race; sex differences; social determinants of health; veterans.

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Conflict of interest statement

Funding support and author disclosures Dr Gaffey was supported by a National Institutes of Health/National Heart, Lung, and Blood Institute grant (K23HL168233). Dr Chang was supported by an American Heart Association Predoctoral Fellowship (#23PRE1018200/2023-2024). Dr Dhruvawas supported by a grant from the Veterans Affairs Health Services Research & Development (1IK2HX003357). Dr Spatz receives grant funding from the Centers for Disease Control and Prevention (20042801-Sub01), the National Heart, Lung, and Blood Institute (R01HL151240), and the Patient-Centered Outcomes Research Institute (HM-2022C2-28354). Dr Dhruva reported funding from Arnold Ventures, serving on the Institute for Clinical and Economic Review California Technology Assessment Forum and Medicare Evidence Development & Coverage Advisory Committee. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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