Blood Pressure Trajectories Among Adults Living in Extreme Poverty: A Population-Based Cohort in Port-au-Prince, Haiti

BACKGROUND: Elevated blood pressure (BP) is the leading cause of death globally, with the greatest burden in low-and-middle income countries. Longitudinal BP data are limited in settings of extreme poverty. We identified longitudinal BP trajectories and associated risk factors in urban Haiti. METHODS: We analyzed data from 2073 adults (≥18 years) with ≥3 facility-based BP measurements between March 2019 and April 2025 in the population-based Haiti Cardiovascular Disease Cohort. Demographic, behavioral, and clinical data were collected annually. Participants received routine clinical care based on Ministry of Health guidelines. Latent class growth mixture modeling identified systolic BP trajectory groups. Enrollment characteristics associated with BP trajectory group membership were analyzed using multivariable generalized-logit models. RESULTS: At study enrollment, median age was 43 years (interquartile range, 30-56) ; 60% were female, 100% identified as Black Haitian, and 69% lived on <US1/d. Over 13 446 facility visits (median follow-up, 3. 9 years), we identified 4 systolic BP trajectories based on mean enrollment BP: normal, rising (107 mm Hg, 39. 2%, mean change +0. 7 mm Hg/y), moderate, rising (126 mm Hg, 34. 7%, +1. 3 mm Hg/y), high, reduction (151 mm Hg, 19. 2%, -1. 6 mm Hg/y), and very high, rebound (173 mm Hg, 6. 9%, -0. 8 mm Hg/y). Antihypertensive medication usage and BP control among participants with hypertension increased. Older age, lower education, and obesity were associated with high, reduction, or very high, rebound BP trajectory groups. CONCLUSIONS: In this cohort of young, Black adults in Haiti, we identify 4 BP trajectories, describe increases in antihypertensive medication usage and improvement in BP control, demonstrating BP care is feasible in a low-resourced setting.