Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND: Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research. METHODS: We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed. RESULTS: Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts. CONCLUSIONS: Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.