Abstract TP069: Role of Lifestyle Factors and Cognitive Function on the Association of Educational Attainment with Incident Hypertension in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: Hypertension is one of the most important determinants of cardiac and brain health. We previously showed that higher educational attainment is associated with a lower risk of incident hypertension. The factors that mediate such an association have not been described. Hypothesis: Higher education attainment reduces risk of incident hypertension both directly and indirectly through higher global cognitive scores and improved health behaviors. Methods: Data from the Hispanic Community Health Study/Study of Latinos were analyzed. Education attainment was grouped into 3 categories: Less than High School (HS), HS, or greater than HS. Global cognition (GC) of non-hypertensive participants at Visit 1 was derived by averaging the z scores across four neurocognitive tests (Brief Spanish-English Verbal Learning Test Sum and Recall; Word Fluency; and Digit Symbol Substitution Test). Sociodemographic characteristics and unhealthy behaviors (smoking, obesity, sedentary life, lower diet quality, and presence of sleep apnea) were ascertained at Visit 1. Incident hypertension was investigated at Visit 2, conducted, in average, 6 years later. The association of education attainment at Visit 1 with incident hypertension at Visit 2 (defined as BP ≥130/80 mmHg or on treatment) was investigated using logistic regression analyses adjusted for sociodemographic characteristics and time between visits. We used multimodal analyses to assess whether unhealthy behaviors and GC were pathway variables between education attainment and incident hypertension. Results: A total of 8,482 hypertension free participants (mean [IQR] age, 41[40-41] years; 62% female) were included. At Visit 2, 39% of individuals developed hypertension. In our final model, achieving greater than HS for education, was associated with lower odds of incident hypertension (OR=0.86; 95% CI 0.74- 0.99). In the pathway analysis, each level increase in the education attainment was associated with lower odds of incident hypertension, either directly or through higher global cognitive scores, which in turn led to lower rates of sedentarism, obesity, and sleep apnea ( Figure ). Conclusions: Higher education attainment was associated with lower odds of incident hypertension six years later. Global cognitive scores were an important mediator between education attainment and unhealthy behaviors, which were pathways variables in the development of hypertension.