Blood Pressure Control and Maintenance in U.S. Veterans

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.