Clinical Hypertension Guidelines and Social Determinants of Health: A Systematic Scoping Review

Background Social and economic factors impact hypertension risk and control. We examined the integration of social determinants of health (SDH) guidance into adult US hypertension guidelines to explore how existing hypertension guidelines reference social care activities. Objective To explore how existing hypertension management guidelines reference social care activities. Methods Systematic scoping review of clinical guidelines (guidelines, protocols, and professional organization statements) for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines and protocols published in the US between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on non-pregnant adults with essential hypertension. We extracted instances where included guidelines referred to social determinants of health or social care. The primary outcome was how guidelines covered topics related to social care, defined using a framework adapted from the National Academies of Sciences, Engineering and Medicine (NASEM). Results Search terms yielded 126 guidelines. Thirty-six guidelines met inclusion criteria. Of those 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical care practice based on social risk information. These recommendations often lacked specific guidance around how to address SDH. When guidelines referred to specific social factors, patient financial security was the most common social determinant highlighted (n = 101). Ten guidelines (28%) did not reference social care activities. Conclusion Information about social determinants of health is included in many adult hypertension management guidelines, but few guidelines provide clear guidance for clinicians on how to identify and address actionable social risk factors in the context of care delivery.