Abstract FR468: Utilizing a Health Equity Framework to Explore Patient-Level Factors Impacting Effective Hypertension Management Across Two Academic Health Systems

Introduction: Hypertension affects nearly half of U.S. adults, with over two-thirds of cases uncontrolled. Social determinants of health, including environmental and socioeconomic structures, are associated with community- and individual-level disparities in cardiovascular health. Hypothesis (Objective): This study utilized a health equity framework (HEF) to examine the impact of patient-level factors on hypertension management across two health systems in North Carolina and Kansas. Methods: From 2022-2023, we interviewed 29 providers and 25 patients with hypertension from 13 high- and low-performing primary care clinics – assessed via hypertension control rates – and one cardiology clinic. Interview guide and codebook development incorporated HEF themes, with both thematic analysis and inductive and deductive coding methodologies utilized during analysis. Results: Participants identified many patient-level factors that impact hypertension management, including five salient themes: patient resources, health literacy, lifestyle, intentionality, and patient-centered care. Providers often discussed health literacy as a critical barrier, characterizing hypertension as a “silent disease” that is frequently underprioritized by patients until adverse events occur. Providers in low-performing clinics more regularly cited health literacy challenges, with some NC providers associating patients’ rurality with decreased health literacy. Discussions of healthy eating were nuanced, with patients often detailing cost-related barriers, while some providers referenced the affordability of healthy foods (e.g., beans, lentils) and called for improved diet-focused education. Multiple participants linked patients’ mental health to hypertension management, specifically the potential for anxiety to exacerbate symptoms and depression to reduce treatment intentionality. Conclusion: Our findings underscore the need for individualized, equity-informed hypertension management strategies that address health literacy, behavioral support, and social determinants in both rural and underserved settings.