O-57 Contextual Factors and Ambulatory Blood Pressure Patterns

Methods: Among a sample of adults from the Eastern Caribbean Health Outcomes Network study, we assessed 24-hour ABPM, 3-day/night sleep and fitness patterns using Actigraph wristbands, and clinical and contextual data (sociodemographic characteristics, lifestyle behaviors, social experiences, and community-level variables). Gradient-boosted decision trees, K-means clustering, and one-way ANOVA (Kruskal Wallis for non-parametric data) were used to analyze associations between contextual factors and hypertension as well as to identify unique phenotypes for high-risk BP patterns.

Results: Among the cohort (n=77; mean 57.6 years; 65% Female), 32% had sustained hypertension, 19% normotension, 1% masked hypertension, 46% whitecoat hypertension, and 45% nocturnal hypertension/non-dipping. Clinical factors associated with hypertensive BP patterns were: obstructive sleep apnea, diabetes, asthma, menstruation, and adverse pregnancy outcomes; associated non-clinical contextual factors included: housing insecurity, neighborhood disorder and violence, absent social support, healthcare overutilization, and lower life evaluation. K-means clustering generated four unique phenotypes of clinical and non-clinical contextual factors, although not aligning with high-risk BP patterns.

Conclusion: Several contextual factors were associated with high-risk BP patterns, potentially informing more personalized approaches to hypertension prevention and control. However, larger cohort studies are needed to determine whether contextual factors cluster among specific hypertensive phenotypes and could be used to identify persons who would most benefit from ABPM.