Hypertension among Middle Eastern and North African adults residing in the United States: addressing equity in health research representation using the All of Us Research Program, 2000-2024.

BACKGROUND

Hypertension (HTN) is a leading modifiable risk factor for cardiovascular disease and mortality; however, its epidemiology among the Middle Eastern and North African (MENA) population residing in the United States (US) remains uncharacterized due to historical racial misclassification and underrepresentation in national datasets. This study aimed to evaluate HTN prevalence, treatment, control, and predictors among MENA adults using data from the All of Us Research Program (2000-2024).

METHODS

This was a retrospective cohort study of self-identified MENA adults aged ≥18 years with at least one outpatient blood pressure (BP) measurement. HTN was defined by an outpatient diagnosis of essential HTN. BP control was assessed using time in target range among participants with at least two outpatient BP measurements after index date and was defined as BP < 140/90 mm Hg ≥50% of outpatient visits. A stepwise logistic regression model was used to identify significant predictors of HTN.

RESULTS

Among 2,572 MENA adults included in the analysis, 18% (463) had HTN. Among hypertensive participants, 76% (352 of 463) received antihypertensive treatment, and 85% (400 of 463) achieved BP control. Participants aged ≤ 50 years demonstrated significantly higher BP control proportion, compared with those aged >50 years (97 vs. 83%, p = 0.0137). Significant predictors of HTN included diabetes, chronic kidney disease, coronary artery disease, hyperlipidemia, sleep apnea, obesity, male sex, age, anxiety, vitamin D deficiency, and anemia.

CONCLUSIONS

Among US MENA adults that participated in the All of Us research Program, HTN prevalence was lower than estimates reported for the general US adult population, while treatment and BP control were higher. Cardiometabolic conditions were the primary drivers of HTN risk, with additional associations observed for vitamin D deficiency and anemia, highlighting the need for improved inclusion of MENA adults in national health research to inform targeted prevention and management strategies.