Abstract Background Dismantling structural inequities in health care requires that physicians understand the impacts of social determinants of health (SDH). Although many medical schools incorporate SDH education, integration of these principles into the preclinical curriculum remains challenging. Methods Students and faculty at the University of Vermont, Larner College of Medicine developed the Social Medicine Theme of the Week (SMTW), a peer-teaching approach to integrating SDH topics across the preclinical curriculum as part of a broader social medicine curriculum. Students created objectives to link SDH-related topics to the weekly curriculum and presented them to the class. Student innovation led to the incorporation of creative online infographics that were published in the curriculum calendar. First year medical students and faculty members were surveyed to assess preferences and educational impact of the SMTW announcements with accompanying infographics. Results Of the 40 student respondents, 77.5% reported that their knowledge of SDH had improved due to the SMTW. Most students (82.5%) preferred the infographic modality over traditional teaching modalities. Faculty respondents reported limited engagement with the SMTW and, although they supported the need for these objectives, many (61%) found it difficult to integrate SDH content into their class materials. Conclusion Student-led infographics are a popular method of integrating SDH content in the preclinical curriculum that can be optimized through faculty orientation and support. Success for this type of instruction requires opportunities for student developers, integration and formal assessment of objectives, faculty engagement and training, and institutional support for creating and delivering a robust social medicine curriculum. 

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Integrating social determinants of health principles into the preclinical medical curriculum via student-led pedagogical modalities


 Background:
 Hypertension is a modifiable stroke risk factor, but hypertension severity isn't completely captured by blood pressure (BP) alone. Prior studies have shown that among adults with similar systolic BP, those taking a greater number of antihypertensive medications have greater stroke risk. However, count of antihypertension medications does not consider relative dose across classes and incompletely characterizes hypertension medical therapy. The recently described Hypertension Daily Dose (HDD) metric quantifies total dose of BP-lowering medications across multiple classes. The association between HDD and BP with stroke risk is unknown.
 
 
 Objective:
 Determine stroke risk by HDD and BP levels.
 
 
 Methods:
 We included Black and White adults from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study without prevalent stroke at visit 2 (2013-2017; treated as baseline) with follow-up data and full BP assessment. We classified systolic BP using JNC7 groupings and HDD by no BP medications and tertiles among those on BP medications. Cox proportional hazards models estimated hazard ratios (HR) for incident stroke by HDD group and BP group.
 
 
 Results:
 Of 13,265 participants included (mean age 72 [SD 8.5], 36% Black race, 56% women), 344 incident stroke events occurred during a median follow-up of 5.5 years. The stroke rate was higher among Black than White participants (5.6 vs. 5.0/1000 person-years). Relative to no BP medications and normotension, those with systolic BP ≥140 mm Hg and HDD in tertiles ≥2 had a 2.3x to 3.7x greater risk of incident stroke (
 Table
 ). Those with systolic BP <140 mm Hg had similar stroke risk across HDD groupings.
 
 
 Conclusion:
 Among Black and White US adults without prevalent stroke, higher HDD was associated with greater risk of incident stroke in those with systolic BP ≥140 mm Hg, possibly reflecting greater disease severity and treatment resistance. These findings support aggressive BP control with antihypertensive medications to lower stroke risk among adults with hypertension.
 
 
 


Abstract P116: Hypertension Severity As Quantified By Hypertension Daily Dose (HDD) And Blood Pressure And Risk Of Stroke In The REGARDS Study

Hypertensive patients may encounter early and subtle myocardial changes. Global longitudinal strain (GLS) enables the early detection of left ventricular (LV) systolic dysfunction. Inter-observer variability and training duration are known limitations of GLS. The aims of the study were to: (A) Measure GLS in both normal and healthy individuals; and (B) Test the intra-and-inter observer GLS measurement variability in both groups. The study included 30 participants: 15 healthy individuals (group 1) and 15 hypertensive individuals (group 2) were included using strict exclusion criteria. LV GLS was measured in all participants using two-dimensional speckle-tracking echocardiography. Images were acquired and measured by one sonographer-operator and re-measured by two independent sonographers-observers one and two. Average GLS for group 1(-17.4%+/-1.6). Average GLS for group 2 (-17.0%+/-1.6). Weich-two sample t-test p= 0.46. The average percentage differences of the GLS measurements between the operator and two observer groups had a relatively small delta between groups, the greatest variability was seen in the HTN group (Graph 1). When examining these results further, it showed there was greater variability amongst observer 1 measurements with an average percentage difference of -0.6+/-2.3 in comparison to original operator -0.2 +/-1.8. The average percentage difference in LV GLS for the single operator was less than for the two observers, indicating that the inter-observer variability is an important limitation to consider when analysing measurements. While a statistically non-significant reduction in LV GLS in hypertensive-patients was found, a larger sample size along with allowance for GLS differences between sexes may yield different results. 

The Reproducibility of Global Longitudinal Strain in Normal and Hypertensive Patients: A Single Centre Study


 Background:
 High C-reactive protein (a nonspecific inflammatory biomarker) is a risk factor for incident hypertension. The role of specific inflammation pathways in hypertension’s origins are unresolved. E-selectin, ICAM-1, and VCAM are cell adhesion molecules expressed by endothelial cells that aid leukocyte adhesion during inflammation. Their association with incident hypertension is unclear.
 
 
 Objective:
 To determine risk of incident hypertension by level of E-selectin, ICAM-1, and VCAM.
 
 
 Methods:
 REGARDS enrolled 30,239 Black and White US adults aged ≥45 years from across the continental US in 2003-2006, with a second exam in 2013-2016. The Biomarkers as Mediators of Racial Disparities in Risk Factors (BioMedioR) study included 4,400 REGARDS participants who attended both exams. We excluded participants with hypertension or missing biomarkers of interest at baseline. Hypertension was defined using a 140/90 mm Hg threshold or self-reported use of blood pressure (BP) lowering medications. Modified Poisson regression estimated relative risk (RR) of incident hypertension by baseline E-Selectin, ICAM-1, and VCAM.
 
 
 Results:
 Among 1,923 normotensive participants (mean [SD] age 71 [8] years, 36% Black race, 51% women) with 9 years median follow up, 37% developed hypertension. Baseline E-selectin and ICAM-1 but not VCAM were higher among Black participants and obese participants. In multivariable adjusted models, higher E-selectin was associated with greater risk of incident hypertension among White but not Black adults (P
 interaction
 = 0.05) in all but the final model (
 Table
 ). Higher ICAM-1 and VCAM were not associated with risk of hypertension in any model.
 
 
 Conclusion:
 In a prospective study of Black and White US adults, E-selectin was associated with incident hypertension among White adults except when adjusting for medical comorbidities, including baseline systolic BP. Modification of E-selectin through behavioral interventions or medical therapies might be tested to lower risk of hypertension development.
 
 
 


Abstract P092: Cell Adhesion Molecules And Incident Hypertension In Black And White Adults: The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study

T. Harkness

Papers

Integrating social determinants of health principles into the preclinical medical curriculum via student-led pedagogical modalities

Abstract P116: Hypertension Severity As Quantified By Hypertension Daily Dose (HDD) And Blood Pressure And Risk Of Stroke In The REGARDS Study

The Reproducibility of Global Longitudinal Strain in Normal and Hypertensive Patients: A Single Centre Study

Abstract P092: Cell Adhesion Molecules And Incident Hypertension In Black And White Adults: The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study