- Adults with hypertension who screened positive for food insecurity were less likely to be adherent to their antihypertensive medications than those who screened negative. This difference remained after adjusting for demographic and clinical characteristics.
- Patients who screened positive also had more frequent gaps in their medication supply and lower blood pressure (BP) control at 12 months, even though baseline BP was similar between groups.
This report summarizes our poster presented at ISPOR Europe 2026, titled Food insecurity and antihypertensive medication adherence among adults with hypertension: A real-world study.
Taking antihypertensive medications as prescribed is an important contributor to BP control, and nonadherence remains a challenge in hypertension management (1). Food insecurity can create competing demands between food and medications, which may lead patients to prioritize basic needs over treatment (2). Food insecurity has been associated with medication nonadherence in chronic disease populations, including adults with hypertension (2). Research among older adults with hypertension also suggests that participating in food assistance programs is associated with better adherence to antihypertensive medications (2).
Using a subset of Truveta Data, we examined whether individual food insecurity screening results were associated with antihypertensive medication adherence among adults with hypertension.
Methods
Study design
We conducted a retrospective cohort study using de-identified electronic health record (EHR) data from US health systems. The index date was a documented food insecurity screening between January 2022 and April 2025, with 12 months of follow-up through April 2026.
Study population
We included adults with a hypertension diagnosis, an active antihypertensive prescription, and a documented food insecurity screen. We excluded patients with end-stage renal disease or dialysis on or before the index date. Patients were classified as screen-positive or screen-negative for food insecurity using the Hunger Vital Sign, supplemented by the US Food Security Survey.
Outcomes
- Adherence: Measured as the proportion of days covered (PDC) across eight antihypertensive drug classes over the 12 months after screening. Patients were considered adherent if their PDC was at least 0.80
- Medication gaps: Gaps in medication supply of 30 days or longer and 90 days or longer
- BP control: Systolic BP below 130 mmHg at 12 months
Analysis
We used chi-square tests to compare unadjusted differences between groups. We used multivariable logistic regression to estimate adjusted odds ratios (aORs) for adherence. The model adjusted for age, sex, race and ethnicity, region, baseline systolic BP, and comorbidities.
Results
Food insecurity was associated with lower adherence
We identified 333,182 adults with hypertension and a food insecurity screen. Of these, 227,500 (68.3%) screened positive and 105,682 (31.7%) screened negative. Mean age was 63.1 years, and 56.7% of patients were female. Age and sex were similar between groups.
Screen-positive patients were less often adherent to their antihypertensive medications than screen-negative patients (78.4% vs. 80.2%; p < 0.0001). This difference remained after adjustment (aOR = 0.922; 95% CI: 0.901–0.943; p < 0.0001). How strongly food insecurity was associated with adherence varied by region and by severity of food insecurity, suggesting that barriers may differ across patient contexts.
Medication gaps were more common and BP control was lower
Screen-positive patients more often had a gap in their medication supply, as shown in Figure 1 of the poster:
- 30-day or longer gap: 24.7% vs. 22.7% (p < 0.0001)
- 90-day or longer gap: 7.3% vs. 6.5% (p < 0.0001)
Mean baseline systolic BP was similar in both groups (134.1 mmHg). However, 12-month BP control was lower among screen-positive patients (47.7% vs. 49.4%; p < 0.0001).
Discussion
In this large real-world cohort of adults with hypertension, food insecurity was associated with modest but consistent differences in antihypertensive medication adherence, medication gaps, and BP control at 12 months.
Lower odds of adherence remained after adjustment for demographic and clinical characteristics. Because baseline BP was similar between groups, the lower BP control at 12 months is consistent with food insecurity–related barriers to staying on treatment over time. However, this analysis did not test whether adherence explained the difference in BP control.
These findings support including social needs screening in hypertension management and addressing food insecurity as part of cardiovascular risk reduction. Future research should examine why these associations vary by region and by severity of food insecurity. It should also evaluate whether interventions such as food assistance programs improve adherence and BP outcomes.
Data are constantly changing and updating. These findings are consistent with data analyzed for the ISPOR Europe 2026 study.
Citations
- K. Choudhry, I. M. Kronish, W. Vongpatanasin, et al., Medication adherence and blood pressure control: a scientific statement from the American Heart Association. Hypertension 79, e1–e14 (2022).
- O. Ojinnaka, I. Arteaga, L. Hodges, C. Heflin, Supplemental Nutrition Assistance Program participation and medication adherence among Medicaid-insured older adults living with hypertension. J Gen Intern Med. 38, 1349–1356 (2023).
