Potential Role Of Physical Activity On Hypertension In Immigrants Versus Non-immigrants

High blood pressure (BP) increases cardiovascular disease risk, with a higher hypertension prevalence observed in immigrant populations vs. non-immigrants in the U.S. Physical inactivity is linked to high BP and may contribute to hypertension prevalence in immigrants. Immigrants may be predisposed to lower physical activity (PA) levels, as they face barriers to PA engagement and the acculturation process may lead to a physically inactive lifestyle. The contribution of PA levels towards hypertension prevalence in immigrants remains unknown. PURPOSE: To examine PA as a mediator for the relationship between immigrant status and hypertension prevalence using the 2017-2020 NHANES. METHODS: A total of 1,233 immigrants (44.7 ± 12.4 years, 640F) were pair matched with 1,233 non-immigrants (44.4 ± 12.5 years, 668F) based on age, gender, education, family income and body mass index (BMI). Immigrants were defined via self-reported foreign-born status. Hypertension was defined through self-reported physician’s diagnosis or mean systolic BP ≥140 mmHg or diastolic BP ≥ 90 mmHg of two BP readings. Moderate-to-vigorous PA (MVPA) levels were available for 667 non-immigrants/644 immigrants and appraised via the global PA questionnaire. Mediation analysis determined if there was a significant indirect effect of immigrant status through MVPA on hypertension prevalence. We also explored health insurance (yes/no) as a mediator for this relationship. RESULTS: Age, gender, education, family income, BMI and MVPA did not differ in immigrants vs. non-immigrants (p > 0.05), but non-immigrants were more likely to have health insurance (83.3% vs. 76.6%, p < 0.001). Hypertension prevalence was higher in non-immigrants vs. immigrants (37.8% vs. 29.9%, p < 0.001). Mediation analysis did not reveal a significant indirect effect of immigrant status through MVPA on hypertension prevalence (estimate = -0.001, 95% CI = -0.03 - 0.02); but lower health insurance in immigrants mediated the relationship of immigrant status and hypertension prevalence (estimate = -0.02, 95% CI = -0.04 - -0.001). CONCLUSIONS: In U.S. adults, PA levels did not explain the difference in hypertension prevalence in immigrants vs. non-immigrants. Lower health insurance in immigrants vs. non-immigrants may underestimate hypertension prevalence in this study.