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Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Background: This study examined the longitudinal association between ultraprocessed food (UPF) consumption and overall hypertension risk and explored the contribution of UPF to racial disparities in risk for hypertension., Methods: We analyzed data from 5957 participants from the REGARDS cohort study (Reasons for Geographic and Racial Disparities in Stroke) free from hypertension during visit 1 (2003-2007), had complete dietary information at visit 1, and completed visit 2 (2013-2016). UPF consumption was measured using the Nova classification system and operationalized percent calories and grams. The main outcome was incident hypertension. Logistic regression was used for analysis., Results: Thirty-six percent of participants developed hypertension at visit 2. Results showed a positive linear relationship between UPF and hypertension incidence. Aggregate model results showed that those in the highest UPF consumption quartile had 23% greater odds of incident hypertension compared with the lowest quartile. Multivariable results showed that Black and White participants in the highest consumption quartile had 1.26 (95% CI, 0.92-1.74) and 1.22 (95% CI, 1.01-1.47) greater odds of hypertension compared with those in the lowest quartile, respectively. Analyses using UPF consumption as percent grams showed similar aggregate results; however, race-stratified results differed. Findings were no longer statistically significant among White participants (odds ratio, 1.09 [95% CI, 0.89-1.33]) but showed significant differences in incident hypertension between Black participants in the highest versus lowest UPF quartiles (odds ratio, 1.43 [95% CI, 1.01-2.02])., Conclusions: This study demonstrated that high consumption of UPF is associated with increased hypertension risk. Further research is warranted to better understand differences in the intakes of UPF subgroups that may underpin the racial differences in hypertension incidence observed with different UPF metrics.

Objectives: To use the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate an educational model addressing self-management of uncontrolled hypertension., Methods: We used a pre-post single cohort design to identify minoritized patients with uncontrolled hypertension (systolic > 160 mmHg and/or diastolic > 100 mmHg). Trained Ambassadors provided telephone outreach, skill-based blood pressure (BP) monitoring, and goal-setting for 4 months. Follow-up occurred at 7 months. We evaluated the initiative using the RE-AIM framework and quantitative analysis for process and outcome measures post-intervention., Results: Among Black patients (n = 345), the average age was 55.4 years (8.7), half identified as male (n = 173, 50.1 %); many were uninsured (n = 159, 46.1 %). Engagement in calls occurred for 67.8 % (n = 234) of the cohort; monitor distribution was 22.9 % (n = 79); and goal setting occurred for 64 patients. BP improved for 40 % of the cohort (mean pre: 168/98 mmHg, mean post: 150/89 mmHg; p < 0.0001) and 40 % of patients' last known BP was < 140/90., Conclusions: RE-AIM evaluation of the Closing the Gap initiative suggests that the model is associated with BP reduction in high-risk Black patients., Practice Implications: An educational model for patient-centered hypertension management in low-income populations is feasible and addresses self-monitoring barriers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)