Robert D. Brook

Background: Awareness and control of cardiometabolic disease risk factors remain suboptimal in the United States. Mobile health units may improve detection, particularly in socially disadvantaged urban communities. Methods: The Wayne State University/Wayne Health mobile health units program has conducted screening events across metropolitan Detroit (>1000 locations) since 2020. Adults ≥18 years undergo medical history assessment and may elect blood pressure (BP) and laboratory testing. We conducted a serial cross‐sectional analysis of electronic health records data from July 26, 2021 to September 8, 2025 to characterize the population screened. Results: The median BP (122/75 mm Hg), low‐density lipoprotein‐cholesterol (103 mg/dL) and hemoglobin A1c (5.7%) were modestly elevated. Roughly half of the population had high BP (systolic ≥130 mm Hg or diastolic ≥80 mm Hg; 48%; n=6182/12821) and low‐density lipoprotein‐cholesterol levels ≥100 mg/dL (54%; n=3860/7115), whereas 16% had hemoglobin A1c levels ≥6.5% (n=1137/7061). Among individuals with all 4 results (n=5393), only 4% had an ideal cardiometabolic disease risk profile (systolic BP <120 mm Hg + low‐density lipoprotein‐cholesterol <70 mg/dL + hemoglobin A1c <5.7%). Conversely, 70% had ≥1 uncontrolled cardiometabolic disease risk factor(s) (systolic BP ≥130 mm Hg or low‐density lipoprotein‐cholesterol ≥100 mg/dL or hemoglobin A1c ≥7.0%). Older age was associated with all 4 risk factors being uncontrolled, whereas Black race was associated with uncontrolled BP and male sex with both uncontrolled BP and HbA1c. Conclusions: Population screening using mobile health unit‐based outreach identified a high burden of cardiometabolic disease abnormalities in socially disadvantaged urban communities. These programs are potentially valuable for improving detection and enabling targeted interventions to reduce health disparities.

Results from the ACCOMPLISH (Avoiding Cardiovascular Events through COMbination Therapy in Patients LIving with Systolic Hypertension) trial suggest that combining benazepril with amlodipine, rather than hydrochlorothiazide, provides superior cardiovascular protection potentially in a BP‐independent manner. We employed random survival forest, a powerful machine learning approach, to compare the relative importance of risk factors (i.e., variable importance factor (VIF)), focusing on in‐trial BP control for predicting the primary composite cardiovascular outcome in the 2 treatment limbs. Among the 6 risk factors with significantly different VIFs between treatments, all were lower under benazepril/amlodipine combination. The VIF for achieved systolic BP at 6‐months was 35% lower in the benazepril/amlodipine (0.082) versus the benazepril/hydrochlorothiazide (0.126) limb. The fact that in‐trial BP control was less important for preventing cardiovascular events during benazepril/amlodipine treatment provides novel support for our contention that this combination regimen provides a degree of clinically‐relevant cardio‐protective actions in a BP‐independent manner.

Portable air cleaners (PACs) can reduce blood pressure (BP) by decreasing fine particulate matter (PM _2.5 ) air pollution exposure. However, the effectiveness of a single PAC in a bedroom and the impact on self‐measured home BPs over 4 weeks have not been evaluated. We conducted a randomized‐order double‐blind cross‐over trial of active PAC (HEPA filter in‐place) versus sham (no filter) intervention in the bedroom of older adults living in a senior residential facility from 1/11/2021‐11/4/2024. Each study limb lasted 4 weeks with a 2‐week washout period. Participants measured triplicate home BPs in the mornings and evenings during weeks 1 and 4. Bedroom PM _2.5 concentrations were continuously monitored, and 24‐h personal exposures were determined during week 4. Results from 33 participants (74.9 ± 7.7 years old) completing the trial were analyzed. Active PAC intervention reduced bedroom PM _2.5 concentrations (1.3±1.5 vs. 8.3±12.8 µg/m ³ , p < 0.001) and 24‐h personal exposures (5.1 ± 4.6 vs. 12.4±15.6 µg/m ³ , p < 0.001) versus sham. Average home systolic BP levels did not differ during active PAC versus sham intervention in the full study cohort (127.0 ± 16.2 vs. 126.5 ± 16.0 mm Hg, p = 0.59). However, having a larger body mass index plus higher baseline systolic BP, older age plus higher baseline systolic BP, and older age plus larger body mass index showed trends for modifying the benefits by active PAC. We showed for the first time that air filtration in the bedroom alone can successfully reduce PM _2.5 exposures. While systolic BPs were not lowered over 4 weeks in the entire cohort, some individuals may have benefited.

Mobile health units (MHUs) can reach populations facing barriers to traditional primary care, but information about factors associated with their utilization is limited. The objective of this ecological study was to evaluate whether MHU encounter density is increased in census tracts designated as Primary Care Health Professional Shortage Areas (HPSAs) and explore whether associations varied by socioeconomic vulnerability. We analyzed Wayne State University/Wayne Health MHU encounters with adult patients from July 2021 to September 2025. Negative binomial regression models with a log link and log(population) offset tested the a priori hypothesis that encounter density was increased in designated versus undesignated HPSA census tracts. Sensitivity analyses assessed variation by social vulnerability index score quartiles established by the US Centers for Disease Control and Prevention. One quarter of the five-county metropolitan Detroit, Michigan, catchment area census tracts were designated healthcare shortage areas. Overall, 13,852 encounters with 10,924 unique patients occurred across 924 of 1305 census tracts. Encounter rate per adult population was significantly increased by severalfold comparing designated versus undesignated shortage areas, with stronger associations at lower socioeconomic vulnerability index score quartiles (interaction p = 0.0006). These findings support continued efforts to scale and evaluate MHUs to address projected healthcare shortages, particularly in socioeconomically vulnerable areas.

Mobile health units (MHUs) offer an attractive means to reach people facing barriers that limit engagement with traditional primary care providers, but evidence on utilization as-sociated factors is sparse. This ecological study leveraged data from Wayne State University/Wayne Health MHU encounters with adult patients from 07/2021-09/2025 to address the knowledge gap. We fit negative binomial regression models with a log link and log(population) offset to test the a priori hypothesis that the density of MHU encounters is increased in designated versus undesignated Primary Care Health Professional Shortage Area census tracts established by the U.S. Health Resources and Services Administration. Sensitivity analyses examined whether the association varied by socioeconomic status vulnerability index score quartiles established by the US Centers for Disease Control and Prevention. One quarter of the five-county metropolitan Detroit, Michigan, catchment area census tracts were designated healthcare shortage areas. There were 13,852 encounters with 10,924 unique patients living in 924 of the total 1,305 census tracts in the catchment. The MHU encounter rate per adult population was significantly increased by severalfold comparing designated versus undesignated healthcare shortage areas; the estimated magnitude of association strengthened with increasing socioeconomic vulnerability index score quartile (interaction p-value, 0.0006). Continued efforts to scale and evaluate the capacity for mobile health units to help address projected healthcare shortages appears warranted, particularly in areas with heightened socioeconomic vulnerability.

Hypertension is a multifactorial condition influenced by the intricate interplay of biological and genetic determinants. The growing field of Environmental Hypertensionology endorses the outsized role of environmental factors in the pathogenesis and exacerbation of hypertension. It provides a clinical approach to address these factors at the individual and societal levels. Environmental stressors contributing to blood pressure levels can be viewed within the mosaic model of hypertension, which offers a comprehensive framework for understanding blood pressure regulation through its connection with multiple other nodes causally related to the pathogenesis of hypertension. This review synthesizes growing evidence supporting the impact of several factors in the physical environment and adverse stressors embedded in key provisioning systems, including air, noise, and chemical pollution, along with aspects of the built environment, green spaces, food systems, on the global burden of hypertension. Although many factors may not be directly in the causal cascade of hypertension, the web of connections between many behooves an understanding of the important nodes for intervention. Public health strategies emphasizing the redesign of environments present an unprecedented opportunity to enhance global hypertension control rates. Future research should thus focus on integrating environmental risk assessment and interventions into clinical practice, optimizing urban planning, and public policy to achieve meaningful reductions in the global burden of hypertension. By understanding hypertension as a mosaic of interconnected causes, healthcare professionals are better equipped to individualize treatment, combining lifestyle interventions and multiple drug classes to target environmental and genetic factors driving high blood pressure.

Fine particulate matter (PM_2.5) poses significant health risks, prompting public health organizations to recommend the use of respirators and facemasks (RFMs) to mitigate exposure. Consequently, interest in their usage has increased, leading to several studies assessing the efficiency of these personal-level interventions against various fractions of ambient particulate matter (PM). We conducted a comprehensive literature search across PubMed, Web of Science, and Scopus to identify relevant studies and address the following objectives: (1) explore the efficiency of RFMs in reducing ambient PM; (2) discuss discrepancies in efficiencies reported; (3) critique the experimental setups used to evaluate the efficiency of RFMs; and (4) propose recommendations for future research. Five relevant studies we reviewed reported significantly lower RFM effectiveness against ambient PM, with a size-dependent efficiency that decreases for smaller PM fractions. Variations in the reported efficiencies were primarily attributed to design-related factors, resulting in poor facial fit. Therefore, it is crucial to consider standardizing and properly designing these products. These studies overlooked essential factors, such as using dummy heads with flexible textures that mimic human skin. The use of rigid-textured dummy heads, as seen in previous studies, may fail to accurately represent real-world conditions. We recommend researchers take into account diverse facial profiles in their experiments. Moreover, it is essential to consider facial characteristics in the design of RFMs. We believe the evidence supports the increasing need for the adoption of appropriate guidelines and regulations to govern RFM suppliers at both national and international levels.