ABSTRACT: The burden of non-communicable diseases has grown significantly in low- and middle-income countries (LMICs) with devastating consequences on morbidity and mortality. Cardiovascular disease is now the leading cause of mortality in Haitian adults, having surpassed HIV in the last decade. Preliminary data from Haiti has shown early onset hypertension (HTN) is significantly more prevalent among Haitian adolescents and youth ages 18-29 years than in similarly aged black Americans. Earlier onset of hypertension in this younger population puts them on a trajectory for other co-morbidities and will ultimately limit their life expectancy with devastating consequences for families and communities. Data on the natural history of HTN including underlying risk factors in this young population is severely lacking. Elucidating the social and environmental determinants of hypertension among Haitian adolescents and youth will inform evidenced-based screening programs and interventions to prevent HTN and other CVD risk factors, ultimately preventing early death among young and middle-aged adults. Findings will be directly applicable to other urban areas with people of African descent in the Caribbean, Africa, and in the US. We propose to study the natural history of HTN among adolescents and youth enrolled in the longitudinal cohort of the parent R01 (R01 HL143788). The specific aims of my proposed mentored research are within the scope of the parent grant and include: 1. Estimate the population-based prevalence of pre-HTN (systolic blood pressure (SBP) 120-139 or diastolic blood pressure (DBP) 80-89) and HTN (SBP >140 or DBP >90) and other CVD risk factors and their association with social and environmental determinants in participants ages 18-29 years. a. Cardiovascular risk factors other than pre-HTN and HTN include diabetes, obesity, hypercholesterolemia, kidney disease, poor diet, cigarette smoking, physical inactivity, and serum markers of inflammation. b. Determinants include stress, social isolation, depression, family support, food insecurity, lead exposure, and HIV infection. 2. Determine the incidence of pre-HTN (systolic blood pressure (SBP) 120-139 or diastolic blood pressure (DBP) 80-89) and HTN (SBP >140 or DBP >90) and other CVD risk factors among participants ages 18-29 years during 2 to 3.5 years of follow-up and their association with social and environmental determinants. This study will provide important insights into the epidemiology of HTN among adolescents and youth in Haiti. Our ultimate goal is to translate new research findings from this study into pragmatic screening interventions to prevent early onset HTN in young people in Haiti and among Haitian immigrants in the US.