Abstract
BACKGROUND: Research suggests a link between the urban built environment and blood pressure, potentially mediated by physical activity. This study aims to investigate the relationship between perceived neighborhood characteristics and blood pressure in older adults, as well as the mediating role of walking in this relationship. METHODS: Data from the third wave of the EpiFloripa Aging Cohort Study in Florianopolis, Brazil (2017-2019; n = 1335) were used for this cross-sectional analysis. Blood pressure was measured using digital devices, and hypertension diagnosis relied on healthcare professionals' information. The neighborhood environment was assessed with the Abbreviated Neighborhood Environment Walkability Scale, while walking was evaluated with the International Physical Activity Questionnaire. Multilevel logistic regression analyzed the association between the neighborhood environment, blood pressure, and hypertension. Structural equation modeling assessed the mediation effect of walking. RESULTS: Hypertension prevalence was 85.3 %, with 69.0 % having objectively measured elevated blood pressure. Results showed that older adults perceiving better infrastructure for physical activity (OR: 0.88; CI: 0.78-0.99), increased safety in their neighborhood (OR: 0.88; CI: 0.79-0.99), traffic security (OR: 0.88; CI: 0.78-0.99) and better overall perception of the environment (OR: 0.73; IC: 0.55-0.98) had a lower likelihood of self-reported hypertension. The association between self-reported hypertension and overall perception of the environment was partially explained by leisure-time walking (β = -0.01; p < 0.05). CONCLUSION: Our findings suggest that public policies promoting the establishment of safe and supportive spaces for physical activity emerge as essential measures in the prevention and management of hypertension in older adults.