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Birmingham WC, Herr RM, Cressman M, Patel N, Hung M. While You Are Sleeping: Marital Ambivalence and Blunted Nocturnal Blood Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:723. [PMID: 38928969 PMCID: PMC11204195 DOI: 10.3390/ijerph21060723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Marital relationships offer health benefits, including a lower risk of cardiovascular disease (CVD). However, quality of the relationship matters; ambivalent behaviors may increase CVD risk by affecting blunted nocturnal blood pressure (BP) dipping. This study tracked daytime and nocturnal SBP and DBP in 180 normotensive individuals (90 couples; participant mean age 25.04; 91.58% white) over a 24 h period using ambulatory blood pressure monitors to explore the impact of martial quality. Results showed that perceptions of spousal ambivalence were associated with blunted nocturnal BP dipping. Perceptions of one's own behavior as ambivalent also showed blunted nocturnal dipping. When in an ambivalent relationship, a gender interaction was found such that women were most likely to have blunted SBP dipping, but men were more likely to have blunted nocturnal DBP dipping. Overall, this study found an association between ambivalence and BP dipping, thus uncovering one virtually unexplored pathway by which marital relationships may have adverse effects on health.
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Affiliation(s)
| | - Raphael M. Herr
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Mikel Cressman
- Psychology Department, Brigham Young University, Provo, UT 84602, USA;
| | - Neha Patel
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA (M.H.)
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA (M.H.)
- Department of Orthopedic Surgery Operations, University of Utah, Salt Lake City, UT 84108, USA
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Bokov P, Koehl B, Benzouid C, Verlhac S, Missud F, Benkerrou M, Delclaux C. No Increase in Masked Hypertension Prevalence in Children With Sickle Cell Disease in France. Am J Hypertens 2024; 37:358-365. [PMID: 38323455 DOI: 10.1093/ajh/hpae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND An important prevalence (32%-45%) of masked hypertension has been reported in children with sickle cell disease (SCD). Stroke screening is well established using transcranial Doppler (TCD) ultrasound. The objectives of our proof-of-concept study in childhood SCD were to evaluate the prevalence of hypertension and its relationships with cerebral vasculopathy (TCD velocity) and to further evaluate in a subgroup of children the correlations of cardiovascular autonomic nervous system indices with TCD velocity. METHODS Ambulatory blood pressure measurement (ABPM) and TCD velocity were obtained in children with SCD and in a restricted sample, cardiac sympathovagal balance using heart rate variability analyses, baroreflex sensitivity, and pulse wave velocity were measured. RESULTS In 41 children with SCD (median age 14.0 years, 19 girls, SS/Sβ + thalassemia/SC: 33/2/6), ABPM results showed masked hypertension in 2/41 (5%, 95% confidence interval, 0-11) children, consistent with the prevalence in the general pediatric population, elevated blood pressure (BP) in 4/41 (10%) children, and a lack of a normal nocturnal dip in 19/41 children (46%). Children with increased TCD velocity had lower nocturnal dipping of systolic BP. In the 10 participants with extensive cardiovascular assessment, increased TCD velocity was associated with parasympathetic withdrawal and baroreflex failure. Exaggerated orthostatic pressor response or orthostatic hypertension was observed in 7/10 children that was linked to parasympathetic withdrawal. CONCLUSIONS Autonomic nervous system dysfunction, namely loss of parasympathetic modulation, of SCD contributes to increase TCD velocity but is not associated with an increased prevalence of masked hypertension. CLINICAL TRIALS REGISTRATION NCT04911049.
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Affiliation(s)
- Plamen Bokov
- Paris University, AP-HP, Robert Debré Hospital, Department of Physiology, INSERM NeuroDiderot, Paris, France
| | - Berengere Koehl
- Department of Hematology, Paris University, AP-HP, Robert Debré Hospital, Sickle Cell Disease Center, Hematology Unit, Paris, France
- UMR_S1134, BIGR, INSERM, Institut National de la Transfusion Sanguine, Laboratoire d'Excellence GR-Ex, Paris, France
| | - Chérine Benzouid
- Department of Physiology, AP-HP, Robert Debré Hospital, Paris, France
| | - Suzanne Verlhac
- Department of Pediatric Imaging, AP-HP, Robert Debré Hospital, Paris, France
| | - Florence Missud
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, AP-HP, Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Malika Benkerrou
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, AP-HP, Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Christophe Delclaux
- Paris University, AP-HP, Robert Debré Hospital, Department of Physiology, INSERM NeuroDiderot, Paris, France
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1209] [Impact Index Per Article: 1209.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Yano Y, Poudel B, Chen L, Sakhuja S, Jaeger BC, Viera AJ, Shimbo D, Clark D, Anstey DE, Lin FC, Lewis CE, Shikany JM, Rana JS, Correa A, Lloyd-Jones DM, Schwartz JE, Muntner P. Impact of Asleep and 24-Hour Blood Pressure Data on the Prevalence of Masked Hypertension by Race/Ethnicity. Am J Hypertens 2022; 35:627-637. [PMID: 35303061 PMCID: PMC9248918 DOI: 10.1093/ajh/hpac027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We pooled ambulatory blood pressure monitoring data from 5 US studies, including the Jackson Heart Study (JHS), the Coronary Artery Risk Development in Young Adults (CARDIA) study, the Masked Hypertension Study, the Improving the Detection of Hypertension Study, and the North Carolina Masked Hypertension Study. Using a cross-sectional study design, we estimated differences in the prevalence of masked hypertension by race/ethnicity when out-of-office blood pressure (BP) included awake, asleep, and 24-hour BP vs. awake BP alone. METHODS We restricted the analyses to participants with office systolic BP (SBP) <130 mm Hg and diastolic BP (DBP) <80 mm Hg. High awake BP was defined as mean SBP/DBP ≥130/80 mm Hg, high asleep BP as mean SBP/DBP ≥110/65 mm Hg, and high 24-hour BP as mean SBP/DBP ≥125/75 mm Hg. RESULTS Among participants not taking antihypertensive medication (n = 1,292), the prevalence of masked hypertension with out-of-office BP defined by awake BP alone or by awake, asleep, or 24-hour BP was 34.5% and 48.7%, respectively, among non-Hispanic White, 39.7% and 67.6% among non-Hispanic Black, and 19.4% and 35.1% among Hispanic participants. After multivariable adjustment, non-Hispanic Black were more likely than non-Hispanic White participants to have masked hypertension by asleep or 24-hour BP but not awake BP (adjusted odds ratio [OR] 2.14 95% confidence interval [CI] 1.45-3.15) and by asleep or 24-hour BP and awake BP (OR 1.61; 95% CI 1.12-2.32) vs. not having masked hypertension. CONCLUSIONS Assessing asleep and 24-hour BP measures increases the prevalence of masked hypertension more among non-Hispanic Black vs. non-Hispanic White individuals.
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Affiliation(s)
- Yuichiro Yano
- Department of Advanced Epidemiology, Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Bharat Poudel
- Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ligong Chen
- Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Swati Sakhuja
- Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Byron C Jaeger
- Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Donald Clark
- Department of Medicine, University of Mississippi Medical Center, Jackson, Jackson, Mississippi, USA
| | - David Edmund Anstey
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North CarolinaUSA
| | - Cora E Lewis
- Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Shikany
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamal S Rana
- Division of Cardiology, Kaiser Permanente Northern California, Oakland, California,USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Jackson, Mississippi, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph E Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, New York,USA
| | - Paul Muntner
- Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cepeda M, Hubbard D, Oparil S, Schwartz JE, Jaeger BC, Hardy ST, Medina J, Chen L, Muntner P, Shimbo D. Evaluating novel approaches for estimating awake and sleep blood pressure: design of the Better BP Study - a randomised, crossover trial. BMJ Open 2022; 12:e058140. [PMID: 35667722 PMCID: PMC10098258 DOI: 10.1136/bmjopen-2021-058140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION For many people, blood pressure (BP) levels differ when measured in a medical office versus outside of the office setting. Out-of-office BP has a stronger association with cardiovascular disease (CVD) events compared with BP measured in the office. Many BP guidelines recommend measuring BP outside of the office to confirm the levels obtained in the office. Ambulatory BP monitoring (ABPM) can assess out-of-office BP but is not available in many US practices and some individuals find it uncomfortable. The aims of the Better BP Study are to (1) test if unattended office BP is closer to awake BP on ABPM compared with attended office BP, (2) assess if sleep BP assessed by home BP monitoring (HBPM) agrees with sleep BP from a full night of ABPM and (3) compare the strengths of associations of unattended versus attended office BP, unattended office BP versus awake BP on ABPM and sleep BP on HBPM versus ABPM with markers of end-organ damage. METHODS AND ANALYSIS We are recruiting 630 adults not taking antihypertensive medication in Birmingham, Alabama, and New York, New York. Participants are having their office BP measured with (attended) and without (unattended) a technician present, in random order, using an automated oscillometric office BP device during each of two visits within one week. Following these visits, participants complete 24 hours of ABPM and one night of HBPM, in random order. Psychosocial factors, anthropometrics, left ventricular mass index and albumin-to-creatinine ratio are also being assessed. ETHICS AND DISSEMINATION This study was approved by the University of Alabama at Birmingham and the Columbia University Medical Center Institutional Review Boards. The study results will be disseminated at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04307004.
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Affiliation(s)
- Maria Cepeda
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Demetria Hubbard
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Suzanne Oparil
- Medicine, Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph E Schwartz
- Department of Medicine, Columbia University, New York, New York, USA
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Byron C Jaeger
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Shakia T Hardy
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julia Medina
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ligong Chen
- Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Paul Muntner
- Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2443] [Impact Index Per Article: 1221.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Zhang Y, Schwartz JE, Jaeger BC, An J, Bellows BK, Clark D, Langford AT, Kalinowski J, Ogedegbe O, Carr JJ, Terry JG, Min YI, Reynolds K, Shimbo D, Moran AE, Muntner P. Association Between Ambulatory Blood Pressure and Coronary Artery Calcification: The JHS. Hypertension 2021; 77:1886-1894. [PMID: 33896192 PMCID: PMC8119358 DOI: 10.1161/hypertensionaha.121.17064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yiyi Zhang
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Byron C. Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Jaejin An
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Brandon K. Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Clark
- School of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Aisha T. Langford
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Jolaade Kalinowski
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Olugbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, NY
| | - John Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - James G. Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Yuan-I Min
- School of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Andrew E. Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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8
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Bundy JD, Jaeger BC, Huffman MD, Knox SS, Thomas SJ, Shimbo D, Booth JN, Lewis CE, Edwards LJ, Schwartz JE, Muntner P. Twenty-Five-Year Changes in Office and Ambulatory Blood Pressure: Results From the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hypertens 2021; 34:494-503. [PMID: 33201230 PMCID: PMC8140654 DOI: 10.1093/ajh/hpaa189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Blood pressure (BP) measured in the office setting increases from early through later adulthood. However, it is unknown to what extent out-of-office BP derived via ambulatory BP monitoring (ABPM) increases over time, and which participant characteristics and risk factors might contribute to these increases. METHODS We assessed 25-year change in office- and ABPM-derived BP across sex, race, diabetes mellitus (DM), and body mass index (BMI) subgroups in the Coronary Artery Risk Development in Young Adults study using multivariable-adjusted linear mixed effects models. RESULTS We included 288 participants who underwent ABPM at the Year 5 Exam (mean [SD] age, 25.1 [3.7]; 45.8% men) and 455 participants who underwent ABPM at the Year 30 Exam (mean [SD] age, 49.5 [3.7]; 42.0% men). Office, daytime, and nighttime systolic BP (SBP) increased 12.8 (95% confidence interval [CI], 7.6-17.9), 14.7 (95% CI, 9.7-19.8), and 16.6 (95% CI, 11.4-21.8) mm Hg, respectively, over 25 years. Office SBP increased 6.5 (95% CI, 2.3-10.6) mm Hg more among black compared with white participants. Daytime SBP increased 6.3 (95% CI, 0.2-12.4) mm Hg more among participants with a BMI ≥25 vs. <25 kg/m2. Nighttime SBP increased 4.7 (95% CI, 0.5-8.9) mm Hg more among black compared with white participants, and 17.3 (95% CI, 7.2-27.4) mm Hg more among participants with vs. without DM. CONCLUSIONS Office- and ABPM-derived BP increased more from early through middle adulthood among black adults and participants with DM and BMI ≥25 kg/m2.
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Affiliation(s)
- Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Tulane University Translational Science Institute, New Orleans, Louisiana, USA
| | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark D Huffman
- Department of Preventive Medicine and Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sarah S Knox
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - S Justin Thomas
- Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- CTI Clinical Trials and Consulting Services, Inc., Covington, Kentucky, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lloyd J Edwards
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph E Schwartz
- Department of Psychiatry, Stony Brook University, New York, New York, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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9
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Santillan MK, Becker RC, Calhoun DA, Cowley AW, Flynn JT, Grobe JL, Kotchen TA, Lackland DT, Leslie KK, Liang M, Mattson DL, Meyers KE, Mitsnefes MM, Muntner PM, Pierce GL, Pollock JS, Sigmund CD, Thomas SJ, Urbina EM, Kidambi S. Team Science: American Heart Association's Hypertension Strategically Focused Research Network Experience. Hypertension 2021; 77:1857-1866. [PMID: 33934625 DOI: 10.1161/hypertensionaha.120.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2015, the American Heart Association awarded 4-year funding for a Strategically Focused Research Network focused on hypertension composed of 4 Centers: Cincinnati Children's Hospital, Medical College of Wisconsin, University of Alabama at Birmingham, and University of Iowa. Each center proposed 3 integrated (basic, clinical, and population science) projects around a single area of focus relevant to hypertension. Along with scientific progress, the American Heart Association put a significant emphasis on training of next-generation hypertension researchers by sponsoring 3 postdoctoral fellows per center over 4 years. With the center projects being spread across the continuum of basic, clinical, and population sciences, postdoctoral fellows were expected to garner experience in various types of research methodologies. The American Heart Association also provided a number of leadership development opportunities for fellows and investigators in these centers. In addition, collaboration was highly encouraged among the centers (both within and outside the network) with the American Heart Association providing multiple opportunities for meeting and expanding associations. The area of focus for the Cincinnati Children's Hospital Center was hypertension and target organ damage in children utilizing ambulatory blood pressure measurements. The Medical College of Wisconsin Center focused on epigenetic modifications and their role in pathogenesis of hypertension using human and animal studies. The University of Alabama at Birmingham Center's areas of research were diurnal blood pressure patterns and clock genes. The University of Iowa Center evaluated copeptin as a possible early biomarker for preeclampsia and vascular endothelial function during pregnancy. In this review, challenges faced and successes achieved by the investigators of each of the centers are presented.
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Affiliation(s)
- Mark K Santillan
- Obstetrics/Gynecology (M.K.S.,K.K.L), University of Iowa, Iowa City, IA
| | - Richard C Becker
- Internal Medicine (R.C.B.), Cincinnati Children's Hospital, Cincinnati, OH
| | - David A Calhoun
- Internal Medicine (D.A.C., J.S.P.), University of Alabama at Birmingham, AL
| | - Allen W Cowley
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | | | - Justin L Grobe
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | - Theodore A Kotchen
- Internal Medicine (T.A.K., S.K.), Medical College of Wisconsin, Milwaukee, WI
| | - Daniel T Lackland
- Neurology, Medical University of South Carolina, Charleston, SC (D.T.L.)
| | - Kimberly K Leslie
- Obstetrics/Gynecology (M.K.S.,K.K.L), University of Iowa, Iowa City, IA
| | - Mingyu Liang
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | - David L Mattson
- Physiology, Medical College of Georgia, Augusta, GA (D.L.M.)
| | - Kevin E Meyers
- Pediatrics, Children's Hospital of Philadelphia, PA (K.E.M.)
| | - Mark M Mitsnefes
- Pediatrics (M.M.M., E.M.U), Cincinnati Children's Hospital, Cincinnati, OH
| | - Paul M Muntner
- Epidemiology (P.M.M.), University of Alabama at Birmingham, AL
| | - Gary L Pierce
- Health and Human Physiology (G.L.P), University of Iowa, Iowa City, IA
| | - Jennifer S Pollock
- Internal Medicine (D.A.C., J.S.P.), University of Alabama at Birmingham, AL
| | - Curt D Sigmund
- Physiology (A.W.C., J.L.G., M.L., C.D.S.), Medical College of Wisconsin, Milwaukee, WI
| | | | - Elaine M Urbina
- Pediatrics (M.M.M., E.M.U), Cincinnati Children's Hospital, Cincinnati, OH
| | - Srividya Kidambi
- Internal Medicine (T.A.K., S.K.), Medical College of Wisconsin, Milwaukee, WI
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Guirguis-Blake JM, Evans CV, Webber EM, Coppola EL, Perdue LA, Weyrich MS. Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1657-1669. [PMID: 33904862 DOI: 10.1001/jama.2020.21669] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Hypertension is a major risk factor for cardiovascular disease and can be modified through lifestyle and pharmacological interventions to reduce cardiovascular events and mortality. OBJECTIVE To systematically review the benefits and harms of screening and confirmatory blood pressure measurements in adults, to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, Cochrane Collaboration Central Registry of Controlled Trials, and CINAHL; surveillance through March 26, 2021. STUDY SELECTION Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies for effectiveness of screening; accuracy studies for screening and confirmatory measurements (ambulatory blood pressure monitoring as the reference standard); RCTs and nonrandomized controlled intervention studies and observational studies for harms of screening and confirmation. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; meta-analyses and qualitative syntheses. MAIN OUTCOMES AND MEASURES Mortality; cardiovascular events; quality of life; sensitivity, specificity, positive and negative predictive values; harms of screening. RESULTS A total of 52 studies (N = 215 534) were identified in this systematic review. One cluster RCT (n = 140 642) of a multicomponent intervention including hypertension screening reported fewer annual cardiovascular-related hospital admissions for cardiovascular disease in the intervention group compared with the control group (difference, 3.02 per 1000 people; rate ratio, 0.91 [95% CI, 0.86-0.97]). Meta-analysis of 15 studies (n = 11 309) of initial office-based blood pressure screening showed a pooled sensitivity of 0.54 (95% CI, 0.37-0.70) and specificity of 0.90 (95% CI, 0.84-0.95), with considerable clinical and statistical heterogeneity. Eighteen studies (n = 57 128) of various confirmatory blood pressure measurement modalities were heterogeneous. Meta-analysis of 8 office-based confirmation studies (n = 53 183) showed a pooled sensitivity of 0.80 (95% CI, 0.68-0.88) and specificity of 0.55 (95% CI, 0.42-0.66). Meta-analysis of 4 home-based confirmation studies (n = 1001) showed a pooled sensitivity of 0.84 (95% CI, 0.76-0.90) and a specificity of 0.60 (95% CI, 0.48-0.71). Thirteen studies (n = 5150) suggested that screening was associated with no decrement in quality of life or psychological distress; evidence on absenteeism was mixed. Ambulatory blood pressure measurement was associated with temporary sleep disturbance and bruising. CONCLUSIONS AND RELEVANCE Screening using office-based blood pressure measurement had major accuracy limitations, including misdiagnosis; however, direct harms of measurement were minimal. Research is needed to determine optimal screening and confirmatory algorithms for clinical practice.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Department of Family Medicine, University of Washington, Tacoma
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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11
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3063] [Impact Index Per Article: 1021.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Thomas SJ, Johnson DA, Guo N, Abdalla M, Booth JN, Spruill TM, Jackson CL, Yano Y, Sims M, Calhoun D, Muntner P, Redline S. Association of Obstructive Sleep Apnea With Nighttime Blood Pressure in African Americans: The Jackson Heart Study. Am J Hypertens 2020; 33:949-957. [PMID: 32492711 PMCID: PMC7577643 DOI: 10.1093/ajh/hpaa088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/08/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA), nocturnal hypertension, and nondipping systolic blood pressure (BP) are each highly prevalent among African Americans. However, few data are available on the association between OSA and nighttime BP in this population. METHODS We examined the association of OSA with nighttime BP among African Americans who completed 24-hour ambulatory BP monitoring (ABPM) at Exam 1 (2000-2004) of the Jackson Heart Study (JHS) and subsequently participated in the JHS Sleep Study (2012-2016). Type 3 home sleep apnea testing was used to assess OSA measures, including respiratory event index (REI4%) and percent sleep time <90% oxygen saturation (nocturnal hypoxemia). Nocturnal hypertension was defined as mean asleep systolic BP (SBP) ≥120 mm Hg or diastolic BP (DBP) ≥70 mm Hg. Multivariable linear regression models were fit to estimate the association between each OSA measure and nighttime SBP and DBP. RESULTS Among 206 participants who completed ABPM and participated in the Jackson Heart Sleep Study, 50.5% had nocturnal hypertension and 26.2% had moderate to severe OSA (REI4% ≥15 events/hour). After multivariable adjustment, each SD (13.3 events/hour) increase in REI4% was associated with 1.75 mm Hg higher nighttime DBP (95% confidence interval (CI): 0.38, 3.11) and a prevalence ratio of 1.11 (95% CI: 1.00, 1.24) for nocturnal hypertension. Each SD (10.4%) increase in nocturnal hypoxemia was associated with a 1.91 mm Hg higher nighttime SBP (95% CI: 0.15, 3.66). CONCLUSIONS Severity of OSA and nocturnal hypoxemia were associated with high nighttime BP in African American participants in the JHS.
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Affiliation(s)
- Stephen Justin Thomas
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dayna A Johnson
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Na Guo
- Departments of Medicine and Epidemiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Marwah Abdalla
- Department of Medicine, Columbia University, New York, New York, USA
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tanya M Spruill
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Yuichiro Yano
- Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David Calhoun
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susan Redline
- Department of Sleep Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Sleep Medicine, Brigham and Women’s Hospital, Beth Israel Deaconess Medical School, Harvard Medical School, Boston, Massachusetts, USA
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13
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Yano Y, Tanner RM, Sakhuja S, Jaeger BC, Booth JN, Abdalla M, Pugliese D, Seals SR, Ogedegbe G, Jones DW, Muntner P, Shimbo D. Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals. JAMA Cardiol 2020; 4:910-917. [PMID: 31411629 DOI: 10.1001/jamacardio.2019.2845] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. Objective To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. Design, Setting, and Participants This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. Main Outcomes and Measures Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6%] male; and 583 [56.4%] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95% CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95% CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95% CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95% CI, 0.97-1.33) and daytime (HR, 0.95; 95% CI, 0.81-1.10) and nighttime (HR, 1.06; 95% CI, 0.90-1.24) DBP. Conclusions and Relevance Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk.
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Affiliation(s)
- Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Marwah Abdalla
- Department of Medicine, Columbia University, New York, New York
| | - Daniel Pugliese
- Department of Medicine, Columbia University, New York, New York
| | - Samantha R Seals
- Department of Mathematics and Statistics, University of West Florida, Pensacola
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York
| | - Daniel W Jones
- Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York
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Piskorz D. Hypertension and metabolic disorders, a glance from different phenotypes. Am J Prev Cardiol 2020; 2:100032. [PMID: 34327456 PMCID: PMC8315388 DOI: 10.1016/j.ajpc.2020.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 12/28/2022] Open
Abstract
The extraordinary expansion of cardiometabolic risk factors, the impact they generate in the development of hypertension and its specific phenotypes, and its implications in cardiovascular risk and therapeutic decision-making deserve an extensive and careful reflection. The aim of this review is to analyze the available evidence and gaps in the relationship between cardiometabolic risk factors and hypertension phenotypes. Overweight or obese patients, dyslipidemic, carbohydrate intolerant and type 2 diabetic patients have a significantly higher probability of suffering from high blood pressure than subjects without metabolic disorders. Masked hypertension should be systematically suspected in subjects with type 2 diabetes or metabolic disorders and borderline hypertension independently of the debate on the reproducibility of blood pressure phenotypes diagnosis. Some minor difficulties emerge to understand the phenotypes of hypertension in diabetic individuals, since clinical practice guidelines are not homogeneous in their postulates regarding the blood pressure targets at office and ambulatory and home blood pressure monitoring. The small number of diabetic hypertensive patients included in epidemiological studies, and the presence of confounding factors, such as the duration of diabetes, the quantity and type of drugs indicated for the treatment of both hypertension and diabetes, or the level of diabetes control, undermine the possibilities to draw conclusions of value for the clinical practice.
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15
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Booth JN, Jaeger BC, Huang L, Abdalla M, Sims M, Butler M, Muntner P, Shimbo D. Morning Blood Pressure Surge and Cardiovascular Disease Events and All-Cause Mortality in Blacks: The Jackson Heart Study. Hypertension 2020; 75:835-843. [PMID: 32008430 PMCID: PMC7035156 DOI: 10.1161/hypertensionaha.119.14233] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 01/14/2023]
Abstract
The cardiovascular disease (CVD) and mortality risk associated with morning blood pressure (BP) surge and its components among black adults, a population with high BP during the asleep period, is unknown. We studied Jackson Heart Study participants who completed 24-hour ambulatory BP monitoring at the baseline exam in 2000 to 2004 (n=761). The sleep-trough morning surge was calculated as the mean 2-hour postawakening systolic BP (SBP) minus the lowest nighttime SBP, preawakening morning surge as mean 2-hour postawakening SBP minus mean 2-hour preawakening SBP, and rising morning surge as the first postawakening SBP minus the last preawakening SBP. The primary outcome was the occurrence of CVD events including the composite of coronary heart disease or stroke. Over a median follow-up of 14.0 years, there were 74 CVD (coronary heart disease or stroke) events and 144 deaths. Higher tertiles of sleep-trough, preawakening, and rising SBP surge were not associated with CVD risk after multivariable adjustment. In contrast, the highest tertile of the individual components of morning surge, including postawakening SBP (tertiles 2 and 3 versus 1: hazard ratio [95% CI]: 1.58 [0.71-3.53] and 4.04 [1.91-8.52], respectively), lowest nighttime SBP (1.29 [0.59-2.84] and 2.87 [1.41-5.83]), preawakening SBP (1.26 [0.57-2.80] and 2.79 [1.32-5.93]), first postawakening SBP (1.60 [0.73-3.51] and 2.93 [1.40-6.16]), and last preawakening SBP (1.23 [0.57-2.68] and 2.99 [1.46-6.12]), was associated with increased CVD risk after multivariable adjustment. Among black adults, the components of morning SBP surge, but not morning SBP surge itself, were associated with increased CVD risk.
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Affiliation(s)
| | | | - Lei Huang
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Mario Sims
- University of Mississippi Medical Center, Jackson, MS
| | | | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, AL
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16
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4802] [Impact Index Per Article: 1200.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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17
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5298] [Impact Index Per Article: 1059.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rader F, Franklin SS, Mirocha J, Vongpatanasin W, Haley RW, Victor RG. Superiority of Out-of-Office Blood Pressure for Predicting Hypertensive Heart Disease in Non-Hispanic Black Adults. Hypertension 2019; 74:1192-1199. [PMID: 31522619 DOI: 10.1161/hypertensionaha.119.13542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00344903.
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Affiliation(s)
- Florian Rader
- From the Smidt Heart Institute, Hypertension Center of Excellence (F.R., R.G.V.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stanley S Franklin
- Heart Disease Prevention Program Department of Medicine, University of California, Irvine (S.S.F.)
| | - James Mirocha
- Research Institute and Clinical and Translational Science Institute (J.M.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Wanpen Vongpatanasin
- Hypertension Section, Cardiology Division (W.V.), University of Texas Southwestern Medical Center, Dallas
| | - Robert W Haley
- Department of Internal Medicine/Division of Epidemiology (R.W.H.), University of Texas Southwestern Medical Center, Dallas
| | - Ronald G Victor
- From the Smidt Heart Institute, Hypertension Center of Excellence (F.R., R.G.V.), Cedars-Sinai Medical Center, Los Angeles, CA
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19
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Sakhuja S, Booth JN, Lloyd-Jones DM, Lewis CE, Thomas SJ, Schwartz JE, Shimbo D, Shikany JM, Sims M, Yano Y, Muntner P. Health Behaviors, Nocturnal Hypertension, and Non-dipping Blood Pressure: The Coronary Artery Risk Development in Young Adults and Jackson Heart Study. Am J Hypertens 2019; 32:759-768. [PMID: 30715142 PMCID: PMC6636688 DOI: 10.1093/ajh/hpz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/20/2018] [Accepted: 01/28/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several health behaviors have been associated with hypertension based on clinic blood pressure (BP). Data on the association of health behaviors with nocturnal hypertension and non-dipping systolic BP (SBP) are limited. METHODS We analyzed data for participants with ambulatory BP monitoring at the Year 30 Coronary Artery Risk Development in Young Adults (CARDIA) study exam in 2015-2016 (n = 781) and the baseline Jackson Heart Study (JHS) exam in 2000-2004 (n = 1,046). Health behaviors (i.e., body mass index, physical activity, smoking, and alcohol intake) were categorized as good, fair, and poor and assigned scores of 2, 1, and 0, respectively. A composite health behavior score was calculated as their sum and categorized as very good (score range = 6-8), good (5), fair (4), and poor (0-3). Nocturnal hypertension was defined as mean asleep SBP ≥ 120 mm Hg or mean asleep diastolic BP ≥ 70 mm Hg and non-dipping SBP as < 10% awake-to-asleep decline in SBP. RESULTS Among CARDIA study and JHS participants, 41.1% and 56.9% had nocturnal hypertension, respectively, and 32.4% and 72.8% had non-dipping SBP, respectively. The multivariable-adjusted prevalence ratios (95% confidence interval) for nocturnal hypertension associated with good, fair, and poor vs. very good health behavior scores were 1.03 (0.82-1.29), 0.98 (0.79-1.22), and 0.96 (0.77-1.20), respectively in CARDIA study and 0.98 (0.87-1.10), 0.96 (0.86-1.09), and 0.86 (0.74-1.00), respectively in JHS. The health behavior score was not associated non-dipping SBP in CARDIA study or JHS after multivariable adjustment. CONCLUSIONS A health behavior score was not associated with nocturnal hypertension or non-dipping SBP.
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Affiliation(s)
- Swati Sakhuja
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John N Booth
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Joseph E Schwartz
- Columbia University, New York, USA
- Stony Brook University, Stony Brook, New York, USA
| | | | - James M Shikany
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mario Sims
- University of Mississippi, Jackson, Mississippi, USA
| | | | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
See Article Ayala Solares et al
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Affiliation(s)
- Amier Ahmad
- 1 Division of Cardiology New York University School of Medicine New York NY
| | - Suzanne Oparil
- 2 Vascular Biology and Hypertension Program Division of Cardiovascular Disease University of Alabama at Birmingham AL
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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35-e66. [PMID: 30827125 DOI: 10.1161/hyp.0000000000000087] [Citation(s) in RCA: 648] [Impact Index Per Article: 129.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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22
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Becker BK, Zhang D, Soliman R, Pollock DM. Autonomic nerves and circadian control of renal function. Auton Neurosci 2019; 217:58-65. [PMID: 30704976 PMCID: PMC6415626 DOI: 10.1016/j.autneu.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
Cardiovascular and renal physiology follow strong circadian rhythms. For instance, renal excretion of solutes and water is higher during the active period compared to the inactive period, and blood pressure peaks early in the beginning of the active period of both diurnal and nocturnal animals. The control of these rhythms is largely dependent on the expression of clock genes both in the central nervous system and within peripheral organs themselves. Although it is understood that the central and peripheral clocks interact and communicate, few studies have explored the specific mechanism by which various organ systems within the body are coordinated to control physiological processes. The renal sympathetic nervous innervation has long been known to have profound effects on renal function, and because the sympathetic nervous system follows strong circadian rhythms, it is likely that autonomic control of the kidney plays an integral role in modulating renal circadian function. This review highlights studies that provide insight into this interaction, discusses areas lacking clarity, and suggests the potential for future work to explore the role of renal autonomics in areas such as blood pressure control and chronic kidney disease.
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Affiliation(s)
- Bryan K Becker
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, United States of America
| | - Dingguo Zhang
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, United States of America
| | - Reham Soliman
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, United States of America
| | - David M Pollock
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, United States of America.
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23
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Muntner P, Einhorn PT, Cushman WC, Whelton PK, Bello NA, Drawz PE, Green BB, Jones DW, Juraschek SP, Margolis KL, Miller ER, Navar AM, Ostchega Y, Rakotz MK, Rosner B, Schwartz JE, Shimbo D, Stergiou GS, Townsend RR, Williamson JD, Wright JT, Appel LJ. Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 73:317-335. [PMID: 30678763 PMCID: PMC6573014 DOI: 10.1016/j.jacc.2018.10.069] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 11/21/2022]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Paula T Einhorn
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland
| | - William C Cushman
- Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Paul E Drawz
- Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel W Jones
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Edgar R Miller
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Yechiam Ostchega
- National Center for Health Statistics of the Centers for Disease Control and Prevention, Hyattsville, Maryland
| | | | - Bernard Rosner
- Department of Medicine, Brigham's and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Joseph E Schwartz
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- The Hypertension Center, Columbia University Medical Center, New York, New York
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Raymond R Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeff D Williamson
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jackson T Wright
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Cho MC. Clinical Significance and Therapeutic Implication of Nocturnal Hypertension: Relationship between Nighttime Blood Pressure and Quality of Sleep. Korean Circ J 2019; 49:818-828. [PMID: 31456375 PMCID: PMC6713830 DOI: 10.4070/kcj.2019.0245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
Recent global hypertension guidelines recommend an early, strict and 24-hour blood pressure (BP) control for the prevention of target organ damage and cardiovascular events. Out-of-office BP measurement such as ambulatory BP monitoring and home BP monitoring is now widely utilized to rule out white-coat hypertension, to detect masked hypertension, to evaluate the effects of antihypertensive medication, to analyze diurnal BP variation, and to increase drug adherence. Nocturnal hypertension has been neglected in the management of hypertension despite of its clinical significance. Nighttime BP and non-dipping patterns of BP are stronger risk predictors for the future cardiovascular mortality and morbidity than clinic or daytime BP. In addition to ambulatory or home daytime BP and 24-hour mean BP, nocturnal BP should be a new therapeutic target for the optimal treatment of hypertension to improve prognosis in hypertensive patients. This review will provide an overview of epidemiology, characteristics, and pathophysiology of nocturnal hypertension and clinical significance, therapeutic implication and future perspectives of nocturnal hypertension will be discussed.
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Affiliation(s)
- Myeong Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
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Abstract
PURPOSE OF REVIEW Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. RECENT FINDINGS To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.
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Affiliation(s)
- N P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA.
| | - S S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| | - M X Herzig
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| | - S A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
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Omboni S. A working definition of white-coat hypertension must include nocturnal blood pressure. J Clin Hypertens (Greenwich) 2018; 20:1183-1186. [PMID: 30009422 PMCID: PMC8031214 DOI: 10.1111/jch.13355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Anstey DE, Colantonio LD, Yano Y, Booth JN, Muntner P. The importance of using 24-hour and nighttime blood pressure for the identification of white coat hypertension: Data from the Jackson Heart Study. J Clin Hypertens (Greenwich) 2018; 20:1176-1182. [PMID: 29978543 PMCID: PMC6320734 DOI: 10.1111/jch.13330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/27/2018] [Accepted: 05/29/2018] [Indexed: 01/17/2023]
Abstract
We calculated the prevalence of white coat hypertension (WCH) using out-of-clinic blood pressure (BP) in the daytime period; daytime and 24-hour periods; and daytime, 24-hour, and nighttime periods among 199 African Americans with clinic-measured systolic/diastolic BP ≥140/90 mm Hg in the Jackson Heart Study. Left ventricular mass index (LVMI) was measured among participants with WCH and 374 participants with sustained normotension (ie, non-hypertensive clinic, daytime, 24-hour, and nighttime BP). The prevalence of WCH was 29.6%, 21.1%, and 10.6% using daytime BP; daytime and 24-hour BP; and daytime, 24-hour, and nighttime BP, respectively. Compared with sustained normotension, LVMI was higher when WCH was defined using daytime BP (adjusted mean difference [95% CI] 5.0 [-0.2, 10.1] g/m2 ), but not when defined using daytime and 24-hour BP or daytime, 24-hour, and nighttime BP (adjusted mean difference [95% CI] 3.9 [-1.9, 9.7] and 0.4 [-7.3,8.2] g/m2 , respectively). Using only daytime BP overestimates the prevalence of WCH among African Americans.
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Affiliation(s)
| | | | - Yuichiro Yano
- University of Mississippi Medical CenterJacksonMSUSA
| | | | - Paul Muntner
- University of Alabama at BirminghamBirminghamALUSA
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28
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Mwasongwe S, Min YI, Booth JN, Katz R, Sims M, Correa A, Young B, Muntner P. Masked hypertension and kidney function decline: the Jackson Heart Study. J Hypertens 2018; 36:1524-1532. [PMID: 29601413 PMCID: PMC5990961 DOI: 10.1097/hjh.0000000000001727] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypertension diagnosed by blood pressure (BP) measured in the clinic is associated with rapid kidney function decline (RKFD) and incident chronic kidney disease (CKD). The extent to which hypertension defined using out-of-clinic BP measurements is associated with these outcomes is unclear. METHODS We evaluated the association of any masked hypertension (daytime SBP/DBP ≥ 135/85 mmHg, night-time SBP/DBP ≥ 120/70 mmHg or 24-h SBP/DBP ≥ 130/80 mmHg) with RKFD and incident CKD among 676 African-Americans in the Jackson Heart Study with clinic-measured SBP/DBP less than 140/90 mmHg who completed ambulatory BP monitoring in 2000-2004. RKFD was defined as a decline in estimated glomerular filtration rate (eGFR) at least 30% and incident CKD was defined as development of eGFR less than 60 ml/min per 1.73 m with an at least 25% decline in eGFR between 2000-2004 and 2009-2013. RESULTS The mean age of participants was 57.6 years, 28.8% were men and 52.7% had any masked hypertension. After a median follow-up of 8 years, 13.8 and 8.6% of participants had RKFD and incident CKD, respectively. In unadjusted analyses, masked hypertension was associated with an increased odds for incident CKD [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.22, 3.97]. This association remained statistically significant after adjustment for demographic characteristics, baseline eGFR and albumin-to-creatinine ratio (OR 1.95, 95% CI 1.04, 3.67) but was eliminated after propensity score adjustment (OR 1.62, 95% CI 0.87, 3.00). There was no association between masked hypertension and RKFD. CONCLUSION Masked hypertension may be associated with the development of CKD in African-Americans.
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Affiliation(s)
| | - Yuan-I Min
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - John N. Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronit Katz
- Division of Nephrology, Kidney Research Institute, University of Washington
| | - Mario Sims
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - Bessie Young
- Division of Nephrology, Kidney Research Institute, University of Washington
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4499] [Impact Index Per Article: 749.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Should sleep blood pressure be used as a criterion to define white-coat hypertension? J Hypertens 2017; 35:2372-2373. [PMID: 29095229 DOI: 10.1097/hjh.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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