Association of Plasma Endothelin-1 with Blood Pressure Progression Among African Americans: The Jackson Heart Study

Introduction: Masked hypertension has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Hypothesis: Determine the association of masked hypertension with CVD events and all-cause mortality in African Americans (AA). Methods: The Jackson Heart Study, an exclusively AA population-based, prospective cohort study, was restricted to participants with clinic systolic/diastolic blood pressure (SBP/DBP) < 140/90 mmHg and valid ambulatory blood pressure monitoring (ABPM) at the baseline exam in 2000-2004 (n=738). Masked daytime hypertension was defined as mean ambulatory daytime (10am-8pm) SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. Masked nocturnal hypertension was defined as mean ambulatory nighttime (12am-6am) SBP ≥ 120 mmHg or DBP ≥ 70 mmHg. Using all ABPM measurements, masked 24-hour hypertension was defined as mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and all-cause mortality were identified and adjudicated through December 31, 2011. Results: Any masked hypertension (masked daytime, nocturnal or 24-hour hypertension) was present in 52.2% of participants; 28.2% had masked daytime hypertension, 48.2% had masked nocturnal hypertension and 31.7% had masked 24-hour hypertension. There were 51 CVD events and 44 deaths over a median follow up of 8.2 and 8.5 years, respectively. The CVD rate (95% CI) per 1,000 person years in participants with and without any masked hypertension were 13.5 (9.9-18.4) and 3.9 (2.2-7.1), respectively (Table). The multivariable adjusted hazard ratio (95% CI) between any masked hypertension and CVD was 2.49 (1.26-4.93). CVD rates for those with and without masked daytime, nocturnal and 24-hour hypertension, and the hazard ratios for CVD associated with masked daytime, nocturnal and 24-hour hypertension, were similar. Masked hypertension was not associated with all-cause mortality. Conclusion: Masked hypertension is common and associated with increased CVD risk in AAs.

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Association Between Cardiometabolic Factors and Dizziness in African Americans: The Jackson Heart Study

Journal of the American Academy of Audiology ◽

10.1055/s-0041-1722949 ◽

2021 ◽

Author(s):

Amrita Ray ◽

Christopher Spankovich ◽

Charles E. Bishop ◽

Dan Su ◽

Yuan-I Min ◽

...

Keyword(s):

Blood Pressure ◽

African American ◽

African Americans ◽

Noise Exposure ◽

Medication Use ◽

Blood Pressure Medication ◽

Jackson Heart Study ◽

Screening Questionnaire ◽

Heart Study ◽

Cardiometabolic Factors

Abstract Background Balance dysfunction is a complex, disabling health condition that can present with multiple phenotypes and etiologies. Data regarding prevalence, characterization of dizziness, or associated factors is limited, especially in an African American population. Purpose The aim of the study is to characterize balance dysfunction presentation and prevalence in an African American cohort, and balance dysfunction relationship to cardiometabolic factors. Research Design The study design is descriptive, cross sectional analysis. Study Sample The study sample consist of N = 1,314, participants in the Jackson Heart Study (JHS). Data Collection and Analysis JHS participants were presented an initial Hearing health screening questionnaire (N = 1,314). Of these, 317 participants reported dizziness and completed a follow-up Dizziness History Questionnaire. Descriptive analysis was used to compare differences in the cohorts' social-demographic characteristics and cardiometabolic variables to the 997 participants who did not report dizziness on the initial screening questionnaire. Based on questionnaire responses, participants were grouped into dizziness profiles (orthostatic, migraine, and vestibular) to further examine differences in cardiometabolic markers as related to different profiles of dizziness. Logistical regression models were adjusted for age, sex, education, reported noise exposure, and hearing sensitivity. Results Participants that reported any dizziness were slightly older and predominantly women. Other significant complaints in the dizzy versus nondizzy cohort included hearing loss, tinnitus, and a history of noise exposure (p < 0.001). Participants that reported any dizziness had significantly higher prevalence of hypertension, blood pressure medication use, and higher body mass index (BMI). Individuals with symptoms alluding to an orthostatic or migraine etiology had significant differences in prevalence of hypertension, blood pressure medication use, and BMI (p < 0.001). Alternatively, cardiometabolic variables were not significantly related to the report of dizziness symptoms consistent with vestibular profiles. Conclusion Dizziness among African Americans is comparable to the general population with regards to age and sex distribution, accordingly to previously published estimates. Participants with dizziness symptoms appear to have significant differences in BMI and blood pressure regulation, especially with associated orthostatic or migraine type profiles; this relationship does not appear to be conserved in participants who present with vestibular etiology symptoms.

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Abstract P348: Association Between Sleep Apnea and Blood Pressure Control Among African-Americans, the Jackson Heart Study

Circulation ◽

10.1161/circ.137.suppl_1.p348 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Dayna A Johnson ◽

Stephen J Thomas ◽

Marwah Abdalla ◽

Yuichiro Yano ◽

Na Guo ◽

...

Keyword(s):

Blood Pressure ◽

Sleep Apnea ◽

African Americans ◽

Resistant Hypertension ◽

Significant Risk ◽

Apnea Hypopnea Index ◽

Jackson Heart Study ◽

Antihypertensive Medications ◽

Heart Study ◽

The Impact

Background: African-Americans have the highest prevalence of elevated blood pressure (BP) and poorer BP control than other racial/ethnic groups in the US. Untreated sleep apnea, common among minority populations, may explain the high prevalence of uncontrolled BP. We studied the association of objective measurements of sleep apnea severity with resistant hypertension and uncontrolled BP among African-Americans in the Jackson Heart Study (JHS) Sleep Ancillary study. Methods: Between 2012 and 2016, JHS participants (N=913) underwent an in-home sleep apnea study (measuring nasal pressure, abdominal and thoracic inductance plethysmography, oximetry, position, ECG); resting blood pressure; anthropometry; and completed questionnaires. Sleep apnea was defined as an apnea-hypopnea index > 15 and nocturnal hypoxemia was quantified as % sleep time <90% oxyhemoglobin saturation (%Sat<90%). Elevated BP was defined as systolic BP ≥ 140 mmHg or diastolic BP > 90mmHg. Controlled BP was defined as systolic BP <140mmHg or diastolic BP <90mmHg. Uncontrolled BP was defined as having elevated BP with use of < 2 antihypertensive medications. Resistant hypertension was defined as having elevated BP while on 3-4 antihypertensive medications with one being a diuretic; or use of > 4 antihypertensive medications. The study sample was limited to individuals with prevalent hypertension (N=613). Multinomial models were fit to determine the association between sleep apnea severity and resistant hypertension or uncontrolled BP (vs. controlled BP) adjusted for age, sex, education, smoking status, obesity (body mass index>30) and diabetes. Results: The study sample had a mean age of 54.8 years, were predominately female (69.8%), obese (57.8%), and college educated (52.7%). Approximately 40.5% had sleep apnea, which was untreated in 95% of individuals. Among the sample, 25.4% had uncontrolled BP and 4.9% were classified as resistant hypertension. After adjustment for confounders, individuals with sleep apnea had a 2.6-fold higher odds of resistant hypertension (95% confidence interval: 1.1, 5.9). A standard deviation higher %Sat<90% was associated with a 41% higher odds (1.1, 1.8) of resistant hypertension after adjustment for covariates. Sleep apnea and %Sat<90% were not related to uncontrolled BP. Conclusion: Among our sample of African-Americans in the JHS, sleep apnea was related to resistant hypertension but not uncontrolled BP. The study identifies the high burden of untreated sleep apnea in African-Americans and its association with resistant hypertension, a significant risk factor for stroke and heart disease. Research is needed on the impact of treating sleep apnea as a strategy for decreasing resistant hypertension, and thus, narrowing cardiovascular health disparities.

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Abstract P488: Discrimination and Hypertension Risk Among African Americans in The Jackson Heart Study

Circulation ◽

10.1161/circ.141.suppl_1.p488 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Allana T Forde ◽

Mario Sims ◽

Paul Muntner ◽

Tené Lewis ◽

Amanda Onwuka ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

African Americans ◽

The United States ◽

Jackson Heart Study ◽

Incident Hypertension ◽

Hypertension Risk ◽

Heart Study ◽

Low Levels

Background: African Americans have a higher risk for hypertension compared to other racial or ethnic groups in the United States. One possible explanation for this health disparity is perceived discrimination. Few studies have prospectively examined the association between discrimination and the incidence of hypertension. Methods: We examined the associations of everyday, lifetime, and stress from lifetime discrimination with incident hypertension and whether these associations differed by sex, discrimination attribution (i.e. the main reason for the discrimination event), and coping responses to discrimination among African Americans enrolled in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000-2004). Participants completed two follow-up study visits from 2005-2008 and 2009-2013. We used interval-censored Cox regression to estimate associations of discrimination with incident hypertension (antihypertensive medication use; and/or systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure ≥ 90 mm Hg at follow-up visits 2 or 3) after adjustment for confounding variables. Results: Overall, 52% (954 of 1845) of participants developed hypertension over the follow-up period. After adjustment for age, sex, education and hypertension risk factors (body mass index, alcohol use, smoking, diet and physical activity), medium versus low levels of lifetime discrimination (hazard ratio-HR: 1.45, 95% confidence interval-CI: 1.15-1.82) and high versus low levels of lifetime discrimination (HR: 1.35, CI: 1.08-1.68) were associated with a higher incidence of hypertension. High versus low stress from lifetime discrimination was associated with hypertension risk after adjustment for demographics (HR: 1.20, CI: 1.02-1.41), but the association was attenuated after adjustment for hypertension risk factors (HR: 1.14, CI: 0.97-1.35). Lifetime discrimination and stress from discrimination were associated with an increased hypertension risk among females, but not males. No interactions with age, attribution or coping were present for any type of discrimination. Conclusions: Findings from this study support an association between lifetime discrimination and incident hypertension in African Americans.

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Letter by Triantafyllou and Straub Regarding Article, “Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study”

Circulation ◽

10.1161/circulationaha.117.030600 ◽

2017 ◽

Vol 136 (24) ◽

pp. 2395-2396

Author(s):

Georgios A. Triantafyllou ◽

Adam C. Straub

Keyword(s):

Blood Pressure ◽

African Americans ◽

Ambulatory Blood Pressure ◽

Jackson Heart Study ◽

Heart Study

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The association of reduced lung function with blood pressure variability in African Americans: data from the Jackson Heart Study

BMC Cardiovascular Disorders ◽

10.1186/s12872-015-0182-2 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

John N. Booth III ◽

Nicole Redmond ◽

Mario Sims ◽

Daichi Shimbo ◽

Paul Muntner

Keyword(s):

Blood Pressure ◽

African Americans ◽

Lung Function ◽

Blood Pressure Variability ◽

Jackson Heart Study ◽

Heart Study

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The Association of Serum Aldosterone and Plasma Renin Activity with Ambulatory Blood Pressure in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circulationaha.120.050896 ◽

2021 ◽

Author(s):

Joshua J. Joseph ◽

Neal K. Pohlman ◽

Songzhu Zhao ◽

David Kline ◽

Guy Brock ◽

...

Keyword(s):

Blood Pressure ◽

African Americans ◽

Plasma Renin Activity ◽

Ambulatory Blood Pressure ◽

Plasma Renin ◽

Renin Activity ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Nocturnal Hypertension ◽

Heart Study

Background: The renin-angiotensin-aldosterone system (RAAS) is an important driver of BP but the association of the RAAS with ambulatory blood pressure (ABP) and ABPM phenotypes among African Americans (AA) has not been assessed. Methods: ABP and ABPM phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analysis were used to analyze the association of aldosterone, and PRA with clinic, awake and asleep systolic blood pressure (SBP) and diastolic blood pressure (DBP) and ABPM phenotypes, adjusting for important confounders. Results: The mean age of participants was 59 ±11 years and 69% were female. In fully adjusted models, lower log-PRA was associated with higher clinic, awake, and asleep SBP and DBP (all p<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all p<0.05). A 1-unit higher log-PRA was associated with lower odds of daytime hypertension (OR: 0.59, 95%CI: 0.49, 0.71), nocturnal hypertension (OR: 0.68, 95%CI: 0.58, 0.79), daytime and nocturnal hypertension (OR: 0.59, 95%CI: 0.48, 0.71), sustained hypertension (OR: 0.52, 95%CI: 0.39, 0.70) and masked hypertension (OR 0.75, 95%CI: 0.62, 0.90). A 1-unit higher log-aldosterone was associated with higher odds of nocturnal hypertension (OR: 1.38, 95%CI: 1.05, 1.81). Neither PRA nor aldosterone were associated with percent dipping, non-dipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to PRA. Conclusions: Suppressed renin activity and higher aldosterone:renin ratios were associated with both higher SBP and DBP in the office and during the awake and asleep periods as evidenced by ABPM. Higher aldosterone levels were associated with higher DBP, but not SBP, in the clinic and during the awake and asleep periods. Further clinical investigation of novel and approved medications that target low renin physiology such as epithelial sodium channel inhibitors and mineralocorticoid receptor antagonists may be paramount in improving hypertension control in AAs.

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Clinic and ambulatory blood pressure in a population-based sample of African Americans: the Jackson Heart Study

Journal of the American Society of Hypertension ◽

10.1016/j.jash.2017.02.001 ◽

2017 ◽

Vol 11 (4) ◽

pp. 204-212.e5 ◽

Cited By ~ 16

Author(s):

S. Justin Thomas ◽

John N. Booth ◽

Samantha G. Bromfield ◽

Samantha R. Seals ◽

Tanya M. Spruill ◽

...

Keyword(s):

Blood Pressure ◽

African Americans ◽

Ambulatory Blood Pressure ◽

Population Based ◽

Jackson Heart Study ◽

Heart Study

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Abstract P114: Low Prevalence of Ideal Cardiovascular Health Metrics among African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p114 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Luc Djousse ◽

Andrew Petrone ◽

Chad Blackshear ◽

Michael Griswold ◽

Jane Harman ◽

...

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Cardiovascular Health ◽

Smoking Status ◽

Jackson Heart Study ◽

Men And Women ◽

Ideal Cardiovascular Health ◽

Heart Study

Background: While the prevalence of cardiovascular health metrics or Life’s Simple Seven (LSS) has been shown to be far from optimal in the US, such information has been predominantly reported in Caucasians. The burden of cardiovascular disease among African Americans underscores the need to evaluate the prevalence and secular trends of LSS in other ethnic groups. Objective: To test the hypothesis that the prevalence of the LSS is far from ideal among participants of the Jackson Heart Study. Methods: We analyzed LSS with 3,500 African Americans from the Jackson Heart Study, using data from their first clinic visit (2000-2004). Standard methods were used to measure blood pressure, glucose, body mass index (BMI), and cholesterol. Information on physical activity, smoking, and diet was collected with interviewer-administered questionnaires. Each of the LSS metrics (smoking status, diet, physical activity, BMI, fasting blood glucose, total cholesterol, and blood pressure) was categorized as poor, intermediate, or ideal, as defined by the AHA guidelines. Results: The mean age at baseline was 56.9 ± 12.2 years and 2,350 participants (67%) were women. Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal cardiovascular health metrics was 6.6%, 25.8%, 32.7%, 21.6%, 10.6%, 2.3%, 0.4%, and 0%, respectively. Corresponding values for women were 3.2%, 28.1%, 32.9%, 22.3%, 10.1%, 2.9%, 0.38%, and 0%. While about two-thirds of men and women reported ideal smoking status, almost none reported ideal diet quality, and few met recommendations for BMI and blood pressure ( Figure) . Conclusions: Our data are consistent with less than optimal prevalence of cardiovascular health metrics in both men and women from the Jackson Heart Study. The lower prevalence of meeting ideal recommendations for diet, physical activity, BMI, and blood pressure underscores the need for targeted interventions to improve these modifiable lifestyle factors in order to reduce the burden of cardiovascular disease among African-Americans.

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