scholarly journals White-Coat Effect Among Older Adults: Data From the Jackson Heart Study

2015 ◽  
Vol 18 (2) ◽  
pp. 139-145 ◽  
Author(s):  
Rikki M. Tanner ◽  
Daichi Shimbo ◽  
Samantha R. Seals ◽  
Kristi Reynolds ◽  
C. Barrett Bowling ◽  
...  
Keyword(s):  
Older Adults ◽  
White Coat ◽  
Jackson Heart Study ◽  
White Coat Effect ◽  
Heart Study

Abstract P198: Clinic versus Out-of-Clinic Daytime Blood Pressure Among Older Adults: Data From the Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Rikki M Tanner ◽  
Daichi Shimbo ◽  
Samantha Seals ◽  
Gbenga Ogedegbe ◽  
Paul Muntner
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Blood Pressure Monitoring ◽  
White Coat ◽  
Older Individuals ◽  
Jackson Heart Study ◽  
Large White ◽  
Younger Adults ◽  
White Coat Effect ◽  
Heart Study

In the US, antihypertensive medication treatment decisions are primarily based on blood pressure (BP) measurements obtained in the clinic setting. The optimal systolic BP (SBP) goal for adults ≥60 years is controversial and a large difference between clinic and out-of-clinic daytime BP, a white-coat effect, may be present in older individuals. We estimated the white-coat effect and calculated the percentage of untreated and treated adults <60 and ≥60 years with elevated clinic BP (defined as SBP/diastolic BP [DBP] ≥140/90 mmHg), but non-elevated out-of-clinic daytime BP (“daytime BP”, defined as SBP/DBP <135/85 mmHg) among 257 African-American participants in the Jackson Heart Study with at least 10 daytime ambulatory BP measurements. For the overall population, the white-coat effect for SBP was 12.2 mmHg (95% confidence interval [CI]: 9.2-15.1) in older adults and 8.4 mmHg (95% CI: 5.7-11.1) in younger adults (p=0.06). After multivariable (MV) adjustment, this difference was 1.3 mmHg. Among those without diabetes or chronic kidney disease (CKD), the white coat effect for SBP was 15.2 mmHg (95% CI: 10.1-20.2) and 8.6 mmHg (95% CI: 5.0-12.3) for older and younger adults, respectively (p=0.04). After MV adjustment, this difference was 5.9 mmHg. Also, SBP ≥150 mmHg versus <150 mm Hg was associated with a larger white-coat effect in the overall population after MV adjustment. Among those without CKD or diabetes, older age and SBP ≥150 mmHg were associated with a larger white-coat effect after MV adjustment. Among younger and older participants with elevated clinic BP, the prevalence of non-elevated daytime BP was 34% (95% CI: 26%-44%) and 32% (95% CI: 24%-40%), respectively (p=0.64), in the overall population and 35% (95% CI: 24%-48%) and 43% (95% CI: 31%-56%), respectively, for those without CKD or diabetes (p=0.37). In conclusion, a large white-coat effect was present among older adults. These data suggest a role for ambulatory blood pressure monitoring in preventing potential over-treatment for hypertension among older adults.

scholarly journals The importance of using 24-hour and nighttime blood pressure for the identification of white coat hypertension: Data from the Jackson Heart Study

2018 ◽  
Vol 20 (8) ◽  
pp. 1176-1182 ◽  
Author(s):  
D. Edmund Anstey ◽  
Lisandro D. Colantonio ◽  
Yuichiro Yano ◽  
John N. Booth ◽  
Paul Muntner
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Jackson Heart Study ◽  
Heart Study ◽  
Nighttime Blood Pressure

Abstract P187: The Associations of White Coat and Masked Hypertension With Cardiovascular Disease and Mortality in the Jackson Heart Study

Circulation ◽  
2019 ◽  
Vol 139 (Suppl_1) ◽  
Author(s):  
Rikki M Tanner ◽  
John Booth ◽  
Yuichiro Yano ◽  
Olugbenga Ogedegbe ◽  
Laura P Cohen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
White Coat ◽  
Masked Hypertension ◽  
Jackson Heart Study ◽  
Heart Study

Relationship of Overall Cardiovascular Health and Hearing Loss in The Jackson Heart Study Population

2019 ◽  
Vol 130 (12) ◽  
pp. 2879-2884
Author(s):  
Steven A. Curti ◽  
Joseph A. DeGruy ◽  
Christopher Spankovich ◽  
Charles E. Bishop ◽  
Dan Su ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cardiovascular Health ◽  
Jackson Heart Study ◽  
Heart Study ◽  
Study Population ◽  
Relationship Of

The white-coat effect is associated with increased blood pressure reactivity to physical activity

2002 ◽  
Vol 7 (4) ◽  
pp. 209-213 ◽  
Author(s):  
Andrew C. Leary ◽  
Peter T. Donnan ◽  
Thomas M. MacDonald ◽  
Michael B. Murphy
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
White Coat ◽  
Blood Pressure Reactivity ◽  
White Coat Effect ◽  
Pressure Reactivity

scholarly journals Neighborhood social environment as risk factors to health behavior among African Americans: The Jackson Heart Study

2017 ◽  
Vol 45 ◽  
pp. 199-207 ◽  
Author(s):  
Xu Wang ◽  
Amy H. Auchincloss ◽  
Sharrelle Barber ◽  
Stephanie L. Mayne ◽  
Michael E. Griswold ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
Health Behavior ◽  
Social Environment ◽  
Jackson Heart Study ◽  
Heart Study

scholarly journals Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard A. Parker ◽  
Paul Padfield ◽  
Janet Hanley ◽  
Hilary Pinnock ◽  
John Kennedy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Statistical Analysis ◽  
Propensity Score ◽  
Random Coefficient ◽  
White Coat ◽  
White Coat Effect ◽  
Regression Adjustment ◽  
The Impact

Abstract Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

Abstract P439: Risk Factor Profile and Prevalence of Subclinical Disease in African Americans with Diabetes and Metabolic Syndrome: The Jackson Heart Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Kamel A Gharaibeh ◽  
Vanessa Xanthakis ◽  
Jung Hye Sung ◽  
Tandaw S Samdarshi ◽  
Herman A Taylor ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
African Americans ◽  
Left Ventricular ◽  
Jackson Heart Study ◽  
Cvd Risk ◽  
Metabolic Derangement ◽  
Risk Factor Profile ◽  
Subclinical Disease ◽  
Heart Study

Background . Metabolic derangements such as diabetes (DM) and metabolic syndrome (MetS) are common in African Americans (AA) and contribute to the higher cardiovascular disease (CVD) mortality in this group. A greater prevalence of subclinical disease (ScD) among those with DM and MetS in the AA community may be an explanatory factor. Objective . We assessed the CVD risk factor profile and distribution of ScD among AA with DM and MetS in the Jackson Heart Study (JHS). Methods . We evaluated 4,365 AA participants [mean age (SD) of 53.8 (12.3) years, 64.5% women] free of overt CVD who attended JHS Exam 1 (between 2000- 2004), when ScD assessment was routinely performed(with the exception of CT for coronary calcium that occurred in Exam2). SCD measures included 1) peripheral artery disease (PAD, defined as ankle-brachial index<0.9), 2) high coronary artery calcium (CAC, defined as score>100), 3) left ventricular (LV) hypertrophy (LVH defined as left ventricular mass index>51 g/m 2.7 , 4) low LV ejection fraction (low EF, defined as an EF<50%), and 5) microalbuminuria (MA, defined as an albumin-to-creatinine ratio>25 μg/mg in men and >35 μg/mg in women). We compared the distribution of standard CVD risk factors and ScD prevalence in 1) those without DM or MetS (referent), 2) those with MetS but no DM and 3) those with DM. Results . In our study sample, 1,089 (24.9%) had MetS with no DM and 752 (17.2%) had DM. Compared to the referent group, groups with metabolic derangement tended to be older, female, hypertensive, obese, and had lower HDL, higher fasting glucose, and higher triglycerides levels. Table 1 compares the distribution of ScD for the three groups, and demonstrates the greater odds of. CAC, LVH and microalbuminuria in participants with MetS or DM. Conclusion . In our large community-based sample of AAs, we observed a significantly high prevalence of ScD overall, especially so in participants with MetS and DM. These findings likely contribute to the high CVD rates in AA with MetS and DM. -->

Sign in / Sign up

Export Citation Format

Share Document