Metabolic syndrome and masked hypertension among African Americans: The Jackson 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. -->

Download Full-text

Association of psychosocial stressors with metabolic syndrome severity among African Americans in the Jackson Heart Study

Psychoneuroendocrinology ◽

10.1016/j.psyneuen.2018.02.014 ◽

2018 ◽

Vol 90 ◽

pp. 141-147 ◽

Cited By ~ 3

Author(s):

Michelle I. Cardel ◽

Yuan-I Min ◽

Mario Sims ◽

Solomon K. Musani ◽

Akilah Dulin-Keita ◽

...

Keyword(s):

Metabolic Syndrome ◽

African Americans ◽

Psychosocial Stressors ◽

Jackson Heart Study ◽

Heart Study

Download Full-text

Abstract MP65: Masked Hypertension is Associated with Cardiovascular Disease Events in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.133.suppl_1.mp65 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John N Booth ◽

Keith M Diaz ◽

Samantha Seals ◽

Mario Sims ◽

Joseph Ravenell ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Blood Pressure Monitoring ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Cvd Risk ◽

Nocturnal Hypertension ◽

Heart Study ◽

All Cause Mortality

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.

Download Full-text

Prevalence, associated factors and heritabilities of metabolic syndrome and its individual components in African Americans: the Jackson Heart Study

BMJ Open ◽

10.1136/bmjopen-2015-008675 ◽

2015 ◽

Vol 5 (10) ◽

pp. e008675 ◽

Cited By ~ 22

Author(s):

Rumana J Khan ◽

Samson Y Gebreab ◽

Mario Sims ◽

Pia Riestra ◽

Ruihua Xu ◽

...

Keyword(s):

Metabolic Syndrome ◽

African Americans ◽

Associated Factors ◽

Jackson Heart Study ◽

Heart Study

Download Full-text

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.

Download Full-text

Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans: The Jackson Heart Study

American Journal of Hypertension ◽

10.1093/ajh/hpu241 ◽

2014 ◽

Vol 28 (7) ◽

pp. 900-908 ◽

Cited By ~ 49

Author(s):

Keith M. Diaz ◽

Praveen Veerabhadrappa ◽

Michael D. Brown ◽

Matthew C. Whited ◽

Patricia M. Dubbert ◽

...

Keyword(s):

African Americans ◽

Clinical Significance ◽

Population Based ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Heart Study

Download Full-text

Prevalence of Masked Hypertension and Its Association With Subclinical Cardiovascular Disease in African Americans: Results From the Jackson Heart Study

Journal of the American Heart Association ◽

10.1161/jaha.115.002284 ◽

2016 ◽

Vol 5 (3) ◽

Cited By ~ 24

Author(s):

Nicole Redmond ◽

John N. Booth ◽

Rikki M. Tanner ◽

Keith M. Diaz ◽

Marwah Abdalla ◽

...

Keyword(s):

Cardiovascular Disease ◽

African Americans ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Heart Study ◽

Subclinical Cardiovascular Disease

Download Full-text

Abstract P015: Plasma Brain Natriuretic Peptide Concentration Is Inversely Associated With Prevalent Metabolic Syndrome and Metabolic Syndrome Components: Findings From the Jackson Heart Study

Circulation ◽

10.1161/circ.125.suppl_10.ap015 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Harsha Nagarajarao ◽

Solomon K Musani ◽

Vasan S Ramachandran ◽

Aurelian Bidulescu ◽

Herman A Taylor ◽

...

Keyword(s):

Metabolic Syndrome ◽

African Americans ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Assessment Model ◽

Jackson Heart Study ◽

Men And Women ◽

Plasma Brain Natriuretic Peptide ◽

Heart Study ◽

Metabolic Syndrome Components

Introduction: There is emerging evidence that brain natriuretic peptide (BNP) may play a role in human metabolism. Suppressed concentrations in BNP in obese individuals may contribute to clinical phenotypes of metabolic syndrome. There is limited data on the relation of BNP to metabolic syndrome in African Americans. Methods: To assess the association between plasma brain natriuretic peptide (BNP) concentration and metabolic syndrome (MetS) and MetS risk factors in blacks, we analyzed cross-sectional data from 3,729 Jackson Heart Study participants free of heart failure (mean age, 54 years; 64% women). We performed sex-specific Tobit regression analysis on log transformed BNP to account for the left censored BNP distribution and adjusted for clinical and echocardiographic variables. Prevalence of MetS was 44% and 35% in women and men, respectively. We estimated percent changes for the underlying variables by back-transformation. Results: Plasma BNP concentration was inversely associated with metabolic syndrome components (fasting glucose and waist circumference in both men and women; and triglycerides in women). Sex-specific multivariable adjusted BNP concentrations were significantly lower in subjects with MetS than those without. In men, BNP concentration was 35% lower (P < 0.0001); and in women it was 31% lower (P < 0.0001). Men and women with insulin resistance represented by elevated homeostasis assessment model (HOMA-IR) index had significantly (P < 0.0001) lower BNP concentration compared to those with low HOMA-IR index. Discussion and Conclusion: We found in a community based cohort of African Americans a significant relation of low BNP concentration to MetS and individual components of MetS. This data supports a growing body of evidence that BNP plays a potential crucial role in total body metabolism.

Download Full-text