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 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.

Abstract P206: Ambulatory Blood Pressure Monitoring Phenotypes Among Individuals With and Without Diabetes: The Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Samantha G Bromfield ◽  
Daichi Shimbo ◽  
Alain Bertoni ◽  
Mario Sims ◽  
April P Carson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Prevalence Ratio ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring ◽  
Heart Study

Several ambulatory blood pressure monitoring (ABPM) phenotypes including masked hypertension are associated with an increased risk for cardiovascular disease (CVD). Diabetes is associated with CVD risk as well as a higher prevalence of hypertension. However, little is known about whether ABPM phenotypes differ between individuals with versus without diabetes. We evaluated the association between diabetes and ABPM phenotypes including clinic hypertension, awake hypertension, sustained hypertension, nocturnal hypertension, non-dipping pattern, white coat hypertension, and masked hypertension in the Jackson Heart Study (JHS). Baseline data collection included two clinic blood pressure measurements using standardized protocols. ABPM measurements were taken in the 24 hours following the baseline visit. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or use of diabetes medications. Of the 1,032 JHS participants with valid ABPM data (67.7% female, mean age 59.2 years), 253 (24.5%) had diabetes. The prevalence of clinic hypertension was similar for participants with and without diabetes (Table 1). After multivariable adjustment, diabetes was associated with an increased prevalence ratio of awake, sustained, and masked hypertension and a lower prevalence ratio of white coat hypertension compared with individuals without diabetes. In summary, there was an increased prevalence of adverse blood pressure phenotypes among individuals with versus those without diabetes that was not captured in the clinic setting alone. The role of ABPM for identifying high risk individuals with diabetes should be further investigated.

scholarly journals Diagnosis of white-coat hypertension based solely on systolic blood pressure. The PIUMA study

2005 ◽  
Vol 18 (5) ◽  
pp. A46-A46 ◽  
Author(s):  
P VERDECCHIA ◽  
F ANGELI ◽  
G REBOLDI ◽  
R GATTOBIGIO ◽  
M SARDONE ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension

scholarly journals P115 Does Post-stroke White Coat Hypertension/Effect (WCH/E) Require Intensive Blood Pressure Management?

2020 ◽  
Vol 25 (Supplement 1) ◽  
pp. S155
Author(s):  
Fran Kirkham ◽  
GN Nuredini ◽  
A Saunders ◽  
Erin Drazich ◽  
Eva Bunting ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Pressure Management ◽  
Post Stroke ◽  
Blood Pressure Management ◽  
Intensive Blood Pressure

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

Circulation ◽  
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.

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

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.

Abstract 11530: Age-Specific Differences Between Conventional and Ambulatory Daytime Blood Pressure Values

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David Conen ◽  
Stefanie Aeschbacher ◽  
Lutgarde Thijs ◽  
Yan Li ◽  
José Boggia ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Population Based ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Daytime Blood Pressure ◽  
Collaborative Analysis ◽  
The Individual ◽  
Age Range ◽  
Diagnosis Of Hypertension

Introduction: Mean daytime ambulatory blood pressure (ABP) values are considered to be lower than conventional BP (CBP) values, but data on this relation among younger individuals <50 years are scarce. To address this issue, we performed a collaborative analysis in a large group of participants representing a wide age range. Methods: CBP and 24-hour ABP were measured in 9550 individuals not taking BP lowering treatment from 13 population based cohorts. We compared the individual differences between daytime ABP and CBP according to 10-year age categories. Age-specific prevalences of white-coat hypertension and masked hypertension were calculated based on guideline-recommended thresholds. Results: Among individuals aged 18-30, 30-40 and 40-50 years, mean daytime systolic and diastolic ABP were significantly higher than the corresponding CBP (6.0, 5.2 and 4.7 mmHg for systolic BP; 2.5, 2.7 and 1.7 mmHg for diastolic BP, all p<0.0001) (Figure). Systolic and diastolic BP indices were similar in participants aged 50-60 years (p=0.20 and 0.11, respectively). In individuals aged 60-70 and ≥70 years, CBP was significantly higher than daytime ABP (5.0 and 13.0 mmHg for systolic BP; 2.0 and 4.2 mmHg for diastolic BP, all p<0.0001) (Figure). Accordingly, the prevalence of white coat hypertension exponentially increased from 2.2% to 19.5% from those aged 18-30 years to those aged ≥70 years, with some variation between men and women (prevalence 8.0% versus 6.1%, p=0.0003). Masked hypertension was more prevalent among men (21.1% versus 11.4%, p<0.0001). The age-specific prevalence of masked hypertension was 18.2%, 27.3%, 27.8%, 20.1% 13.6% and 10.2% in men, and 9.0%, 9.9%, 12.2%, 11.9%, 14.7% and 12.1% in women. Conclusions: In this large collaborative analysis we found that the relation between daytime ABP and CBP strongly varies by age. These findings may have important implications for the diagnosis of hypertension and its subtypes in clinical practice.

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