Association of West African ancestry and blood pressure control among African Americans taking antihypertensive medication in the Jackson Heart Study

Introduction: Cross-sectional studies have reported the proportion of African-American adults with controlled blood pressure (BP) at a single time point, but few data are available on the proportion that maintains controlled BP over time and the extent to which it is associated with cardiovascular disease (CVD) risk. Methods: We analyzed data from 1,414 African-American Jackson Heart Study (JHS) participants taking antihypertensive medication to estimate the proportion with persistent BP control, defined by having controlled BP at the three JHS visits, conducted over a median of 8 years. At each visit, BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. Follow-up for CVD events began after the third visit. We calculated risk ratios (RR) for factors associated with persistent BP control and hazard ratios (HR) for incident CVD events among participants with versus without persistent BP control. Results: At baseline, 76.5% (n=1,081) of participants had controlled BP, among which 64.4% (n=696) had persistent BP control. Overall, 49.2% (n=696) of participants had persistent BP control. After adjustment for sex, participants ≥65 compared with <65 years of age were less likely (RR; 95% CI) to have persistent BP control (0.73; 0.64 - 0.83). After age and sex adjustment, participants were more likely to have persistent BP control if they had income ≥$25,000 a year at each study visit (1.25; 1.11 - 1.40), a high school education (1.20; 1.01 - 1.41) and health insurance (1.28; 1.05 - 1.57) at Visit 1, and visited a health professional in the past year at each study visit (1.21; 1.07 - 1.37). The multivariable adjusted HR (95% CI) comparing participants with versus without persistent BP control was 0.71 (0.45 - 1.14) for CVD, 0.85 (0.41 - 1.79) for coronary heart disease, 0.68 (0.28 - 1.64) for stroke, and 0.57 (0.33 - 0.98) for heart failure (HF) ( Table ). Conclusions: Less than half of JHS participants taking antihypertensive medication had persistent BP control, putting them at increased risk for CVD, particularly HF.

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The Effect of Home Monitoring and Telemanagement on Blood Pressure Control Among African Americans

Telemedicine Journal ◽

10.1089/107830200311815 ◽

2000 ◽

Vol 6 (1) ◽

pp. 15-23 ◽

Cited By ~ 32

Author(s):

Mary Bondmass ◽

Nadine Bolger ◽

Gerard Castro ◽

Boaz Avitall

Keyword(s):

Blood Pressure ◽

African Americans ◽

Blood Pressure Control ◽

Home Monitoring ◽

Pressure Control

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Marked Underestimation of Blood Pressure Control With Conventional vs. Ambulatory Measurements in an Urban, Developing Community of African Ancestry

American Journal of Hypertension ◽

10.1038/ajh.2011.48 ◽

2011 ◽

Vol 24 (7) ◽

pp. 789-795 ◽

Cited By ~ 5

Author(s):

M. J. Maseko ◽

A. J. Woodiwiss ◽

O. H. I. Majane ◽

N. Molebatsi ◽

G. R. Norton

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

African Ancestry ◽

Pressure Control

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Trend of office and home blood pressure control in treated hypertensive patients: changes in antihypertensive medication and salt intake

Clinical and Experimental Hypertension ◽

10.3109/10641963.2014.892118 ◽

2014 ◽

Vol 36 (2) ◽

pp. 103-107 ◽

Cited By ~ 3

Author(s):

Yuko Ohta ◽

Yoshio Iwashima ◽

Shinichiro Hayashi ◽

Fumiki Yoshihara ◽

Satoko Nakamura ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Antihypertensive Medication ◽

Salt Intake ◽

Pressure Control ◽

Home Blood Pressure ◽

Hypertensive Patients

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Faculty Opinions recommendation of Association of Genetic West African Ancestry, Blood Pressure Response to Therapy, and Cardiovascular Risk Among Self-Reported Black Individuals in the Systolic Blood Pressure Reduction Intervention Trial (SPRINT).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739035170.793585434 ◽

2021 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Response ◽

African Ancestry ◽

Blood Pressure Reduction ◽

West African ◽

Response To Therapy ◽

Pressure Reduction ◽

Intervention Trial ◽

West African Ancestry

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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.

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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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