scholarly journals Ambulatory Blood Pressure Phenotypes in Adults Taking Antihypertensive Medication with and without CKD

2020 ◽  
Vol 15 (4) ◽  
pp. 501-510 ◽  
Author(s):  
Stanford E. Mwasongwe ◽  
Rikki M. Tanner ◽  
Bharat Poudel ◽  
Daniel N. Pugliese ◽  
Bessie A. Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Medication ◽  
Prevalence Ratio ◽  
Uncontrolled Hypertension ◽  
Creatinine Ratio ◽  
Ambulatory Bp Monitoring ◽  
Heart Study ◽  
Black Patients ◽  
Multivariable Adjustment

Background and objectivesRecent guidelines recommend out-of-clinic BP measurements.Design, setting, participants, & measurementsWe compared the prevalence of BP phenotypes between 561 black patients, with and without CKD, taking antihypertensive medication who underwent ambulatory BP monitoring at baseline (between 2000 and 2004) in the Jackson Heart Study. CKD was defined as an albumin-to-creatinine ratio ≥30 mg/g or eGFR <60 ml/min per 1.73 m2. Sustained controlled BP was defined by BP at goal both inside and outside of the clinic and sustained uncontrolled BP as BP above goal both inside and outside of the clinic. Masked uncontrolled hypertension was defined by controlled clinic-measured BP with uncontrolled out-of-clinic BP.ResultsCKD was associated with a higher multivariable-adjusted prevalence ratio for uncontrolled versus controlled clinic BP (prevalence ratio, 1.44; 95% CI, 1.02 to 2.02) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 1.66; 95% CI, 1.16 to 2.36). There were no statistically significant differences in the prevalence of uncontrolled daytime or nighttime BP, nondipping BP, white-coat effect, and masked uncontrolled hypertension between participants with and without CKD after multivariable adjustment. After multivariable adjustment, reduced eGFR was associated with masked uncontrolled hypertension versus sustained controlled BP (prevalence ratio, 1.42; 95% CI, 1.00 to 2.00), whereas albuminuria was associated with uncontrolled clinic BP (prevalence ratio, 1.76; 95% CI, 1.20 to 2.60) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 2.02; 95% CI, 1.36 to 2.99).ConclusionsThe prevalence of BP phenotypes defined using ambulatory BP monitoring is high among adults with CKD taking antihypertensive medication.

scholarly journals Association Between Ambulatory Blood Pressure and Coronary Artery Calcification

Hypertension ◽  
2021 ◽  
Author(s):  
Yiyi Zhang ◽  
Joseph E. Schwartz ◽  
Byron C. Jaeger ◽  
Jaejin An ◽  
Brandon K. Bellows ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Subclinical Atherosclerosis ◽  
Agatston Score ◽  
Ambulatory Bp Monitoring ◽  
Heart Study ◽  
Artery Disease ◽  
Prevalence Ratios ◽  
Multivariable Adjustment

High blood pressure (BP) based on measurements obtained in the office setting has been associated with the presence and level of coronary artery calcification (CAC)—a measure of subclinical atherosclerosis. We studied the association between out-of-office BP and CAC among 557 participants who underwent 24-hour ambulatory BP monitoring at visit 1 in 2000–2004 and a computed tomography scan at visit 2 in 2005–2008 as part of the JHS (Jackson Heart Study)—a community-based cohort of African American adults. Mean awake, asleep, and 24-hour BP were calculated for each participant. Among participants included in this analysis, 279 (50%) had any CAC defined by an Agatston score >0. After multivariable adjustment including office systolic BP (SBP), the prevalence ratios for any CAC comparing the highest versus the lowest quartiles of SBP on ambulatory BP monitoring were 1.08 (95% CI, 0.84–1.39) for awake SBP, 1.32 (95% CI, 1.01–1.74) for asleep SBP, and 1.19 (95% CI, 0.91–1.55) for 24-hour SBP. After multivariable adjustment including office diastolic BP, the prevalence ratios for any CAC comparing the highest versus the lowest quartiles of awake, asleep, and 24-hour diastolic BP were 1.27 (95% CI, 1.02–1.59), 1.29 (95% CI, 1.02–1.64), and 1.25 (95% CI, 0.99–1.59), respectively. The current results suggest that higher asleep SBP and higher awake and asleep diastolic BP may be risk factors for subclinical atherosclerosis and underscore the potential role of ambulatory BP monitoring in identifying individuals at high risk for coronary artery disease.

Abstract P173: The Impact of Asleep Blood Pressure on the Prevalence of Masked Hypertension by Race/ethnicity: Analysis of Pooled Population- and Community-based Studies

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Yuichiro Yano ◽  
Bharat Poudel ◽  
Ligong Chen ◽  
Swati Sakhuja ◽  
Byron Jaeger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Young Adults ◽  
Coronary Artery ◽  
Prevalence Ratio ◽  
Masked Hypertension ◽  
Community Based ◽  
Ambulatory Bp Monitoring ◽  
Heart Study ◽  
Race Ethnicity ◽  
The Impact

Introduction: Masked hypertension is defined as having hypertensive blood pressure (BP) outside of the office setting among adults with non-hypertensive BP when measured in the office. Some guidelines recommend defining out-of-office BP using awake measurements while other guidelines recommend using awake and asleep measurements. Hypothesis: We hypothesized that defining masked hypertension using the awake and asleep BP measurements would increase the prevalence of masked hypertension compared to using the awake period alone, and the magnitude of this difference would be greater among non-Hispanic blacks compared with non-Hispanic whites and Hispanics. Methods: We pooled previously collected data from 5 NHLBI-funded population- and community-based studies including the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study (total participants: 2,866). All participants had office systolic BP (SBP)<140mmHg and diastolic BP (DBP)<90mmHg and underwent ambulatory BP monitoring (ABPM) for 24 hours. Hypertensive awake BP was defined as SBP ≥135mmHg or DBP ≥85mmHg while awake, hypertensive asleep BP as SBP ≥120mmHg or DBP ≥70mmHg while asleep and hypertensive 24-hour BP as SBP ≥130mmHg or DBP ≥80mmHg over the entire ABPM period. Results: The prevalence of masked hypertension increased from 29% to 43% when defined using awake, asleep, or 24-hour BP versus using awake BP alone (Table). This increase was larger in non-Hispanic blacks (31-54%) compared with non-Hispanic whites (28-37%) and Hispanics (17-26%). The adjusted prevalence ratio (95% confidence interval) for having masked hypertension for non-Hispanic blacks compared with Non-Hispanic whites was higher from 1.20(1.05,1.37) to 1.33(1.20,1.47) when defined using awake, asleep and 24-hour BP versus awake BP only. Conclusions: Including asleep BP to define masked hypertension increased the prevalence of masked hypertension to a larger extent among non-Hispanic blacks compared to non-Hispanic whites and Hispanics.

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.

Abstract P180: Ambulatory Blood Pressure Monitoring Phenotypes in Adults With and Without Chronic Kidney Disease Taking Antihypertensive Medication: The Jackson Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Stanford Mwasongwe ◽  
Rikki M Tanner ◽  
Daniel Pugliese ◽  
Bessie Young ◽  
Marwah Abdalla ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Medication ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Sustained Hypertension ◽  
Heart Study

Background: Ambulatory blood pressure monitoring (ABPM) can detect hypertension phenotypes associated with increased risk for chronic kidney disease (CKD) progression. There is a high prevalence of these phenotypes in the general population; however, it is unclear whether they are more common among African Americans (AAs) with versus without CKD. Methods: We examined the prevalence of daytime, nocturnal, white-coat, masked, and sustained hypertension and a non-dipping BP pattern among AAs participating in the Jackson Heart Study. Analyses were restricted to 561 participants taking antihypertensive medication with a complete ABPM recording at baseline (2000-2004). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m 2 or the presence of kidney damage indicated by the presence of albumin-creatinine ratio ≥30 mg/g. We used log binomial regression models in a multivariable adjusted model to calculate the association between CKD and ABPM phenotypes. Results: The mean age of participants included in the current analysis was 62 years, 72% were female, and 26% had CKD. Daytime, nocturnal, masked, and sustained hypertension and non-dipping were more common, while white-coat hypertension was less common, among participants with versus without CKD (Table 1). The prevalence of sustained hypertension was 1.46-fold (CI 1.03-2.06) greater among those with CKD compare to those without after multivariable adjustment. Conclusions: In a large community-based study of AAs, ABPM phenotypes were common among adults with CKD. Sustained hypertension was statistically significantly higher in those with versus without CKD.

Renal denervation alters ambulatory blood pressure-derived salt sensitivity index in patients with uncontrolled hypertension

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Revathy Carnagarin ◽  
Janis M. Nolde ◽  
Rebecca Lee ◽  
Leslie Marisol Lugo-Gavidia ◽  
Natalie C. Ward ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Renal Denervation ◽  
Salt Sensitivity ◽  
Uncontrolled Hypertension ◽  
Sensitivity Index

scholarly journals MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021038 ◽  
Author(s):  
Gianfranco Parati ◽  
Enrico Agabiti-Rosei ◽  
George L Bakris ◽  
Grzegorz Bilo ◽  
Giovanna Branzi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Pressure Measurement ◽  
Management Strategy ◽  
Blood Pressure Measurement ◽  
Uncontrolled Hypertension ◽  
Hypertension Management ◽  
Ambulatory Blood Pressure Measurement ◽  
Group 2 ◽  
Group 1

IntroductionMasked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM.Methods and analysisMASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed.Ethics and disseminationMASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal.Trial registration numberNCT02804074; Pre-results.

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

2020 ◽  
Vol 59 (3) ◽  
pp. 228-235 ◽  
Author(s):  
Michelle Kaplinski ◽  
Heather Griffis ◽  
Fang Liu ◽  
Craig Tinker ◽  
Nina C. Laney ◽  
...  
Keyword(s):  
Blood Pressure ◽  
At Risk ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Medication ◽  
Blood Pressure Monitoring ◽  
Systemic Hypertension ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Multidisciplinary Program

Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.

scholarly journals May Measurement Month 2018: an analysis of blood pressure screening results from Chile

2020 ◽  
Vol 22 (Supplement_H) ◽  
pp. H37-H39
Author(s):  
Fernando Lanas ◽  
Maria Soledad Garcia ◽  
Melanie Paccot ◽  
Jimena Peña ◽  
Pamela Torres ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medication ◽  
Blood Pressure Measurement ◽  
National Health Survey ◽  
Uncontrolled Hypertension ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Systematic Screening ◽  
Temporary Solution ◽  
Global Initiative

Abstract Hypertension is highly prevalent in Chile. The National Health Survey 2016–17 reported a 27.6% prevalence, 68.7% awareness, and 33.3% of hypertensives had controlled blood pressure (BP). May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. A cross-sectional survey of volunteers aged ≥18 years old was carried out in May 2018. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Ninety-four sites participated, most of them from the Public Health System outpatient clinics distributed along the country. In addition, universities, clinical research sites, and private clinics participated. Hypertension was diagnosed as mean systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or receiving antihypertensive medication. Overall 9344 individuals were screened. After multiple imputation, hypertension prevalence was 29.2%, of which 64.0% were aware of their condition. Of those aware of their hypertension diagnosis, 87.7% were receiving antihypertensive medication and 56.1% of the total number of hypertensives were on antihypertensive medication. Moreover, 15.3% of the participants who were not receiving treatment were considered potential hypertensives identified in the MMM18. MMM18 was one of the largest BP screening campaigns performed in Chile. It demonstrated a high prevalence of hypertension with one-third of these individuals having controlled BP. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggests that systematic screening programmes may be a useful tool to improve hypertension control in Chile.

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