Hypertension (HT) in the general population is misdiagnosed by the use of clinic blood pressures (BP) alone. Some pafients have white coat hypertension (WCHT), while others have masked hypertension (MHT;normal clinic BP, but elevated daytime ambulatory BP). Ambulatory BP monitoring (ABPM) is required to correcfiy detect both WCHT and MHT. However, ABPM is costly, complex, and often unavailable for routine use in the esfirnated 65-70 million U.S. adults with pre-hypertension. We will therefore compare 4 methods ofBP measurement currently recommended for clinical practice: two occur in the clinic setting: routine CBP and automated CBP;two during daily life away from the clinic: ambulatory and home BP monitoring; we will test which best identifies those with MHT and WCHT. The study will recruit 300 subjects (men and women, aged 18-70, over-sampling those with elevated, untreated clinic BP) who will get all the BP measurements. CBP (convenfional and using the machine BpTRU) will be measured on 4 visits;Home BP will be measured with 3 readings (morning and evening) for 3 weeks;and Ambulatory BP will be measured twice with concurrent acfigraphy monitoring. Sociodemographic data, health and health behaviors, and anxiety will be assessed by questionnaire. Target organ damage will be assessed by arterial pulse wave recording (pulse wave velocity and augmentation index) and microalbuminuria. Blood will be drawn for metabolic and lipid profiling and genefic analysis. Data analyses will evaluate the reproducibility of the 4 methods, and their sensifivity and specificity for diagnosing HT, where an average daytime BP>135/85 mmHg is treated as the gold standard for this diagnosis.
Aim 1 examines differences in the accuracy of diagnoses based on the different BP assessment methods, and differences in their strength of associafion with TOD and cardiovascular risk.
For Aim 2, we will develop stepped algorithms for diagnosing HT at pre-specified levels of confidence and estimate their projected accuracy in the general population.
Aim 3 will evaluate the short- and long-term cost-effectiveness of the individual methods and developed algorithms. The long-term goal of Project 3 is to improve the detection of HT, including those with MHT, so that treatment decisions are better informed, progression of TOD is slowed, and cardiovascular risk reduced. We believe that the results of this diagnosfic research will substanfially impact future guidelines for the assessment of HT, and facilitate the design of studies to evaluate the benefits of antihypertensive treatment in those with MHT.
|Abdalla, Marwah; Caughey, Melissa C; Tanner, Rikki M et al. (2017) Associations of Blood Pressure Dipping Patterns With Left Ventricular Mass and Left Ventricular Hypertrophy in Blacks: The Jackson Heart Study. J Am Heart Assoc 6:|
|Gerber, Linda M; Sievert, Lynnette L; Schwartz, Joseph E (2017) Hot flashes and midlife symptoms in relation to levels of salivary cortisol. Maturitas 96:26-32|
|Anstey, D Edmund; Booth 3rd, John N; Abdalla, Marwah et al. (2017) Predicted Atherosclerotic Cardiovascular Disease Risk and Masked Hypertension Among Blacks in the Jackson Heart Study. Circ Cardiovasc Qual Outcomes 10:|
|Burg, Matthew M; Brandt, Cynthia; Buta, Eugenia et al. (2017) Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment. Psychosom Med 79:181-188|
|Wang, Y Claire; Shimbo, Daichi; Muntner, Paul et al. (2017) Prevalence of Masked Hypertension Among US Adults With Nonelevated Clinic Blood Pressure. Am J Epidemiol 185:194-202|
|Booth 3rd, John N; Abdalla, Marwah; Tanner, Rikki M et al. (2017) Cardiovascular Health and Incident Hypertension in Blacks: JHS (The Jackson Heart Study). Hypertension 70:285-292|
|Sundquist, Kevin J; Schwartz, Joseph E; Edmondson, Donald et al. (2017) Noncompletion of Nighttime Ambulatory Blood Pressure Monitoring: Potential for Selection Bias in Analyses of Nondipping. Psychosom Med 79:728-729|
|Goldsmith, Jeff; Schwartz, Joseph E (2017) Variable selection in the functional linear concurrent model. Stat Med 36:2237-2250|
|Ravenell, Joseph; Shimbo, Daichi; Booth 3rd, John N et al. (2017) Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study. Circulation 135:2470-2480|
|Quinn, Ashlinn K; Ae-Ngibise, Kenneth Ayuurebobi; Kinney, Patrick L et al. (2017) Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort. Environ Health 16:76|
Showing the most recent 10 out of 189 publications