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.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Program Projects (P01)
Project #
5P01HL047540-18
Application #
8374486
Study Section
Special Emphasis Panel (ZHL1-PPG-Z)
Project Start
Project End
Budget Start
2012-03-01
Budget End
2013-02-28
Support Year
18
Fiscal Year
2012
Total Cost
$402,676
Indirect Cost
$86,050
Name
Columbia University (N.Y.)
Department
Type
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Kent, Shia T; Bromfield, Samantha G; Burkholder, Greer A et al. (2016) Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis. PLoS One 11:e0148920
Booth 3rd, John N; Muntner, Paul; Diaz, Keith M et al. (2016) Evaluation of Criteria to Detect Masked Hypertension. J Clin Hypertens (Greenwich) 18:1086-1094
Beatty Moody, Danielle L; Waldstein, Shari R; Tobin, Jonathan N et al. (2016) Lifetime racial/ethnic discrimination and ambulatory blood pressure: The moderating effect of age. Health Psychol 35:333-42
Abdalla, Marwah; Booth 3rd, John N; Diaz, Keith M et al. (2016) Hypertension and alterations in left ventricular structure and geometry in African Americans: the Jackson Heart Study. J Am Soc Hypertens 10:550-558.e10
Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise et al. (2016) Studies comparing ambulatory blood pressure and home blood pressure on cardiovascular disease and mortality outcomes: a systematic review. J Am Soc Hypertens 10:224-234.e17
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Schwartz, Joseph E; Burg, Matthew M; Shimbo, Daichi et al. (2016) Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population: Results From the Masked Hypertension Study. Circulation 134:1794-1807
Abdalla, Marwah; Booth 3rd, John N; Seals, Samantha R et al. (2016) Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study. Hypertension 68:220-6
Booth 3rd, John N; Muntner, Paul; Abdalla, Marwah et al. (2016) Differences in night-time and daytime ambulatory blood pressure when diurnal periods are defined by self-report, fixed-times, and actigraphy: Improving the Detection of Hypertension study. J Hypertens 34:235-43
Abdalla, Marwah; Goldsmith, Jeff; Muntner, Paul et al. (2016) Is Isolated Nocturnal Hypertension A Reproducible Phenotype? Am J Hypertens 29:33-8

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