Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals

Yuichiro Yano, Rikki M. Tanner, Swati Sakhuja, Byron C. Jaeger, John N. Booth, Marwah Abdalla, Daniel Pugliese, Samantha R. Seals, Olugbenga Ogedegbe, Daniel W. Jones, Paul Muntner, Daichi Shimbo

Research output: Contribution to journalArticle

Abstract

Importance: Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. Objective: To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. Design, Setting, and Participants: This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. Main Outcomes and Measures: Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results: A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6%] male; and 583 [56.4%] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95% CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95% CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95% CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95% CI, 0.97-1.33) and daytime (HR, 0.95; 95% CI, 0.81-1.10) and nighttime (HR, 1.06; 95% CI, 0.90-1.24) DBP. Conclusions and Relevance: Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk..

Original languageEnglish (US)
JournalJAMA Cardiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

African Americans
Cardiovascular Diseases
Blood Pressure
Mortality
Ambulatory Blood Pressure Monitoring
Proportional Hazards Models
Antihypertensive Agents
Coronary Disease
Cohort Studies
Stroke
Outcome Assessment (Health Care)
Prospective Studies
Hypertension
Health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Yano, Y., Tanner, R. M., Sakhuja, S., Jaeger, B. C., Booth, J. N., Abdalla, M., ... Shimbo, D. (Accepted/In press). Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2019.2845

Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals. / Yano, Yuichiro; Tanner, Rikki M.; Sakhuja, Swati; Jaeger, Byron C.; Booth, John N.; Abdalla, Marwah; Pugliese, Daniel; Seals, Samantha R.; Ogedegbe, Olugbenga; Jones, Daniel W.; Muntner, Paul; Shimbo, Daichi.

In: JAMA Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Yano, Y, Tanner, RM, Sakhuja, S, Jaeger, BC, Booth, JN, Abdalla, M, Pugliese, D, Seals, SR, Ogedegbe, O, Jones, DW, Muntner, P & Shimbo, D 2019, 'Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals', JAMA Cardiology. https://doi.org/10.1001/jamacardio.2019.2845
Yano, Yuichiro ; Tanner, Rikki M. ; Sakhuja, Swati ; Jaeger, Byron C. ; Booth, John N. ; Abdalla, Marwah ; Pugliese, Daniel ; Seals, Samantha R. ; Ogedegbe, Olugbenga ; Jones, Daniel W. ; Muntner, Paul ; Shimbo, Daichi. / Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals. In: JAMA Cardiology. 2019.
@article{b09711b244054764a6a26b330b2ef93d,
title = "Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals",
abstract = "Importance: Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. Objective: To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. Design, Setting, and Participants: This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. Main Outcomes and Measures: Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results: A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6{\%}] male; and 583 [56.4{\%}] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95{\%} CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95{\%} CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95{\%} CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95{\%} CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95{\%} CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95{\%} CI, 0.97-1.33) and daytime (HR, 0.95; 95{\%} CI, 0.81-1.10) and nighttime (HR, 1.06; 95{\%} CI, 0.90-1.24) DBP. Conclusions and Relevance: Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk..",
author = "Yuichiro Yano and Tanner, {Rikki M.} and Swati Sakhuja and Jaeger, {Byron C.} and Booth, {John N.} and Marwah Abdalla and Daniel Pugliese and Seals, {Samantha R.} and Olugbenga Ogedegbe and Jones, {Daniel W.} and Paul Muntner and Daichi Shimbo",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamacardio.2019.2845",
language = "English (US)",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",

}

TY - JOUR

T1 - Association of Daytime and Nighttime Blood Pressure with Cardiovascular Disease Events among African American Individuals

AU - Yano, Yuichiro

AU - Tanner, Rikki M.

AU - Sakhuja, Swati

AU - Jaeger, Byron C.

AU - Booth, John N.

AU - Abdalla, Marwah

AU - Pugliese, Daniel

AU - Seals, Samantha R.

AU - Ogedegbe, Olugbenga

AU - Jones, Daniel W.

AU - Muntner, Paul

AU - Shimbo, Daichi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. Objective: To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. Design, Setting, and Participants: This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. Main Outcomes and Measures: Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results: A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6%] male; and 583 [56.4%] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95% CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95% CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95% CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95% CI, 0.97-1.33) and daytime (HR, 0.95; 95% CI, 0.81-1.10) and nighttime (HR, 1.06; 95% CI, 0.90-1.24) DBP. Conclusions and Relevance: Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk..

AB - Importance: Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. Objective: To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. Design, Setting, and Participants: This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. Main Outcomes and Measures: Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results: A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6%] male; and 583 [56.4%] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95% CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95% CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95% CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95% CI, 0.97-1.33) and daytime (HR, 0.95; 95% CI, 0.81-1.10) and nighttime (HR, 1.06; 95% CI, 0.90-1.24) DBP. Conclusions and Relevance: Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk..

UR - http://www.scopus.com/inward/record.url?scp=85071011702&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071011702&partnerID=8YFLogxK

U2 - 10.1001/jamacardio.2019.2845

DO - 10.1001/jamacardio.2019.2845

M3 - Article

C2 - 31411629

AN - SCOPUS:85071011702

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

ER -