Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study

Joseph Ravenell, Daichi Shimbo, John N. Booth, Daniel F. Sarpong, Charles Agyemang, Danielle L.Beatty Moody, Marwah Abdalla, Tanya M. Spruill, Amanda J. Shallcross, Adam P. Bress, Paul Muntner, Gbenga Ogedegbe

Research output: Contribution to journalArticle

Abstract

Background: Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. Methods: We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression-and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. Conclusions: On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.

Original languageEnglish (US)
Pages (from-to)2470-2480
Number of pages11
JournalCirculation
Volume135
Issue number25
DOIs
StatePublished - Jun 20 2017

Fingerprint

African Americans
Blood Pressure
Antihypertensive Agents
Hypertension
Ambulatory Blood Pressure Monitoring
Population
Asian Americans
Reading
Cohort Studies
Cardiovascular Diseases
Mortality

Keywords

  • African American adults
  • ambulatory blood pressure monitoring
  • hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ravenell, J., Shimbo, D., Booth, J. N., Sarpong, D. F., Agyemang, C., Moody, D. L. B., ... Ogedegbe, G. (2017). Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study. Circulation, 135(25), 2470-2480. https://doi.org/10.1161/CIRCULATIONAHA.116.027051

Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study. / Ravenell, Joseph; Shimbo, Daichi; Booth, John N.; Sarpong, Daniel F.; Agyemang, Charles; Moody, Danielle L.Beatty; Abdalla, Marwah; Spruill, Tanya M.; Shallcross, Amanda J.; Bress, Adam P.; Muntner, Paul; Ogedegbe, Gbenga.

In: Circulation, Vol. 135, No. 25, 20.06.2017, p. 2470-2480.

Research output: Contribution to journalArticle

Ravenell, J, Shimbo, D, Booth, JN, Sarpong, DF, Agyemang, C, Moody, DLB, Abdalla, M, Spruill, TM, Shallcross, AJ, Bress, AP, Muntner, P & Ogedegbe, G 2017, 'Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study', Circulation, vol. 135, no. 25, pp. 2470-2480. https://doi.org/10.1161/CIRCULATIONAHA.116.027051
Ravenell J, Shimbo D, Booth JN, Sarpong DF, Agyemang C, Moody DLB et al. Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study. Circulation. 2017 Jun 20;135(25):2470-2480. https://doi.org/10.1161/CIRCULATIONAHA.116.027051
Ravenell, Joseph ; Shimbo, Daichi ; Booth, John N. ; Sarpong, Daniel F. ; Agyemang, Charles ; Moody, Danielle L.Beatty ; Abdalla, Marwah ; Spruill, Tanya M. ; Shallcross, Amanda J. ; Bress, Adam P. ; Muntner, Paul ; Ogedegbe, Gbenga. / Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study. In: Circulation. 2017 ; Vol. 135, No. 25. pp. 2470-2480.
@article{b031f7a6c7b6491ca45cdea2a850e83b,
title = "Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study",
abstract = "Background: Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. Methods: We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression-and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. Conclusions: On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.",
keywords = "African American adults, ambulatory blood pressure monitoring, hypertension",
author = "Joseph Ravenell and Daichi Shimbo and Booth, {John N.} and Sarpong, {Daniel F.} and Charles Agyemang and Moody, {Danielle L.Beatty} and Marwah Abdalla and Spruill, {Tanya M.} and Shallcross, {Amanda J.} and Bress, {Adam P.} and Paul Muntner and Gbenga Ogedegbe",
year = "2017",
month = "6",
day = "20",
doi = "10.1161/CIRCULATIONAHA.116.027051",
language = "English (US)",
volume = "135",
pages = "2470--2480",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "25",

}

TY - JOUR

T1 - Thresholds for Ambulatory Blood Pressure among African Americans in the Jackson Heart Study

AU - Ravenell, Joseph

AU - Shimbo, Daichi

AU - Booth, John N.

AU - Sarpong, Daniel F.

AU - Agyemang, Charles

AU - Moody, Danielle L.Beatty

AU - Abdalla, Marwah

AU - Spruill, Tanya M.

AU - Shallcross, Amanda J.

AU - Bress, Adam P.

AU - Muntner, Paul

AU - Ogedegbe, Gbenga

PY - 2017/6/20

Y1 - 2017/6/20

N2 - Background: Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. Methods: We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression-and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. Conclusions: On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.

AB - Background: Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. Methods: We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression-and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. Conclusions: On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.

KW - African American adults

KW - ambulatory blood pressure monitoring

KW - hypertension

UR - http://www.scopus.com/inward/record.url?scp=85020852534&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020852534&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.116.027051

DO - 10.1161/CIRCULATIONAHA.116.027051

M3 - Article

VL - 135

SP - 2470

EP - 2480

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 25

ER -