Diurnal Blood Pressure Variation and Cardiac Mass in American Blacks and Whites and South African Blacks

Fumo, Maryann T.; Teeger, Susan; Lang, Roberto M.; Bednarz, J.; Sareli, Pinhas; Murphy, Michael B.

doi:10.1093/ajh/5.3.111

Cited by 71 publications

(38 citation statements)

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“…The increased cardiovascular load may contribute to the much higher prevalence of cardiovascular morbidity and mortality in AAs compared with EAs. Although the basis for the differential nocturnal decline between AAs and EAs is not currently known, the fact that blacks outside of the United States experience the same nocturnal decline as whites 32 and that FH of EH can only account in part for the ethnic difference seen here and elsewhere suggest that the ethnic difference in ABP patterns is the result of a gene-environment interaction. We have hypothesized that pressure remains elevated at night in an attempt to excrete the daily sodium load.…”

Section: Discussionmentioning

confidence: 78%

Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories

et al. 2006

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Background-Cross-sectional studies demonstrated ethnic and gender differences in ambulatory blood pressure patterns, but little is known about the longitudinal development of these differences. Methods and Results-Twenty-four-hour ambulatory blood pressure was measured up to 12 times (5 times on average) over a 15-year period in 312 African Americans (AAs) and 351 European Americans aged 7 to 30 years. Multivariate individual growth curves across age were created for daytime and nighttime blood pressure jointly. For both daytime and nighttime systolic blood pressure (SBP), AAs and males had higher levels (PϽ0.001) than European Americans and females. Males also showed a greater increase with age (PϽ0.001) than females. For nighttime SBP, a faster increase of SBP with age (PϽ0.01) in AAs was additionally observed. The ethnic difference in nighttime SBP levels and its increase with age were significantly larger than in daytime SBP. For daytime and nighttime diastolic blood pressure, AAs had higher levels than European Americans (PϽ0.001), and this difference was significantly larger at night. From late adolescence onward, males showed a greater increase in diastolic blood pressure with age than females. Ethnic and gender differences persisted after adjustment for height, body mass index, socioeconomic status, and stress-related coping styles. Family history of essential hypertension explained ethnic differences in daytime SBP. Conclusions-We observed significant ethnic and gender differences in longitudinal trajectories of ambulatory blood pressure in youth and young adults. The blunted nocturnal decline and its exacerbation with age in AAs corroborate and extend findings of cross-sectional studies.

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Section: Discussionmentioning

confidence: 78%

Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories

et al. 2006

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“…In the current study black hypertensives had higher awake and sleeping diastolic blood pressures and less of a nocturnal drop in systolic blood pressure than did white hypertensives. Although higher night-time mean blood pressures in normotensive AfricanAmericans [39] and Afro-Caribbeans [31] in comparison with those in white normotensives have been reported, the magnitude of the nocturnal fall did not differ between the races [31]. Despite black nondippers having significantly greater sleeping blood pressures than do black dippers (140/86 versus 129/80 mmHg, P < 0.005 systolic and P < 0.05 diastolic), we detected no differences between the two groups in cardiac and vascular structure.…”

Section: Discussionmentioning

confidence: 89%

Is the absence of a normal nocturnal fall in blood pressure (nondipping) associated with cardiovascular target organ damage?

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et al. 1997

Journal of Hypertension

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Objective To determine whether the failure to decrease blood pressure normally during sleep is associated with more prominent target organ damage.Methods Cardiac and vascular structure and function were characterized in 183 asymptomatic, unmedicated hypertensive patients and compared with their ambulatory blood pressures. ResultsThe 104 patients with a normal (> 10%) nocturnal fall in systolic blood pressure (dippers) were similar to the 79 patients with an abnormal fall (nondippers) in sex, race, body size, smoking history, and average awake ambulatory blood pressure. Nondippers tended to be older (57 versus 54 years, P = 0.06). The supine blood pressure upon completion of the ultrasound studies was higher in the nondippers (156/93 versus 146/89 mmHg, P < 0.005) as was the variability of the awake diastolic blood pressure. There were no differences between dippers and nondippers in left ventricular mass (170 versus 172 g), mass index (90 versus 91 gm/m 2 ), prevalence of abnormal ventricular geometry, common carotid artery diameter (5.74 versus 5.75 mm), and vascular strain. Although nondippers were more likely to have carotid artery plaque (41 versus 27%, P = 0.053) and an increased intimal-medial thickness (0.84 versus 0.79 mm, P < 0.05), adjustment for age rendered the differences insignificant. There were no differences in the relation of awake and sleeping systolic pressures to the left ventricular mass (r = 0.36 and 0.35, respectively, both P < 0.005) or to the carotid wall thickness (r = 0.28 and 0.29, respectively, both P < 0.005). When the 114 men and 69 women were considered separately, similar findings were obtained. When the 109 whites and 56 blacks (African-Americans and Afro-Caribbeans) were considered separately, there were no differences in left ventricular structure in either group, and differences in vascular structure were confined to the white subgroup. ConclusionThe lack of a normal nocturnal fall in blood pressure is not associated with an increase in left ventricular mass or in arterial disease independently of age. Age-related changes in carotid artery wall thickness and plaque among nondippers may reflect a contribution of an altered baroreceptor function to the lack of normal nocturnal and supine blood pressure decreases.Journal of Hypertension 1997, 15:969-978

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“…In other studies, African Americans have been shown to have higher nighttime BP than whites despite similar daytime BP. 23,24 The majority of patients with uncomplicated hypertension experience a fall in their nighttime BP of Ͼ10% of the daytime mean arterial BP. The absence of a fall in nocturnal BP has been linked to target organ damage, such as carotid artery structural alterations and LVH in some studies [25][26][27][28][29] but not others.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Left Ventricular Hypertrophy in the African American Study of Kidney Disease Cohort Study

et al. 2007

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Abstract-African Americans with hypertensive renal disease represent a high-risk population for cardiovascular events.Although left ventricular hypertrophy is a strong predictor of adverse cardiac outcome, the prevalence and associated factors of left ventricular hypertrophy in this patient population are not well described. The African American Study of Kidney Disease Cohort Study is a prospective, observational study that is an extension of the African American Study of Kidney Disease randomized clinical trial that was conducted from 1994 to 2001 in African Americans with hypertension and mild-to-moderate renal dysfunction. Echocardiograms and 24-hour ambulatory blood pressure monitoring were performed at the baseline visit of the cohort. Of 691 patients enrolled in the cohort study, 599 patients had interpretable baseline echocardiograms and ambulatory blood pressure data. Left ventricular hypertrophy was defined using a cut point for left ventricular mass index Ͼ49.2 g/m 2.7 in men and Ͼ46.7 m/m 2.7 in women. The majority of patients had left ventricular hypertrophy (66.7% of men and 73.9% of women). In a multiple regression analysis, higher average day and nighttime systolic blood pressure, younger age, and lower predicted glomerular filtration rate were associated with left ventricular hypertrophy, but albuminuria was not. These data demonstrate a striking prevalence of left ventricular hypertrophy in the African American Study of Kidney Disease Cohort and identify potential targets for prevention and therapeutic intervention in this high-risk patient population. (Hypertension.

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Diurnal Blood Pressure Variation and Cardiac Mass in American Blacks and Whites and South African Blacks

Cited by 71 publications

References 0 publications

Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories

Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories

Is the absence of a normal nocturnal fall in blood pressure (nondipping) associated with cardiovascular target organ damage?

Prevalence and Correlates of Left Ventricular Hypertrophy in the African American Study of Kidney Disease Cohort Study

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