Predicted Atherosclerotic Cardiovascular Disease Risk and Masked Hypertension Among Blacks in the Jackson Heart Study

Abstract

Background Among individuals without hypertension based on clinic blood pressure (BP), it is unclear who should be screened for masked hypertension, defined as having hypertension based on out-of-clinic BP. We hypothesized that individuals with a higher 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk, calculated using the Pooled Cohort risk equations, have a higher prevalence of masked hypertension. Methods and Results We analyzed data from the Jackson Heart Study, a population-based cohort of African Americans, to determine the association of predicted ASCVD risk with masked hypertension. The sample included 644 participants, 40–79 years of age, with clinic systolic/diastolic BP <140/90 mmHg, who completed ambulatory BP monitoring (ABPM), were free of cardiovascular disease, and had data on factors needed to calculate ASCVD risk. Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Any masked hypertension was defined as masked daytime hypertension (mean daytime systolic/diastolic BP≥135/85 mmHg), masked nighttime hypertension (mean nighttime systolic/diastolic BP≥120/70 mmHg), or masked 24-hour hypertension (mean 24-hour systolic/diastolic BP≥130/80 mmHg). The prevalence of any masked hypertension was 54.0%. Compared to participants in the lowest (<5%) predicted ASCVD risk category, multivariable adjusted prevalence ratios (95% confidence interval [CI]) for any masked hypertension were 1.36 (1.03–1.79), 1.62 (1.22–2.16), and 1.91 (1.47–2.48) for those with ASCVD risk of 5% to <7.5%, 7.5% to <10%, and ≥10%, respectively. The c-statistic for discriminating between participants with versus without any masked hypertension was 0.681 (95% CI 0.640–0.723) for ASCVD risk and 0.703 (95% CI 0.662–0.744) for clinic SBP and DBP. Conclusions Higher ASCVD risk was associated with an increased prevalence of masked hypertension. Although the discrimination of ASCVD risk for masked hypertension was not superior to clinic BP, risk prediction equations may be useful for identifying the subgroup of individuals with both masked hypertension and high predicted ASCVD risk.

An Update on Masked Hypertension

“…We previously found that higher 10-year predicted CVD risk, using the pooled cohort risk equations, was associated with a higher prevalence of masked hypertension. (42) Although 10-year predicted risk was not superior to clinic BP for predicting masked hypertension, the majority of individuals with masked hypertension had a 10-year predicted CVD risk ≥10%. Risk prediction equations may therefore help identify individuals with masked hypertension who would derive the most benefit from antihypertensive treatment.…”

Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis

“…Among 54 CBPM studies, 31 studies (7, 10, 12, 20-35, 41, 59-67, 72, 73) reported 2x2 table data which could be assessed for diagnostic performance, while 7(36-40, 42, 43) and 16 (44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)71) studies reported data for only positive and negative CBPM respectively (see Table 1).…”

Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis

“…All CBPM studies (7, 9, 11, 19-58, 60, 61) were low risk in all domains of applicability. Ten (20,26,31,38,39,44,50,52,57,58) and 6 studies (30,34,41,46,49,55,59) were high and unclear bias in selection of study subjects. Forty three studies (7, 9, 11, 19-31, 33-38, 40-57, 59-61) applied the index/study test before the reference standard but with unclear explanation of blinding.…”