Prevalence of ambulatory blood pressure phenotypes using the 2017 American College of Cardiology/American Heart Association blood pressure guideline thresholds

Poudel, Bharat; Booth, John N.; Sakhuja, Swati; Moran, Andrew E.; Schwartz, Joseph; Lloyd‐Jones, Donald M.; Lewis, Cora E.; Shikany, James M.; Shimbo, Daichi; Muntner, Paul

doi:10.1097/hjh.0000000000002055

Cited by 13 publications

(24 citation statements)

References 24 publications

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“…The higher prevalence of nocturnal HTN, INH, and non‐dipping 8 compared with others, 3,11 including recent studies from ME, 12 may indicate the Arab population to have a different risk profile than other ethnicities. The low prevalence of WHT in our study is comparable with some 13 but not others, 6 including a study from ME with prevalence of 17% 10 . Recent evidence also suggests that the incremental risk of events with WHT may only be slightly higher than normotension 14 …”

Section: Discussionsupporting

confidence: 85%

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

Mahmud

Alahaideb

Alshammary

et al. 2020

J of Clinical Hypertension

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International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24-hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of prehypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.

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Section: Discussionsupporting

confidence: 85%

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

Mahmud

Alahaideb

Alshammary

et al. 2020

J of Clinical Hypertension

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“…Estimates of complete data are based on our prior studies 29 30. For aim 1, we will have 80% statistical power to detect a difference between the absolute value of the difference between unattended office SBP and awake SBP on ABPM versus the absolute value of the difference between attended office SBP and awake SBP on ABPM of 1.5 and 1.2 mm Hg assuming an SD of 15 mm Hg for each SBP measurement and correlations between the two SBP measures of 0.5 and 0.7, respectively 31–35. For DBP and assuming an SD of 10 mm Hg, the detectable difference is 1.3 mm Hg and 1.1 mm Hg for correlations between the two DBP measures of 0.5 and 0.7, respectively.…”

Section: Discussionmentioning

confidence: 99%

Evaluating novel approaches for estimating awake and sleep blood pressure: design of the Better BP Study – a randomised, crossover trial

et al. 2022

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IntroductionFor many people, blood pressure (BP) levels differ when measured in a medical office versus outside of the office setting. Out-of-office BP has a stronger association with cardiovascular disease (CVD) events compared with BP measured in the office. Many BP guidelines recommend measuring BP outside of the office to confirm the levels obtained in the office. Ambulatory BP monitoring (ABPM) can assess out-of-office BP but is not available in many US practices and some individuals find it uncomfortable. The aims of the Better BP Study are to (1) test if unattended office BP is closer to awake BP on ABPM compared with attended office BP, (2) assess if sleep BP assessed by home BP monitoring (HBPM) agrees with sleep BP from a full night of ABPM and (3) compare the strengths of associations of unattended versus attended office BP, unattended office BP versus awake BP on ABPM and sleep BP on HBPM versus ABPM with markers of end-organ damage.Methods and analysisWe are recruiting 630 adults not taking antihypertensive medication in Birmingham, Alabama, and New York, New York. Participants are having their office BP measured with (attended) and without (unattended) a technician present, in random order, using an automated oscillometric office BP device during each of two visits within one week. Following these visits, participants complete 24 hours of ABPM and one night of HBPM, in random order. Psychosocial factors, anthropometrics, left ventricular mass index and albumin-to-creatinine ratio are also being assessed.Ethics and disseminationThis study was approved by the University of Alabama at Birmingham and the Columbia University Medical Center Institutional Review Boards. The study results will be disseminated at scientific conferences and published in peer-reviewed journals.Trial registration numberNCT04307004.

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“…This increment is similar as in other settings, and lowering of threshold also increases the absolute number of individuals with blood-pressure unawareness, and those with white-coat hypertension. [34][35][36] This would increase the burden on health-systems, and push for lowering of BP-control closer to therapeutic threshold of 120/80 mm Hg. (Figure 2) While, this is challenging but need to harmonize various hypertension guidelines to a diagnostic and therapeutic threshold of 130/80mm Hg is unavoidable.…”

Section: Discussionmentioning

confidence: 99%

Evidence for lower threshold for diagnosis of hypertension: inferences from an urban-slum cohort in India

Awadhiya

Tiwari

et al. 2021

Preprint

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Background Hypertension (HTN) is a key risk-factor for cardiovascular diseases (CVDs). Blood-pressure (BP) categorizations between systolic blood pressure (SBP) of 120 and 140 remain debatable. In the current study we aim to evaluate if individuals with a baseline SBP between 130-140 mm Hg (hypertension as per AHA 2017 guidelines) have a significantly higher proportion of incident hypertension on follow-up, as compared to those with SBP between 120-130 mm Hg. Methods Secondary data analysis was performed in a community-based cohort, instituted, and followed since 2017. Participants were aged ≥30 years, residents of urban slums in Bhopal. BP was measured at or near home by Community Health Workers (CHWs). Two-year follow up was completed in 2019. We excluded participants who were on BP reduction therapy, had fewer than two out-of-office BP measurements and who could not be followed. Eligible participants were re-classified based on baseline BP in four categories: Normal (Category-A), Elevated-BP (Category-B), Variable-BP (Category-C) and reclassified HTN based on AHA-2017 (Category-D). Proportion of individuals who developed incident hypertension on follow up was primary outcome. Result Out of 2649 records, 768 (28.9%), 647 (24.4%), 586 (22.1%), 648 (24.4%) belonged to Categories A, B, C and D respectively. Incident HTN with cut-off of 140/90 mm Hg was, 1.6%, 2.6%, 6.7%, 12% in categories A, B, C and D respectively. Incidence of incident hypertension in individuals with a baseline SBP between 130-140 mm Hg (Category D) was significantly higher as compared to those with SBP between 120-130 mm Hg (Category B). Conclusion We conclude that biological basis for AHA-2017 definition of hypertension is relatively robust also for low income and resource-limited settings. Evidence from our longitudinal study will be useful for policy makers for harmonizing national guidelines with AHA-2017. Keywords- hypertension, elevated blood pressure, community health worker, cardiovascular diseases

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Prevalence of ambulatory blood pressure phenotypes using the 2017 American College of Cardiology/American Heart Association blood pressure guideline thresholds

Cited by 13 publications

References 24 publications

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

Evaluating novel approaches for estimating awake and sleep blood pressure: design of the Better BP Study – a randomised, crossover trial

Evidence for lower threshold for diagnosis of hypertension: inferences from an urban-slum cohort in India

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