Prevalence of Masked Hypertension in African Americans

Larsen, Timothy R.; Gelaye, Alehegn; Waanbah, Barryton; Assad, Hadeel; Daloul, Yara; Williams, Frances; Williams, Michael; Steigerwalt, Susan

doi:10.1111/jch.12418

Cited by 13 publications

(17 citation statements)

References 30 publications

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“…A similar prevalence of MHT (45%) has been reported in African Americans, and in African Americans with hypertensive kidney disease (43%) . Among this renal‐impaired MHT group, more cases showed uncontrolled nighttime ABPM (94%) than uncontrolled daytime ABPM (57%).…”

Section: Discussionsupporting

confidence: 73%

Masked Hypertension in Low‐Income South African Adults

Ware

Rennie

Gafane

et al. 2016

J of Clinical Hypertension

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4While South Africa has one of the highest hypertension rates globally, there are few data on masked hypertension (MHT) and white-coat hypertension (WCHT). This study measured the frequency of MHT and WCHT in low-income (<$500 US per month) South African adults, evaluating cardiovascular risk by arterial stiffness. Participants (n=101, 50% male; mean age 39.4AE9.7 years) were recruited from a large North-West Province employer. Clinic and 24-hour blood pressure (BP) and pulse wave analysis were recorded. Clinic BP identified 18% of patients as hypertensive, while 24-hour BP showed that 63% of patients were hypertensive. The frequency of MHT was high (33 of 81, 41%) with only one case of WCHT. In comparison to those with normal clinic and 24-hour BP, augmentation index and pulse wave velocity were significantly higher in those with hypertensive 24-hour BP irrespective of clinic BP, indicating that, in this group, masked and sustained hypertension carry a similar elevated cardiovascular risk.

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Section: Discussionsupporting

confidence: 73%

Masked Hypertension in Low‐Income South African Adults

Ware

Rennie

Gafane

et al. 2016

J of Clinical Hypertension

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“…Two small studies (each <100 participants), which included middle-aged AAs, have reported a prevalence of masked hypertension exceeding 40%. 32, 33 Also, in the African American Study of Kidney Disease (AASK) Cohort Study, which included 691 AAs with established kidney disease, 70% of participants had masked daytime or nighttime hypertension. 30 In the current study, approximately 30% of AAs had masked daytime and 24-hour hypertension.…”

Section: Discussionmentioning

confidence: 99%

Masked Hypertension and Cardiovascular Disease Events in a Prospective Cohort of Blacks

et al. 2016

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Masked hypertension, defined as non-elevated clinic blood pressure (BP) with elevated out-of-clinic BP, has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Few data are available on masked hypertension and CVD and mortality risk among African Americans (AAs). We analyzed data from the Jackson Heart Study, a prospective cohort study of AAs. Analyses included participants with clinic-measured systolic/diastolic BP (SBP/DBP)<140/90mmHg who completed ambulatory BP monitoring (ABPM) following the baseline exam in 2000–2004 (n=738). Masked daytime (10:00am–8:00pm) hypertension was defined as mean ambulatory SBP/DBP≥135/85mmHg. Masked nighttime (midnight-6:00am) hypertension was defined as mean ambulatory SBP/DBP≥120/70mmHg. Masked 24-hour hypertension was defined as mean SBP/DBP≥130/80mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and deaths identified through December 2010 were adjudicated. Any masked hypertension (masked daytime, nighttime or 24-hour hypertension) was present in 52.2% of participants; 28.2%, 48.2% and 31.7% had masked daytime, nighttime and 24-hour hypertension, respectively. There were 51 CVD events and 44 deaths over a median follow-up of 8.2 and 8.5 years, respectively. CVD rates per 1,000 person-years (95% CI) in participants with and without any masked hypertension were 13.5 (9.9–18.4) and 3.9 (2.2–7.1), respectively. The multivariable adjusted hazard ratio (95% CI) for CVD was 2.49 (1.26–4.93) for any masked hypertension and 2.86 (1.59–5.13), 2.35 (1.23–4.50) and 2.52 (1.39–4.58) for masked daytime, nighttime and 24-hour hypertension, respectively. Masked hypertension was not associated with all-cause mortality. Masked hypertension is common and associated with increased risk for CVD events in AAs.

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“…We used data from a population-based sample comprised entirely of AAs. There have been few prior investigations of ABPM among AAs, 4,46 and this population has a high risk for masked hypertension 4 and incident clinic hypertension. 12 Also, given the broad data collection in the JHS, we were able to control for multiple potential confounders.…”

Section: Discussionmentioning

confidence: 99%

Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study

et al. 2016

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Masked hypertension, defined as non-elevated clinic blood pressure and elevated out-of-clinic blood pressure may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic blood pressure and masked hypertension using ambulatory blood pressure monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of African Americans. Analyses included 317 participants with clinic blood pressure <140/90mmHg, complete ABPM, who were not taking antihypertensive medication at baseline in 2000–2004. Masked daytime hypertension was defined as mean daytime blood pressure ≥135/85mmHg; masked nighttime hypertension as mean nighttime blood pressure ≥120/70mmHg; and masked 24-hour hypertension as mean 24-hour blood pressure ≥130/80mmHg. Incident clinic hypertension, assessed at study visits in 2005–2008 and 2009–2012, was defined as the first visit with clinic systolic/diastolic blood pressure ≥140/90mmHg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked nighttime hypertension and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% CI) of incident clinic hypertension for any masked hypertension and masked daytime, nighttime, and 24-hour hypertension were 2.13 (1.51–3.02), 1.79 (1.24–2.60), 2.22 (1.58–3.12), and 1.91 (1.32–2.75), respectively. These findings suggest that ambulatory blood pressure monitoring can identify African Americans at increased risk for developing clinic hypertension.

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Prevalence of Masked Hypertension in African Americans

Cited by 13 publications

References 30 publications

Masked Hypertension in Low‐Income South African Adults

Masked Hypertension in Low‐Income South African Adults

Masked Hypertension and Cardiovascular Disease Events in a Prospective Cohort of Blacks

Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study

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