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. 2017 Jun 20;135(25):2470-2480.
doi: 10.1161/CIRCULATIONAHA.116.027051. Epub 2017 Apr 20.

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

Joseph Ravenell  1 , Daichi Shimbo  2 , John N Booth 3rd  2 , Daniel F Sarpong  2 , Charles Agyemang  2 , Danielle L Beatty Moody  2 , Marwah Abdalla  2 , Tanya M Spruill  2 , Amanda J Shallcross  2 , Adam P Bress  2 , Paul Muntner  2 , Gbenga Ogedegbe  2
Affiliations

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

Joseph Ravenell et al. Circulation. .

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.

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Figures

Figure 1
Figure 1
Daytime, 24-hour, and nighttime blood pressure thresholds corresponding to a clinic systolic blood pressure/diastolic blood pressure threshold of 140/90 mmHg determined using the regression-derived approach in participants not taking antihypertensive medication. Dash line represents the distribution of ambulatory blood pressure. Solid line represents the distribution of clinic blood pressure. Light gray shaded regions indicate the participants with daytime, 24-hour, and nighttime blood pressure at or above the thresholds corresponding to clinic systolic blood pressure/diastolic blood pressure of 140/90 mmHg. Dark gray shaded regions indicate the participants with clinic systolic blood pressure/diastolic blood pressure at or above the thresholds of 140/90 mmHg.
Figure 2
Figure 2
Daytime, 24-hour, and nighttime blood pressure thresholds corresponding to a clinic systolic blood pressure/diastolic blood pressure threshold of 120/80 mmHg, 130/85 mmHg, 140/90 mmHg, and 160/100 mmHg determined using the regression-derived approach in participants not taking antihypertensive medication. Light gray area represents 95% confidence interval bands. Dark gray area represents 95% prediction bands. DBP: diastolic blood pressure; SBP: systolic blood pressure.
Figure 3
Figure 3
Daytime, 24-hour, and nighttime blood pressure thresholds among participants not taking antihypertensive medication compared to published recommendations,- of blood pressure thresholds for ambulatory hypertension: daytime systolic blood pressure/diastolic blood pressure ≥ 135/85 mmHg, 24-hour systolic blood pressure/diastolic blood pressure ≥ 130/80 mmHg, and nighttime systolic blood pressure/diastolic blood pressure ≥ 120/70 mmHg. Blue lines represent recommended systolic blood pressure and diastolic blood pressure thresholds. DBP: diastolic blood pressure; SBP: systolic blood pressure.
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