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Ambulatory blood pressure monitoring phenotypes among individuals with and without diabetes taking antihypertensive medication: the Jackson Heart Study

Journal of Human Hypertension volume 30, pages 731–736 (2016)Cite this article

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Abstract

Ambulatory blood pressure monitoring (ABPM) can detect phenotypes associated with increased cardiovascular disease (CVD) risk. Diabetes is associated with increased CVD risk but few data are available documenting whether blood pressure (BP) phenotypes, detected by ABPM, differ between individuals with versus without diabetes. We conducted a cross-sectional analysis of 567 participants in the Jackson Heart Study, a population-based study of African Americans, taking antihypertensive medication to evaluate the association between diabetes and ABPM phenotypes. Two clinic BP measurements were taken at baseline following a standardized protocol. ABPM was performed for 24 h following the clinic visit. ABPM phenotypes included daytime, sustained, nocturnal and isolated nocturnal hypertension, a non-dipping BP pattern, and white coat, masked and masked isolated nocturnal hypertension. Diabetes was defined as fasting glucose ⩾126 mg dl−1, haemoglobin A1c ⩾6.5% (48 mmol mol−1) or use of insulin or oral hypoglycaemic medications. Of the included participants (mean age 62.3 years, 71.8% female), 196 (34.6%) had diabetes. After multivariable adjustment, participants with diabetes were more likely to have daytime hypertension (prevalence ratio (PR): 1.32; 95% confidence interval (CI): 1.09–1.60), masked hypertension (PR: 1.46; 95% CI: 1.11–1.93) and masked isolated nocturnal hypertension (PR: 1.39; 95% CI: 1.02–1.89). Although nocturnal hypertension was more common among participants with versus without diabetes, this association was not present after adjustment for daytime systolic BP. Diabetes was not associated with the other ABPM phenotypes investigated. This study highlights the high prevalence of ABPM phenotypes among individuals with diabetes taking antihypertensive medication.

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References

  1. He J, Whelton PK . Elevated systolic blood pressure as a risk factor for cardiovascular and renal disease. J Hypertens Suppl 1999; 17: S7–S13.

    CAS  Google Scholar 

  2. Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE et al. Blood pressure and end-stage renal disease in men. N Engl J Med 1996; 334: 13–18.

    Article  CAS  Google Scholar 

  3. Hypertension in Diabetes Study Group. Hypertension in Diabetes Study (HDS): I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens 1993; 11: 309–317.

    Article  Google Scholar 

  4. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE . Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int 1996; 49: 1379–1385.

    Article  CAS  Google Scholar 

  5. Pickering TG, Shimbo D, Haas D . Ambulatory blood-pressure monitoring. N Engl J Med 2006; 354: 2368–2374.

    Article  CAS  Google Scholar 

  6. O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 2013; 31: 1731–1768.

    Article  Google Scholar 

  7. Turner JR, Viera AJ, Shimbo D . Ambulatory blood pressure monitoring in clinical practice: a review. Am J Med 2014; 128 (1): 14–20.

    Article  Google Scholar 

  8. Mancia G, Bombelli M, Seravalle G, Grassi G . Diagnosis and management of patients with white-coat and masked hypertension. Nat Rev Cardiol 2011; 8: 686–693.

    Article  CAS  Google Scholar 

  9. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 2002; 20: 2183–2189.

    Article  CAS  Google Scholar 

  10. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003; 107: 1401–1406.

    Article  Google Scholar 

  11. Gorostidi M, de la Sierra A, González-Albarrán O, Segura J, de la Cruz JJ, Vinyoles E et al. Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes. Hypertens Res 2011; 34: 1185–1189.

    Article  Google Scholar 

  12. Taylor HA, Wilson JG, Jones DW, Sarpong DF, Srinivasan A, Garrison RJ et al. Toward resolution of cardiovascular health disparities in African Americans: design and methods of the Jackson Heart Study. Ethn Dis 2005; 15: S6–4–17.

    PubMed  Google Scholar 

  13. Carpenter MA, Crow R, Steffes M, Rock W, Heilbraun J, Evans G et al. Laboratory, reading center, and coordinating center data management methods in the Jackson Heart Study. Am J Med Sci 2004; 328: 131–144.

    Article  Google Scholar 

  14. Baecke JA, Burema J, Frijters JE . A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36: 936–942.

    Article  CAS  Google Scholar 

  15. Dubbert PM, Carithers T, Ainsworth BE, Taylor HA, Wilson G, Wyatt SB . Physical activity assessment methods in the Jackson Heart Study. Ethn Dis 2005; 15: S6–56–61.

    PubMed  Google Scholar 

  16. Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, Li Y, Dolan E et al. The International Database of Ambulatory Blood Pressure in relation to Cardiovascular Outcome (IDACO): protocol and research perspectives. Blood Press Monit 2007; 12: 255–262.

    Article  Google Scholar 

  17. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1925–1938.

    Article  CAS  Google Scholar 

  18. White IR, Royston P, Wood AM . Multiple imputation using chained equations: issues and guidance for practice. Stat Med 2011; 30: 377–399.

    Article  Google Scholar 

  19. Pierdomenico SD, Lapenna D, Di Mascio R, Cuccurullo F . Short- and long-term risk of cardiovascular events in white-coat hypertension. J Hum Hypertens 2008; 22: 408–414.

    Article  CAS  Google Scholar 

  20. Franklin SS, Thijs L, Li Y, Hansen TW, Boggia J, Liu Y et al. Masked hypertension in diabetes mellitus: treatment implications for clinical practice. Hypertension 2013; 61: 964–971.

    Article  CAS  Google Scholar 

  21. Profant J, Dimsdale JE . Race and diurnal blood pressure patterns. A review and meta-analysis. Hypertension 1999; 33: 1099–1104.

    Article  CAS  Google Scholar 

  22. Brancati FL, Kao WH, Folsom AR, Watson RL, Szklo M . Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis Risk in Communities Study. JAMA 2000; 283: 2253–2259.

    Article  CAS  Google Scholar 

  23. Muntner P, Lewis CE, Diaz KM, Carson AP, Kim Y, Calhoun D et al. Racial differences in abnormal ambulatory blood pressure monitoring measures: results from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hypertens 2014; 28 (5): 640–648.

    Article  Google Scholar 

  24. Viera AJ, Zhu S, Hinderliter AL, Shimbo D, Person SD, Jacobs DR . Diurnal blood pressure pattern and development of prehypertension or hypertension in young adults: the CARDIA study. J Am Soc Hypertens 2010; 5: 48–55.

    Article  Google Scholar 

  25. Hermida RC, Ayala DE, Mojón A, Fernández JR . Sleep-time blood pressure as a therapeutic target for cardiovascular risk reduction in type 2 diabetes. Am J Hypertens 2012; 25: 325–334.

    Article  Google Scholar 

  26. Salles GF, Leite NC, Pereira BB, Nascimento EM, Cardoso CRL . Prognostic impact of clinic and ambulatory blood pressure components in high-risk type 2 diabetic patients: the Rio de Janeiro Type 2 Diabetes Cohort Study. J Hypertens 2013; 31: 2176–2186.

    Article  CAS  Google Scholar 

  27. National Clinical Guideline Centre Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]. NICE Clinical Guidelines, No. 127. Royal College of Physicians: London, UK, 2011.

  28. Siu AL . Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015; 163: 778–786.

    Article  Google Scholar 

  29. O’Brien E, Asmar R, Beilin L, Imai Y, Mallion J-M, Mancia G et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21: 821–848.

    Article  Google Scholar 

  30. Pogue V, Rahman M, Lipkowitz M, Toto R, Miller E, Faulkner M et al. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension 2009; 53: 20–27.

    Article  CAS  Google Scholar 

  31. Maciejewski S, Mohiuddin SM, Packard KA, Mooss AN, Reyes AP, Aryana A et al. Randomized, double-blind, crossover comparison of amlodipine and valsartan in african-americans with hypertension using 24-hour ambulatory blood pressure monitoring. Pharmacotherapy 2006; 26: 889–895.

    Article  CAS  Google Scholar 

  32. Barnes VA, Treiber FA, Johnson MH . Impact of transcendental meditation on ambulatory blood pressure in African-American adolescents. Am J Hypertens 2004; 17: 366–369.

    Article  Google Scholar 

  33. Kuznik A, Mardekian J . Trends in utilization of lipid- and blood pressure-lowering agents and goal attainment among the U.S. diabetic population, 1999-2008. Cardiovasc Diabetol 2011; 10: 31.

    Article  CAS  Google Scholar 

  34. Wong HK, Ong KL, Cheung C-L, Cheung BMY . Utilization of glucose, blood pressure, and lipid lowering medications among people with type II diabetes in the United States, 1999-2010. Ann Epidemiol 2014; 24: 516–521.

    Article  Google Scholar 

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Acknowledgements

The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C and HHSN268201300050C from the National Heart, Lung and Blood Institute (NHLBI) and the National Institute on Minority Health and Health Disparities (NIMHD). The current study is also supported by R01 HL117323 from the NHLBI. The authors thank the Jackson Heart Study team (University of Mississippi Medical Center Jackson State University, and Tougaloo College) and participants for their long-term commitment and significant contributions to the study.

Author contributions

SGB contributed to the concept and design, data analysis and interpretation, statistical analysis, drafting of the manuscript and critical revision of the manuscript for important intellectual content. DS contributed to the study concept and design, data interpretation and critical revision of the manuscript for important intellectual content. AGB, MS and APC contributed to the data interpretation and critical revision of the manuscript for important intellectual content. PM contributed to the study supervision, concept and design, data analysis and interpretation, statistical analysis, drafting of the manuscript and critical revision of the manuscript for important intellectual content. SGB is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    S G Bromfield, A P Carson & P Muntner

  2. Department of Medicine, Columbia University Medical Center, New York, NY, USA

    D Shimbo

  3. Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    A G Bertoni

  4. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    M Sims

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  1. S G Bromfield
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  6. P Muntner
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Correspondence to P Muntner.

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The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

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Bromfield, S., Shimbo, D., Bertoni, A. et al. Ambulatory blood pressure monitoring phenotypes among individuals with and without diabetes taking antihypertensive medication: the Jackson Heart Study. J Hum Hypertens 30, 731–736 (2016). https://doi.org/10.1038/jhh.2016.27

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