Comparison of the association of masked hypertension defined by the 2017 ACC/AHA BP guideline versus the JNC7 guideline with left ventricular hypertrophy

Bharat Poudel, Anthony J. Viera, Daichi Shimbo, Joseph E. Schwartz, James M. Shikany, Swati Sakhuja, Donald M. Lloyd-Jones, Paul Muntner, Yuichiro Yano*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background:Compared with the Seventh Report of the Joint National Committee (JNC7), the 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower BP thresholds to define hypertension and BP control.Methods:We pooled data from five US-based studies to compare the association of masked hypertension (MHT) and masked uncontrolled hypertension, defined using the 2017 ACC/AHA guideline (n = 1653 without high office BP; <130/80 mmHg) versus the JNC7 guideline (n = 2451 without high office BP; <140/90 mmHg), with left ventricular hypertrophy (LVH). MHT and masked uncontrolled hypertension were defined using office BP and awake BP alone and awake, asleep, or 24-h BP. LVH was assessed by echocardiography.Results:Among participants without high office BP not taking antihypertensive medication, the prevalence of MHT defined by the JNC7 guideline and the 2017 ACC/AHA BP guideline was 25.0 and 33.5% using awake BP only and 37.1 and 52.0% when using awake, asleep, or 24-h BP. The adjusted prevalence ratios for LVH associated with MHT versus sustained normotension defined by the JNC7 and 2017 ACC/AHA BP guidelines were 1.72 [95% confidence interval (CI): 1.12-2.64] and 1.56 (95% CI: 0.97-2.51), respectively, when using awake BP only and 2.16 (95% CI: 1.36-3.44) and 1.03 (95% CI: 0.58-1.82), respectively, when using awake, asleep or 24-h BP. There was no evidence that masked uncontrolled hypertension was associated with LVH when defined using the BP thresholds in either the JNC7 or the 2017 ACC/AHA BP guideline.Conclusion:The association of MHT with LVH may depend on the BP thresholds used.

Original languageEnglish (US)
Pages (from-to)1597-1606
Number of pages10
JournalJournal of hypertension
Volume40
Issue number8
DOIs
StatePublished - Aug 1 2022

Keywords

  • ambulatory blood pressure
  • guideline
  • left ventricular hypertrophy
  • masked hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology
  • Internal Medicine

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