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 language | English (US) |
|---|---|
| Pages (from-to) | 1597-1606 |
| Number of pages | 10 |
| Journal | Journal of hypertension |
| Volume | 40 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2022 |
Funding
The current study is supported by R01 HL144773-01 (PI: Yuichiro Yano and Paul Muntner) from the National Heart, Lung, and Blood Institute (NHLBI). CARDIA is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (HHSN268201800005I & HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). This article has been reviewed by CARDIA for scientific content. J.H.S. is supported and conducted in collaboration with Jackson State University (N01-HC-95170); University of Mississippi Medical Center (N01-HC-95171); and Tougaloo College (N01-HC-95172) and contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C from the NHLBI and the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH). This work was also supported by the NIH (R01 HL117323, K24 HL125704) from the NHLBI, Bethesda, MD. MHT and IDH were both supported by NHLBI grant P01-HL047540 (PI: Joseph Schwartz). NCMT was funded by grant R01 HL098604 (PI: Anthony Viera) from the NHLBI with additional support provided by ULI RR025747 from the National Institutes of Health. P.M. and D.S. received support through grant 15SFRN2390002 from the American Heart Association. D.S. received support through grant K24-HL125704 from NHLBI. This article has been reviewed by CARDIA and JHS for scientific content.
Keywords
- ambulatory blood pressure
- guideline
- left ventricular hypertrophy
- masked hypertension
ASJC Scopus subject areas
- Internal Medicine
- Physiology
- Cardiology and Cardiovascular Medicine