Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure

Byron C. Jaeger; John N. Booth; Mark Butler; Lloyd J. Edwards; Cora E. Lewis; Donald M. Lloyd-Jones; Swati Sakhuja; Joseph E. Schwartz; James M. Shikany; Daichi Shimbo; Yuichiro Yano; Paul Muntner

doi:10.1161/JAHA.119.013696

Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure

Byron C. Jaeger^*, John N. Booth, Mark Butler, Lloyd J. Edwards, Cora E. Lewis, Donald M. Lloyd-Jones, Swati Sakhuja, Joseph E. Schwartz, James M. Shikany, Daichi Shimbo, Yuichiro Yano, Paul Muntner

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Background: Nocturnal hypertension, defined by a mean asleep systolic blood pressure (SBP)/diastolic blood pressure (BP) ≥120/70 mm Hg, and nondipping SBP, defined by an awake-to-asleep decline in SBP <10%, are each associated with increased risk for cardiovascular disease. Methods and Results: We developed predictive equations to identify adults with a high probability of having nocturnal hypertension or nondipping SBP using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study (n=787), JHS (Jackson Heart Study) (n=1063), IDH (Improving the Detection of Hypertension) study (n=395), and MHT (Masked Hypertension) study (n=772) who underwent 24-hour ambulatory BP monitoring. Participants were randomized to derivation (n=2511) or validation (n=506) data sets. The prevalence rates of nocturnal hypertension and nondipping SBP were 39.7% and 44.9% in the derivation data set, respectively, and 36.6% and 44.5% in the validation data set, respectively. The predictive equation for nocturnal hypertension included age, race/ethnicity, smoking status, neck circumference, height, high-density lipoprotein cholesterol, albumin/creatinine ratio, and clinic SBP and diastolic BP. The predictive equation for nondipping SBP included age, sex, race/ethnicity, waist circumference, height, alcohol use, high-density lipoprotein cholesterol, and albumin/creatinine ratio. Concordance statistics (95% CI) for nocturnal hypertension and nondipping SBP predictive equations in the validation data set were 0.84 (0.80–0.87) and 0.73 (0.69–0.78), respectively. Compared with reference models including antihypertensive medication use and clinic SBP and diastolic BP as predictors, the continuous net reclassification improvement (95% CI) values for the nocturnal hypertension and nondipping SBP predictive equations were 0.52 (0.35–0.69) and 0.51 (0.34–0.69), respectively. Conclusions: These predictive equations can direct ambulatory BP monitoring toward adults with high probability of having nocturnal hypertension and nondipping SBP.

Original language	English (US)
Article number	e013696
Journal	Journal of the American Heart Association
Volume	9
Issue number	2
DOIs	https://doi.org/10.1161/JAHA.119.013696
State	Published - Jan 21 2020

Funding

The JHS (Jackson Heart Study) is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSNs268201300048C, HHSN268201300049C, and HHSN268201300050C from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute on Minority Health and Health Disparities. The CARDIA (Coronary Artery Risk Development in Young Adults) study is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (HHSN268201800005I and HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). The funding to conduct ambulatory blood pressure monitoring in the CARDIA study was provided by grant 15SFRN2390002 from the American Heart Association. This article has been reviewed by the CARDIA study for scientific content. The IDH (Improving the Detection of Hypertension) and the MHT (Masked Hypertension) studies were supported by a program project grant from the NHLBI (PO1‐HL047540). Drs Jaeger, Booth, Schwartz, Shimbo, Shikany, and Muntner receive support through 15SFRN2390002 from the American Heart Association. Dr Shimbo receives support from R01HL137818 and K24‐HL125704 from the NHLBI at the National Institutes of Health (NIH). Drs Edwards, Shimbo, and Muntner receive support from R01HL117323 from the NHLBI at the NIH. Drs Jaeger, Yano, and Muntner receive support from R01HL144773 from the NHLBI at the NIH. The authors would like to thank the participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study, JHS (Jackson Heart Study), IDH (Improving the Detection of Hypertension) study, and MHT (Masked Hypertension) study who volunteered to undergo 24-hour ambulatory blood pressure monitoring. Dr Muntner receives research grant support from Amgen Inc, unrelated to the current article. Dr Booth is currently employed by CTI Clinical Trials and Consulting Services, which followed the completion of this article. As a group, we have no other conflicts of interest to report.

Keywords

ambulatory
blood pressure
nocturnal hypertension
nondipping
predictive equation
validation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/JAHA.119.013696

Cite this

Jaeger, B. C., Booth, J. N., Butler, M., Edwards, L. J., Lewis, C. E., Lloyd-Jones, D. M., Sakhuja, S., Schwartz, J. E., Shikany, J. M., Shimbo, D., Yano, Y., & Muntner, P. (2020). Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure. Journal of the American Heart Association, 9(2), Article e013696. https://doi.org/10.1161/JAHA.119.013696

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title = "Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure",

abstract = "Background: Nocturnal hypertension, defined by a mean asleep systolic blood pressure (SBP)/diastolic blood pressure (BP) ≥120/70 mm Hg, and nondipping SBP, defined by an awake-to-asleep decline in SBP <10%, are each associated with increased risk for cardiovascular disease. Methods and Results: We developed predictive equations to identify adults with a high probability of having nocturnal hypertension or nondipping SBP using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study (n=787), JHS (Jackson Heart Study) (n=1063), IDH (Improving the Detection of Hypertension) study (n=395), and MHT (Masked Hypertension) study (n=772) who underwent 24-hour ambulatory BP monitoring. Participants were randomized to derivation (n=2511) or validation (n=506) data sets. The prevalence rates of nocturnal hypertension and nondipping SBP were 39.7% and 44.9% in the derivation data set, respectively, and 36.6% and 44.5% in the validation data set, respectively. The predictive equation for nocturnal hypertension included age, race/ethnicity, smoking status, neck circumference, height, high-density lipoprotein cholesterol, albumin/creatinine ratio, and clinic SBP and diastolic BP. The predictive equation for nondipping SBP included age, sex, race/ethnicity, waist circumference, height, alcohol use, high-density lipoprotein cholesterol, and albumin/creatinine ratio. Concordance statistics (95% CI) for nocturnal hypertension and nondipping SBP predictive equations in the validation data set were 0.84 (0.80–0.87) and 0.73 (0.69–0.78), respectively. Compared with reference models including antihypertensive medication use and clinic SBP and diastolic BP as predictors, the continuous net reclassification improvement (95% CI) values for the nocturnal hypertension and nondipping SBP predictive equations were 0.52 (0.35–0.69) and 0.51 (0.34–0.69), respectively. Conclusions: These predictive equations can direct ambulatory BP monitoring toward adults with high probability of having nocturnal hypertension and nondipping SBP.",

keywords = "ambulatory, blood pressure, nocturnal hypertension, nondipping, predictive equation, validation",

author = "Jaeger, {Byron C.} and Booth, {John N.} and Mark Butler and Edwards, {Lloyd J.} and Lewis, {Cora E.} and Lloyd-Jones, {Donald M.} and Swati Sakhuja and Schwartz, {Joseph E.} and Shikany, {James M.} and Daichi Shimbo and Yuichiro Yano and Paul Muntner",

note = "Publisher Copyright: {\textcopyright} 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",

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doi = "10.1161/JAHA.119.013696",

language = "English (US)",

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T1 - Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure

AU - Jaeger, Byron C.

AU - Booth, John N.

AU - Butler, Mark

AU - Edwards, Lloyd J.

AU - Lewis, Cora E.

AU - Lloyd-Jones, Donald M.

AU - Sakhuja, Swati

AU - Schwartz, Joseph E.

AU - Shikany, James M.

AU - Shimbo, Daichi

AU - Yano, Yuichiro

AU - Muntner, Paul

PY - 2020/1/21

Y1 - 2020/1/21

N2 - Background: Nocturnal hypertension, defined by a mean asleep systolic blood pressure (SBP)/diastolic blood pressure (BP) ≥120/70 mm Hg, and nondipping SBP, defined by an awake-to-asleep decline in SBP <10%, are each associated with increased risk for cardiovascular disease. Methods and Results: We developed predictive equations to identify adults with a high probability of having nocturnal hypertension or nondipping SBP using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study (n=787), JHS (Jackson Heart Study) (n=1063), IDH (Improving the Detection of Hypertension) study (n=395), and MHT (Masked Hypertension) study (n=772) who underwent 24-hour ambulatory BP monitoring. Participants were randomized to derivation (n=2511) or validation (n=506) data sets. The prevalence rates of nocturnal hypertension and nondipping SBP were 39.7% and 44.9% in the derivation data set, respectively, and 36.6% and 44.5% in the validation data set, respectively. The predictive equation for nocturnal hypertension included age, race/ethnicity, smoking status, neck circumference, height, high-density lipoprotein cholesterol, albumin/creatinine ratio, and clinic SBP and diastolic BP. The predictive equation for nondipping SBP included age, sex, race/ethnicity, waist circumference, height, alcohol use, high-density lipoprotein cholesterol, and albumin/creatinine ratio. Concordance statistics (95% CI) for nocturnal hypertension and nondipping SBP predictive equations in the validation data set were 0.84 (0.80–0.87) and 0.73 (0.69–0.78), respectively. Compared with reference models including antihypertensive medication use and clinic SBP and diastolic BP as predictors, the continuous net reclassification improvement (95% CI) values for the nocturnal hypertension and nondipping SBP predictive equations were 0.52 (0.35–0.69) and 0.51 (0.34–0.69), respectively. Conclusions: These predictive equations can direct ambulatory BP monitoring toward adults with high probability of having nocturnal hypertension and nondipping SBP.

AB - Background: Nocturnal hypertension, defined by a mean asleep systolic blood pressure (SBP)/diastolic blood pressure (BP) ≥120/70 mm Hg, and nondipping SBP, defined by an awake-to-asleep decline in SBP <10%, are each associated with increased risk for cardiovascular disease. Methods and Results: We developed predictive equations to identify adults with a high probability of having nocturnal hypertension or nondipping SBP using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study (n=787), JHS (Jackson Heart Study) (n=1063), IDH (Improving the Detection of Hypertension) study (n=395), and MHT (Masked Hypertension) study (n=772) who underwent 24-hour ambulatory BP monitoring. Participants were randomized to derivation (n=2511) or validation (n=506) data sets. The prevalence rates of nocturnal hypertension and nondipping SBP were 39.7% and 44.9% in the derivation data set, respectively, and 36.6% and 44.5% in the validation data set, respectively. The predictive equation for nocturnal hypertension included age, race/ethnicity, smoking status, neck circumference, height, high-density lipoprotein cholesterol, albumin/creatinine ratio, and clinic SBP and diastolic BP. The predictive equation for nondipping SBP included age, sex, race/ethnicity, waist circumference, height, alcohol use, high-density lipoprotein cholesterol, and albumin/creatinine ratio. Concordance statistics (95% CI) for nocturnal hypertension and nondipping SBP predictive equations in the validation data set were 0.84 (0.80–0.87) and 0.73 (0.69–0.78), respectively. Compared with reference models including antihypertensive medication use and clinic SBP and diastolic BP as predictors, the continuous net reclassification improvement (95% CI) values for the nocturnal hypertension and nondipping SBP predictive equations were 0.52 (0.35–0.69) and 0.51 (0.34–0.69), respectively. Conclusions: These predictive equations can direct ambulatory BP monitoring toward adults with high probability of having nocturnal hypertension and nondipping SBP.

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KW - blood pressure

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KW - predictive equation

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Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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