Using predicted atherosclerotic cardiovascular disease risk for discrimination of awake or nocturnal hypertension

Swati Sakhuja; John N. Booth; David E. Anstey; Byron C. Jaeger; Cora E. Lewis; Donald M. Lloyd-Jones; Joseph E. Schwartz; Daichi Shimbo; James M. Shikany; Mario Sims; Paul Muntner

doi:10.1093/ajh/hpaa099

Using predicted atherosclerotic cardiovascular disease risk for discrimination of awake or nocturnal hypertension

Swati Sakhuja, John N. Booth, David E. Anstey, Byron C. Jaeger, Cora E. Lewis, Donald M. Lloyd-Jones, Joseph E. Schwartz, Daichi Shimbo, James M. Shikany, Mario Sims, Paul Muntner^*

^*Corresponding author for this work

Preventive Medicine

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

3 Scopus citations

Abstract

BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40–79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015–2016 (n = 716) and the baseline Jackson Heart Study exam in 2000–2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

Original language	English (US)
Pages (from-to)	1011-1020
Number of pages	10
Journal	American Journal of Hypertension
Volume	33
Issue number	11
DOIs	https://doi.org/10.1093/ajh/hpaa099
State	Published - Nov 1 2020

Funding

The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (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 Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I), and the UniversityofMississippiMedicalCenter(HHSN268201800010I, HHSN268201800011I, and HHSN268201800012I) contracts fromtheNationalHeart,Lung,andBloodInstitute(NHLBI)and the National Institute for Minority Health and Health Disparities (NIMHD). DS received support through K24-HL125704 and R01 HL137818 from NHLBI at the National Institutes of Health (NIH). PM and DS received support through R01HL117323 from the NHLBI and PM, DS, and JES received support through 15SFRN2390002 from the American Heart Association. Grant 15SFRN2390002 from the American Heart Association provided funding for the conduct of ambulatory blood pressure monitoring in the CARDIA study.

Keywords

Atherosclerotic cardiovascular disease risk
Awake hypertension
Blood pressure
Hypertension
Nocturnal hypertension
Pooled Cohort risk equations

ASJC Scopus subject areas

Internal Medicine

UN SDGs

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

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10.1093/ajh/hpaa099

Cite this

Sakhuja, S., Booth, J. N., Anstey, D. E., Jaeger, B. C., Lewis, C. E., Lloyd-Jones, D. M., Schwartz, J. E., Shimbo, D., Shikany, J. M., Sims, M., & Muntner, P. (2020). Using predicted atherosclerotic cardiovascular disease risk for discrimination of awake or nocturnal hypertension. American Journal of Hypertension, 33(11), 1011-1020. https://doi.org/10.1093/ajh/hpaa099

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title = "Using predicted atherosclerotic cardiovascular disease risk for discrimination of awake or nocturnal hypertension",

abstract = "BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40–79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015–2016 (n = 716) and the baseline Jackson Heart Study exam in 2000–2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.",

keywords = "Atherosclerotic cardiovascular disease risk, Awake hypertension, Blood pressure, Hypertension, Nocturnal hypertension, Pooled Cohort risk equations",

author = "Swati Sakhuja and Booth, {John N.} and Anstey, {David E.} and Jaeger, {Byron C.} and Lewis, {Cora E.} and Lloyd-Jones, {Donald M.} and Schwartz, {Joseph E.} and Daichi Shimbo and Shikany, {James M.} and Mario Sims and Paul Muntner",

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doi = "10.1093/ajh/hpaa099",

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T1 - Using predicted atherosclerotic cardiovascular disease risk for discrimination of awake or nocturnal hypertension

AU - Sakhuja, Swati

AU - Booth, John N.

AU - Anstey, David E.

AU - Jaeger, Byron C.

AU - Lewis, Cora E.

AU - Lloyd-Jones, Donald M.

AU - Schwartz, Joseph E.

AU - Shimbo, Daichi

AU - Shikany, James M.

AU - Sims, Mario

AU - Muntner, Paul

PY - 2020/11/1

Y1 - 2020/11/1

N2 - BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40–79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015–2016 (n = 716) and the baseline Jackson Heart Study exam in 2000–2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

AB - BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40–79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015–2016 (n = 716) and the baseline Jackson Heart Study exam in 2000–2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

KW - Atherosclerotic cardiovascular disease risk

KW - Awake hypertension

KW - Blood pressure

KW - Hypertension

KW - Nocturnal hypertension

KW - Pooled Cohort risk equations

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ER -

Using predicted atherosclerotic cardiovascular disease risk for discrimination of awake or nocturnal hypertension

Abstract

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