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Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals.

Publication ,  Journal Article
Yano, Y; Tanner, RM; Sakhuja, S; Jaeger, BC; Booth, JN; Abdalla, M; Pugliese, D; Seals, SR; Ogedegbe, G; Jones, DW; Muntner, P; Shimbo, D
Published in: JAMA Cardiol
September 1, 2019

IMPORTANCE: Little is known regarding health outcomes associated with higher blood pressure (BP) levels measured outside the clinic among African American individuals. OBJECTIVE: To examine whether daytime and nighttime BP levels measured outside the clinic among African American individuals are associated with cardiovascular disease (CVD) and all-cause mortality independent of BP levels measured inside the clinic. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from 1034 African American participants in the Jackson Heart Study who completed ambulatory BP monitoring at baseline (September 26, 2000, to March 31, 2004). Mean daytime and nighttime BPs were calculated based on measurements taken while participants were awake and asleep, respectively. Data were analyzed from July 1, 2017, to April 30, 2019. MAIN OUTCOMES AND MEASURES: Cardiovascular disease events, including coronary heart disease and stroke, experienced through December 31, 2014, and all-cause mortality experienced through December 31, 2016, were adjudicated. The associations of daytime BP and nighttime BP, separately, with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. RESULTS: A total of 1034 participants (mean [SD] age, 58.9 [10.9] years; 337 [32.6%] male; and 583 [56.4%] taking antihypertensive medication) were included in the study. The mean daytime systolic BP (SBP)/diastolic BP (DBP) was 129.4/77.6 mm Hg, and the mean nighttime SBP/DBP was 121.3/68.4 mm Hg. During follow-up (median [interquartile range], 12.5 [11.1-13.6] years for CVD and 14.8 [13.7-15.6] years for all-cause mortality), 113 CVD events and 194 deaths occurred. After multivariable adjustment, including in-clinic SBP and DBP, the hazard ratios (HRs) for CVD events for each SD higher level were 1.53 (95% CI, 1.24-1.88) for daytime SBP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime SBP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime DBP (per 9.3 mm Hg), and 1.30 (95% CI, 1.06-1.59) for nighttime DBP (per 9.5 mm Hg). Nighttime SBP was associated with all-cause mortality (HR per 1-SD higher level, 1.24; 95% CI, 1.06-1.45), but no association was present for daytime SBP (HR, 1.13; 95% CI, 0.97-1.33) and daytime (HR, 0.95; 95% CI, 0.81-1.10) and nighttime (HR, 1.06; 95% CI, 0.90-1.24) DBP. CONCLUSIONS AND RELEVANCE: Among African American individuals, higher daytime and nighttime SBPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic. Measurement of daytime and nighttime BP using ambulatory monitoring during a 24-hour period may help identify African American individuals who have an increased cardiovascular disease risk.

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Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

September 1, 2019

Volume

4

Issue

9

Start / End Page

910 / 917

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Outpatients
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Yano, Y., Tanner, R. M., Sakhuja, S., Jaeger, B. C., Booth, J. N., Abdalla, M., … Shimbo, D. (2019). Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals. JAMA Cardiol, 4(9), 910–917. https://doi.org/10.1001/jamacardio.2019.2845
Yano, Yuichiro, Rikki M. Tanner, Swati Sakhuja, Byron C. Jaeger, John N. Booth, Marwah Abdalla, Daniel Pugliese, et al. “Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals.JAMA Cardiol 4, no. 9 (September 1, 2019): 910–17. https://doi.org/10.1001/jamacardio.2019.2845.
Yano Y, Tanner RM, Sakhuja S, Jaeger BC, Booth JN, Abdalla M, et al. Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals. JAMA Cardiol. 2019 Sep 1;4(9):910–7.
Yano, Yuichiro, et al. “Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals.JAMA Cardiol, vol. 4, no. 9, Sept. 2019, pp. 910–17. Pubmed, doi:10.1001/jamacardio.2019.2845.
Yano Y, Tanner RM, Sakhuja S, Jaeger BC, Booth JN, Abdalla M, Pugliese D, Seals SR, Ogedegbe G, Jones DW, Muntner P, Shimbo D. Association of Daytime and Nighttime Blood Pressure With Cardiovascular Disease Events Among African American Individuals. JAMA Cardiol. 2019 Sep 1;4(9):910–917.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

September 1, 2019

Volume

4

Issue

9

Start / End Page

910 / 917

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Outpatients
  • Middle Aged
  • Male
  • Incidence
  • Humans