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The Reproducibility of Racial Differences in Ambulatory Blood Pressure Phenotypes and Measurements.

ABSTRACT: BACKGROUND:We examined the reproducibility of differences in ambulatory blood pressure (BP) monitoring (ABPM) phenotypes and other parameters (sustained hypertension, masked hypertension, nocturnal hypertension, and nondipping) between African Americans and Whites. METHODS:A total of 420 participants untreated for hypertension attended 2 research visits 1 week apart during which traditional office BP averages and ABPM session averages were determined. We computed percent agreement in ABPM phenotypes across the 2 visits stratified by race and associated kappa statistics with 95% confidence intervals. RESULTS:Whites on average were older, more likely to be male, and had a higher body mass index. There was no significant difference in sleep quality as defined by sleep diary between the 2 races. There were also no significant differences between races in the proportions of participants with sustained hypertension, sustained normotension, or masked hypertension at either testing session. The prevalence of nocturnal hypertension was 59% vs. 75% (P = 0.012) at session 1 and 59% vs. 73% (P = 0.024) at session 2 for Whites and African Americans, respectively, with moderate reproducibility for both (kappas 0.45 and 0.44). Nocturnal BP nondipping had a prevalence 29% vs. 53% (P < 0.001) at session 1 and 29% vs. 47% (P = 0.004) at session 2 for Whites and African Americans, respectively, with fair reproducibility (kappas 0.28 and 0.29). CONCLUSIONS:Our findings support that African Americans indeed exhibit a greater preponderance of abnormal nocturnal BP patterns than Whites. Our work is some of the first to demonstrate that these abnormal patterns are modestly reproducible.

SUBMITTER: Husain A

PROVIDER: S-EPMC5861555 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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The Reproducibility of Racial Differences in Ambulatory Blood Pressure Phenotypes and Measurements.

Husain Aamir A Lin Feng-Chang FC Tuttle Laura A LA Olsson Emily E Viera Anthony J AJ

American journal of hypertension 20171001 10

<h4>Background</h4>We examined the reproducibility of differences in ambulatory blood pressure (BP) monitoring (ABPM) phenotypes and other parameters (sustained hypertension, masked hypertension, nocturnal hypertension, and nondipping) between African Americans and Whites.<h4>Methods</h4>A total of 420 participants untreated for hypertension attended 2 research visits 1 week apart during which traditional office BP averages and ABPM session averages were determined. We computed percent agreement ...[more]

PMID: 28531258

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Project description:BACKGROUND:and objectives Our objective was to determine whether clinic BPs (taken at either a single visit or two sequential visits) are inferior to ambulatory BPs in their ability to discriminate risk of adverse outcomes in children with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We included 513 participants of the CKD in Children Study who had clinic BPs and 24-hour ambulatory BP monitoring performed during similar timeframes. Predictors of interest were systolic BPs taken at a single visit or two repeated visits within a 1-year period compared with mean wake and sleep systolic ambulatory BPs. Outcomes were left ventricular hypertrophy and ESKD. We determined the ability for each BP parameter to provide risk discrimination using c statistics. RESULTS:During mean follow-up of 3.5 years, 123 participants developed ESKD. In cross-sectional unadjusted analysis, every 0.1 increase in systolic BP index was associated with a 2.0 times higher odds of left ventricular hypertrophy (95% confidence interval, 1.5 to 2.8) by clinic BPs versus 1.8 times higher odds (95% confidence interval, 1.3 to 2.4) by ambulatory wake BP. The c statistic was highest for clinic BP (c=0.65; 95% confidence interval, 0.58 to 0.73) but similar to ambulatory wake BP (c=0.64; 95% confidence interval, 0.57 to 0.71) for the discrimination of left ventricular hypertrophy. In longitudinal unadjusted analysis, every 0.1 increase in systolic BP index was associated with a higher risk of ESKD using repeated clinic (hazard ratio, 1.5; 95% confidence interval, 1.3 to 1.8) versus ambulatory wake BP (hazard ratio, 1.6; 95% confidence interval, 1.3 to 2.0). Unadjusted c statistics were the same for wake (c=0.61; 95% confidence interval, 0.56 to 0.67) and clinic systolic BPs (c=0.61; 95% confidence interval, 0.55 to 0.66) for discriminating risk of ESKD. CONCLUSIONS:Clinic BPs taken in a protocol-driven setting are not consistently inferior to ambulatory BP in the discrimination of BP-related adverse outcomes in children with CKD.

Project description: INTRODUCTION: Published data on hypertension incidence and management in Anderson-Fabry disease are scant and the contribution of elevated blood pressure to organ damage is not well recognized.AimTherefore, we have assessed blood pressure values and their possible correlations with clinical findings in a well described cohort of Fabry patients.MethodsBetween January 2015 and May 2019, all adult Fabry patients (n = 24 females, n = 8 males) referred to our institute were prospectively enrolled. During the first examination patient's genotype and clinical characteristics were recorded. Blood pressure data were obtained by standard observed office measurements followed, within 6 months, by ambulatory blood pressure monitoring and home self-recordings. Organ involvement, including kidneys, heart and brain, was monitored over time. Consequently, patients were defined as clinically stable or progressive through the Fabry Stabilization Index.ResultsThe standard office measurements have diagnosed hypertension in three (9.37%) patients, but the ambulatory monitoring showed elevated blood pressure in six (18.75%) patients, revealing three cases of masked hypertension. All the hypertensive patients were females and, compared with normotensive subjects, they presented a lower glomerular filtration rate (p < 0.05) and a more advanced cardiac hypertrophy (p < 0.05). Four (66.7%) of them were diagnosed with a progressive form of the disease through the Fabry Stabilization Index while the majority of the normotensive group (84.6%, n = 19) was stable over time. No correlation was found between the prevalence of hypertension and the type of mutations causing Fabry disease.ConclusionHypertension can be found in a restricted portion of clinically stable Fabry patients. In contrast, patients presenting with a progressive organ involvement, particularly renal impairment, have a major risk of developing uncontrolled blood pressure, and should be followed carefully. Moreover, the ambulatory blood pressure monitoring proved to be useful to reveal masked hypertension, which can contribute to the progressive worsening of the organ damage. Therefore, a proper diagnosis and therapy of hypertension may improve the outcome of Fabry patients.

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The Reproducibility of Racial Differences in Ambulatory Blood Pressure Phenotypes and Measurements.

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The Reproducibility of Racial Differences in Ambulatory Blood Pressure Phenotypes and Measurements.

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