Related Experiment Videos
Cardiovascular Risk Factors and Masked Hypertension: The Jackson Heart Study
Samantha G Bromfield1, Daichi Shimbo1, John N Booth1
1From the Department of Epidemiology, University of Alabama at Birmingham (S.G.B., J.N.B., A.P.C., P.M.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); and Department of Population Health, New York University School of Medicine, NY (G.O.).
Insights
Improving cardiovascular health is key to reducing masked hypertension, a condition linked to higher disease risk. Adopting ideal lifestyle factors significantly lowers the prevalence of this condition.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Masked hypertension, normal in-clinic blood pressure but elevated during ambulatory monitoring, increases cardiovascular disease risk.
- Identifying modifiable risk factors for masked hypertension is crucial for developing prevention strategies.
Purpose of the Study:
- To investigate the association between cardiovascular health, as measured by the American Heart Association's Life's Simple 7 metrics, and masked daytime hypertension.
- To assess the prevalence of masked daytime hypertension in an exclusively African American cohort.
Main Methods:
- The Jackson Heart Study assessed Life's Simple 7 factors (body mass index, physical activity, diet, smoking, blood pressure, cholesterol, glucose) categorized as poor, intermediate, or ideal.
- Ambulatory blood pressure monitoring was used to define masked daytime hypertension (clinic BP <140/90 mmHg and daytime ambulatory BP ≥135/85 mmHg) in 758 participants.
- Multivariable regression analyses were performed to determine prevalence ratios.
Main Results:
- 30.5% of participants with normal clinic blood pressure had masked daytime hypertension.
- Higher adherence to ideal Life's Simple 7 factors was associated with a lower prevalence of masked daytime hypertension (Prevalence Ratio for ≥4 vs ≤1 ideal factors: 0.51).
- Ideal levels of physical activity, diet, smoking, and clinic blood pressure were significantly associated with reduced masked daytime hypertension prevalence.
Conclusions:
- Achieving better overall cardiovascular health, indicated by ideal Life's Simple 7 metrics, is associated with a significantly lower prevalence of masked daytime hypertension.
- Public health initiatives promoting cardiovascular health may help reduce the burden of masked hypertension and associated cardiovascular risks.
Abstract:
Masked hypertension is associated with increased risk for cardiovascular disease. Identifying modifiable risk factors for masked hypertension could provide approaches to reduce its prevalence. Life's Simple 7 is a measure of cardiovascular health developed by the American Heart Association that includes body mass index, physical activity, diet, cigarette smoking, blood pressure (BP), cholesterol, and glucose. We examined the association between cardiovascular health and masked daytime hypertension in the Jackson Heart Study, an exclusively African American cohort. Life's Simple 7 factors were assessed during a study visit and categorized as poor, intermediate, or ideal. Ambulatory BP monitoring was performed after the study visit. Using BP measured between 10:00 am and 8:00 pm on ambulatory BP monitoring, masked daytime hypertension was defined as mean clinic systolic BP/diastolic BP <140/90 mm Hg and mean daytime systolic BP/diastolic BP ≥135/85 mm Hg. Among the 758 participants with systolic BP/diastolic BP <140/90 mm Hg, 30.5% had masked daytime hypertension. The multivariable-adjusted prevalence ratios for masked daytime hypertension comparing participants with 2, 3, and ≥4 versus ≤1 ideal Life's Simple 7 factors were 0.99 (95% confidence interval [CI], 0.74-1.33), 0.77 (95% CI, 0.57-1.03), and 0.51 (95% CI, 0.33-0.79), respectively. Masked daytime hypertension was less common among participants with ideal versus poor levels of physical activity (ratio, 0.74; 95% CI, 0.56-1.00), ideal or intermediate levels pooled together versus poor diet (prevalence ratio, 0.73; 95% CI, 0.58-0.91), ideal versus poor levels of cigarette smoking (prevalence ratio, 0.61; 95% CI, 0.46-0.82), and ideal versus intermediate levels of clinic BP (prevalence ratio, 0.28, 95% CI, 0.16-0.48). Better cardiovascular health is associated with a lower preva lence of masked hypertension.