Ravenell Joseph, Shimbo Daichi, Booth John N, Sarpong Daniel F, Agyemang Charles, Beatty Moody Danielle L, Abdalla Marwah, Spruill Tanya M, Shallcross Amanda J, Bress Adam P, Muntner Paul, Ogedegbe Gbenga
From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.).
Circulation. 2017 Jun 20;135(25):2470-2480. doi: 10.1161/CIRCULATIONAHA.116.027051. Epub 2017 Apr 20.
Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults.
We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression- and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use.
Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication.
On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.
动态血压监测是门诊外血压测量的参考标准。识别动态高血压的阈值（日间收缩压[SBP]/舒张压[DBP]≥135/85 mmHg、24小时SBP/DBP≥130/80 mmHg以及夜间SBP/DBP≥120/70 mmHg）源自欧洲、亚洲和南美洲人群。我们在美国以非裔美国成年人为主的样本中确定了动态高血压的血压阈值。
我们分析了杰克逊心脏研究的数据，这是一项仅包含非裔美国成年人的基于人群的队列研究（n = 5306）。分析仅限于2000年至2004年在基线时完成动态血压监测的1016名参与者。分别计算日间（上午10:00至晚上8:00）、24小时（所有可用读数）和夜间（午夜至上午6:00）时段的平均SBP和DBP水平。使用回归法和基于结局的方法确定动态高血压的日间、24小时和夜间血压阈值。基于结局的方法中使用了心血管疾病或全因死亡事件的复合指标。对于后一种方法，仅针对SBP确定血压阈值，因为诊室DBP与结局无关。分析按降压药物使用情况进行分层。
在未服用降压药物的参与者中，对应诊室SBP/DBP为140/90 mmHg的日间、24小时和夜间SBP/DBP的回归法得出的阈值分别为134/85 mmHg、130/81 mmHg和123/73 mmHg。对应诊室SBP≥140 mmHg的日间、24小时和夜间SBP的基于结局的阈值分别为138 mmHg、134 mmHg和129 mmHg。在服用降压药物的参与者中，对应诊室SBP/DBP为140/90 mmHg的日间、24小时和夜间SBP/DBP的回归法得出的阈值分别为135/85 mmHg、133/82 mmHg和128/76 mmHg。在服用降压药物的参与者中，对应日间、24小时和夜间SBP的相应基于结局的阈值分别为140 mmHg、137 mmHg和133 mmHg。
基于SBP的基于结局的方法和DBP的回归法，对于非裔美国成年人，对应诊室SBP/DBP≥140/90 mmHg的日间、24小时和夜间高血压提出以下定义：日间SBP/DBP≥140/85 mmHg、24小时SBP/DBP≥135/80 mmHg以及夜间SBP/DBP≥130/75 mmHg。
