Black adults with higher daytime and nighttime systolic BP may have an increased risk for CVD events and all-cause mortality, regardless of BP measured in clinic.
According to a study published in JAMA Cardiology, in a cohort of 1,034 black adults whoparticipated in the Jackson Heart Study, (mean age, 58.9 years; 32.6% men; 56.4% taking antihypertensive medication at baseline; 27% with diabetes), mean daytime BP was 129.4/77.6 mm Hg and mean nighttime BP was 121.3/68.4 mm Hg at baseline.
During a mean follow-up of 12.5 years, researchers reported 113 CVD events and 194 deaths in this cohort. After multivariable adjustment that included in-clinic BP measurements, the researchers reported that the HR for CVD events for each SD higher level was 1.53 (95% CI, 1.24-1.88) for daytime systolic BP (per 13.5 mm Hg), 1.48 (95% CI, 1.22-1.80) for nighttime systolic BP (per 15.5 mm Hg), 1.25 (95% CI, 1.02-1.51) for daytime diastolic BP (per 9.3 mm Hg) and 1.3 (95% CI, 1.06-1.59) for nighttime diastolic BP (per 9.5 mm Hg), according to the study results.
When the researchers evaluated mortality, they found that nighttime systolic BP was associated with all-cause mortality (HR per 1-SD higher level = 1.24; 95% CI, 1.06-1.45). However, they reported no association with daytime systolic BP (HR = 1.13; 95% CI, 0.97-1.33), daytime diastolic BP (HR = 0.95; 95% CI, 0.81-1.1) or nighttime diastolic BP (HR = 1.06; 95% CI, 0.9-1.24).
“Among African American individuals, higher daytime and nighttime systolic BPs were associated with an increased risk for CVD events and all-cause mortality independent of BP levels measured in the clinic,” Yuichiro Yano, MD, PhD, FAHA, FASH, assistant professor in the department of family medicine and community health at Duke University, and colleagues wrote.
The researchers noted that these findings support the 2017 ACC/AHA BP guideline recommendation for use of ambulatory BP monitoring for management of BP.
“Measuring daytime and nighttime BP using [ambulatory BP measurements] during a 24-hour period may help identify African American individuals who have an increased CVD risk,” the authors wrote. “Randomized clinical trials are needed to assess whether lowering daytime and nighttime BP with nonpharmacologic treatments and/or antihypertensive medications reduces the risk of CVD events beyond reductions in clinic BP.” – by Scott Buzby
Disclosures: Yano reports he received grants from the NHLBI during the conduct of this study. Please see the study for all other authors’ relevant financial disclosures.