Improving the Detection of Masked Hypertension: Analysis of Pooled Population- and Community-Based Studies

改善隐匿性高血压的检测：基于人群和社区的汇总研究分析

• 批准号: 10295572
• 负责人: Paul Muntner
• 金额: $ 43.55万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-28 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10295572
• 关键词: Address; Adult; Affect; African American; Age; Age-Years; Albuminuria; Algorithms; Ambulatory Blood Pressure Monitoring; American; American Heart Association; Antihypertensive Agents; Asia; Blood Pressure; Cardiology; Cardiovascular Diseases; Cardiovascular system; Clinic; Coin; Communities; Confidence Intervals; Coronary Artery Risk Development in Young Adults Study; Data; Data Analyses; Detection; Diastolic blood pressure; Discrimination; Echocardiography; Equation; Ethnic group; Europe; Event; Female; Funding; Goals; Guidelines; High Prevalence; Hispanics; Hour; Hypertension; Individual; Jackson Heart Study; Lead; Left Ventricular Hypertrophy; Measurement; Measures; National Heart, Lung, and Blood Institute; North Carolina; Not Hispanic or Latino; Participant; Pattern; Persons; Pharmaceutical Preparations; Population; Prevalence; Race; Recommendation; Reference Standards; Reporting; Research; Sample Size; Sensitivity and Specificity; Sleep; Testing; Time; Update; Wakefulness; awake; base; blood pressure reduction; cardiovascular disorder risk; college; ethnic difference; improved; masked hypertension; predictive modeling; screening; screening guidelines; standard measure

PROJECT SUMMARY/ABSTRACT Blood pressure (BP) based on measurements obtained in the clinic often does not accurately reflect a person’s BP outside of the clinic setting. Masked hypertension refers to BP levels not in the hypertensive range when measured in the clinic but in the hypertensive range when measured outside of the clinic. Previous studies, primarily from Europe and Asia, have reported masked hypertension to be common and associated with a two- times greater risk of cardiovascular disease (CVD) compared with non-hypertensive BP both in and outside of the clinic. The 2017 American College of Cardiology (ACC) / American Heart Association (AHA) BP guideline recommends screening for masked hypertension to guide the initiation and intensification of antihypertensive medication. Ambulatory blood pressure monitoring (ABPM), the reference standard for measuring BP outside of the clinic setting, measures BP over a 24-hour period including while a person is awake and asleep. However, the 2017 ACC/AHA BP guideline recommends only to use awake BP and not asleep or 24-hour BP to define masked hypertension, and BP thresholds for defining masked hypertension are lower in this guideline compared to prior definitions. We propose to: (1) determine the impact of using awake, asleep, and 24-hour BP versus awake BP alone on the prevalence of masked hypertension and associations with sub-clinical CVD and albuminuria; (2) determine the impact of the 2017 ACC/AHA BP guideline definition on the prevalence of masked hypertension and associations with sub-clinical CVD and albuminuria; and (3) develop a prediction model to identify who should be screened for masked hypertension. We will address these aims among participants taking and not taking antihypertensive medication, separately, and for non-Hispanic whites, non- Hispanic blacks and Hispanics. To address these aims, we will pool previously collected data from 5 NHLBI- funded population- and community-based studies: the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study, the Masked Hypertension Study, the Improving the Detection of Hypertension Study, and the North Carolina Masked Hypertension Study. These studies include non-Hispanic whites (n=1,202), non-Hispanic African Americans (n=1,612), Hispanics (n=359), and other race/ethnicity groups (n=126) who had their BP measured in the clinic and by ABPM; completed an echocardiogram and an albuminuria assessment; and have extensive covariate data for analysis. Of the 3,299 participants (>2,800 with clinic SBP<140 mm Hg and <90 mm Hg) we plan to include in our analyses, the mean age was 48 [95% confidence interval: 43 to 53 years of age] years, 62% were female, and 74% were not taking antihypertensive medication. This research could lead to updated guideline recommendations to define masked hypertension and an algorithm to identify who should undergo ABPM to screen for masked hypertension. Findings could also improve assessment of BP-related CVD risk and identify adults who would benefit from treatment.

项目摘要/摘要 基于诊所获得的测量值的血压（BP）通常不能准确反映一个人的 BP在诊所环境外。蒙面的高血压是指BP水平不在高血压范围内 在诊所中测量，但在诊所外进行高血压范围。先前的研究， 来自欧洲和亚洲的初学报告已报告了蒙面高血压是常见的，并且与两个 与非高血压BP相比，心血管疾病（CVD）的风险更大 诊所。 2017年美国心脏病学院（ACC） /美国心脏协会（AHA）BP指南 建议筛查蒙版的高血压，以指导抗高血压的主动性和强化 药物。门诊血压监测（ABPM），用于测量BP外部的参考标准 在诊所环境中，在24小时内测量BP，包括一个人醒着和睡着。 但是，2017年ACC/AHA BP指南建议仅使用清醒的BP而不是睡着或24小时BP 在本指南中，定义掩盖的高血压和定义掩盖高血压的BP阈值较低 与先前的定义相比。我们建议：（1）确定使用清醒，入睡和24小时BP的影响 仅与醒着的BP相对于掩盖高血压的患病率以及与亚临床CVD的患病率和关联 蛋白尿； （2）确定2017 ACC/AHA BP指南定义对患病率的影响 掩盖高血压以及与亚临床CVD和蛋白尿的关联； （3）制定预测 确定应该筛选谁的蒙面高血压的模型。我们将解决这些目标 参与者服用降压药，分别服用降压药 西班牙裔黑人和西班牙裔。为了解决这些目标，我们将汇总以前收集的5个NHLBI-的数据 资助的人群和社区研究：杰克逊心脏研究，冠状动脉风险 年轻人研究的发展，蒙面高血压研究，改善了检测 高血压研究和北卡罗来纳州掩盖的高血压研究。这些研究包括非西班牙裔 白人（n = 1,202），非西班牙裔美国人（n = 1,612），西班牙裔（n = 359）和其他种族/种族 在诊所和ABPM中测量其BP的组（n = 126）；完成了超声心动图和一个 蛋白尿评估；并具有广泛的协变量数据进行分析。在3299名参与者中（> 2,800 我们计划在分析中包括诊所SBP <140 mm Hg和<90 mm Hg），平均年龄为48 [95％ 置信区间：43至53岁]年，女性为62％，有74％的人没有服用降压 药物。这项研究可能会导致最新的指南建议，以定义蒙面高血压 以及一种算法，以识别谁应该经历ABPM以筛选掩盖高血压。发现也可以 改善对BP相关的CVD风险的评估，并确定将从治疗中受益的成年人。