title: Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans: The Jackson Heart Study.
abstract: BACKGROUND
  The disproportionate rates of cardiovascular disease in African Americans may, in part, be due to suboptimal assessment of blood pressure (BP) with clinic BP measurements alone. To date, however, the prevalence of masked hypertension in African Americans has not been fully delineated. The purpose of this study was to evaluate masked hypertension prevalence in a large population-based sample of African Americans and examine its determinants and association with indices of target organ damage (TOD).
  
  
  METHODS
  Clinic and 24-hour ambulatory BP monitoring were conducted in 972 African Americans enrolled in the Jackson Heart Study. Common carotid artery intima-media thickness, left ventricular mass index, and the urinary albumin:creatinine excretion ratio were evaluated as indices of TOD.
  
  
  RESULTS
  Masked hypertension prevalence was 25.9% in the overall sample and 34.4% in participants with normal clinic BP. All indices of TOD were significantly higher in masked hypertensives compared to sustained normotensives and were similar between masked hypertensives and sustained hypertensives. Male gender, smoking, diabetes, and antihypertensive medication use were independent determinants of masked hypertension in multivariate analyses.
  
  
  CONCLUSIONS
  In this population-based cohort of African Americans, approximately one-third of participants with presumably normal clinic BP had masked hypertension when BP was assessed in their daily environment. Masked hypertension was accompanied by a greater degree of TOD in this cohort.
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, USA; kd2442@columbia.edu.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Diaz
authors.affiliation: Department of Exercise Science, Shippensburg University, Shippensburg, Pennsylvania, USA;
authors.forename: Praveen
authors.initials: P
authors.lastname: Veerabhadrappa
authors.affiliation: Vascular Health Laboratory, Department of Kinesiology & Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA;
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brown
authors.affiliation: Department of Psychology, East Carolina University, Greenville, North Carolina, USA;
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Whited
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dubbert
authors.affiliation: Jackson Heart Study, Jackson State University, Jackson, Mississippi, USA; Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
authors.forename: DeMarc A
authors.initials: DA
authors.lastname: Hickson
mesh_terms: D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000208:ethnology / Q000503:physiopathology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003920:Diabetes Mellitus / Q000208:ethnology; D018450:Disease Progression; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000208:ethnology / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology
chemical_list: D000959:Antihypertensive Agents
keywords: African Americans; ambulatory blood pressure monitoring; blood pressure; hypertension; masked hypertension; target organ damage.