title: Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study.
abstract: Masked hypertension, defined as nonelevated clinic blood pressure (BP) and elevated out-of-clinic BP may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic BP and masked hypertension using ambulatory BP monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of blacks. Analyses included 317 participants with clinic BP <140/90 mm Hg, complete ambulatory BP monitoring, who were not taking antihypertensive medication at baseline in 2000 to 2004. Masked daytime hypertension was defined as mean daytime blood pressure ≥135/85 mm Hg, masked night-time hypertension as mean night-time BP ≥120/70 mm Hg, and masked 24-hour hypertension as mean 24-hour BP ≥130/80 mm Hg. Incident clinic hypertension, assessed at study visits in 2005 to 2008 and 2009 to 2012, was defined as the first visit with clinic systolic/diastolic BP ≥140/90 mm Hg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked night-time hypertension, and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% confidence interval) of incident clinic hypertension for any masked hypertension and masked daytime, night-time, and 24-hour hypertension were 2.13 (1.51-3.02), 1.79 (1.24-2.60), 2.22 (1.58-3.12), and 1.91 (1.32-2.75), respectively. These findings suggest that ambulatory BP monitoring can identify blacks at increased risk for developing clinic hypertension.
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.). ma2947@cumc.columbia.edu.
authors.forename: Marwah
authors.initials: M
authors.lastname: Abdalla
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: John N
authors.initials: JN
authors.lastname: Booth
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Samantha R
authors.initials: SR
authors.lastname: Seals
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Spruill
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Keith M
authors.initials: KM
authors.lastname: Diaz
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Mario
authors.initials: M
authors.lastname: Sims
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (M.A., K.M.D., D.S.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center of Biostatistics and Bioinformatics, Department of Preventive Medicine (S.R.S.) and Department of Medicine (M.S.), University of Mississippi Medical Center, Jackson; Department of Population Health, NYU School of Medicine, NY (T.M.S.); and Hypertension Research Program, Department of Family Medicine, University of North Carolina at Chapel Hill (A.J.V.).
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002940:Circadian Rhythm; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000208:ethnology; D015994:Incidence; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis* / Q000208:ethnology*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
keywords: blacks; blood pressure; hypertension; masked hypertension