title: Associations of Blood Pressure Dipping Patterns With Left Ventricular Mass and Left Ventricular Hypertrophy in Blacks: The Jackson Heart Study.
abstract: BACKGROUND
  Abnormal diurnal blood pressure (BP), including nondipping patterns, assessed using ambulatory BP monitoring, have been associated with increased cardiovascular risk among white and Asian adults. We examined the associations of BP dipping patterns (dipping, nondipping, and reverse dipping) with cardiovascular target organ damage (left ventricular mass index and left ventricular hypertrophy), among participants from the Jackson Heart Study, an exclusively black population-based cohort.
  
  
  RESULTS
  Analyses included 1015 participants who completed ambulatory BP monitoring and had echocardiography data from the baseline visit. Participants were categorized based on the nighttime to daytime systolic BP ratio into 3 patterns: dipping pattern (≤0.90), nondipping pattern (>0.90 to ≤1.00), and reverse dipping pattern (>1.00). The prevalence of dipping, nondipping, and reverse dipping patterns was 33.6%, 48.2%, and 18.2%, respectively. In a fully adjusted model, which included antihypertensive medication use and clinic and daytime systolic BP, the mean differences in left ventricular mass index between reverse dipping pattern versus dipping pattern was 8.3±2.1 g/m2(P<0.001) and between nondipping pattern versus dipping pattern was -1.0±1.6 g/m2(P=0.536). Compared with participants with a dipping pattern, the prevalence ratio for having left ventricular hypertrophy was 1.65 (95% CI, 1.05-2.58) and 0.96 (95% CI, 0.63-1.97) for those with a reverse dipping pattern and nondipping pattern, respectively.
  
  
  CONCLUSIONS
  In this population-based study of blacks, a reverse dipping pattern was associated with increased left ventricular mass index and a higher prevalence of left ventricular hypertrophy. Identification of a reverse dipping pattern on ambulatory BP monitoring may help identify black at increased risk for cardiovascular target organ damage.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY ma2947@cumc.columbia.edu.
authors.forename: Marwah
authors.initials: M
authors.lastname: Abdalla
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, NC.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Caughey
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, AL.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, AL.
authors.forename: John N
authors.initials: JN
authors.lastname: Booth
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Diaz
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: D Edmund
authors.initials: DE
authors.lastname: Anstey
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Mario
authors.initials: M
authors.lastname: Sims
authors.affiliation: Department of Population Health, Center for Healthful Behavior Change, New York University Medical Center, New York, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ravenell
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, AL.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Hypertension Research Program and Department of Family Medicine, University of North Carolina at Chapel Hill, NC.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
mesh_terms: D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D015995:Prevalence
chemical_list: D000959:Antihypertensive Agents
keywords: ambulatory blood pressure monitoring; black; dipping; diurnal variation; left ventricular hypertrophy; left ventricular mass