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 That's because measurements in doctors' offices and clinics may not
accurately reflect blood pressure levels that a person experiences
at home, work, and while asleep - and this may be a particularly
important issue for African-Americans, researchers say.
Higher daytime and nighttime blood pressure measured outside the
doctor's office is associated with an increased risk of coronary
artery disease, stroke, and death, they explain.
"Blood pressure varies in a complex and irregular way even at
steady-state condition," Dr. Yuichiro Yano from Duke University,
Durham, North Carolina told Reuters Health.
"Our study suggests that higher blood pressure measurements outside
versus inside the clinic had stronger association with
cardiovascular disease and all-cause mortality," said Yano, who
worked on the study. "This means that, even if your blood pressure
levels are not in the hypertensive range when measured in the clinic
but in the hypertensive range when measured outside of the clinic,
you may have a high risk for cardiovascular disease and all-cause
mortality."
African American individuals are more likely than individuals with
other racial/ethnic background to have hypertension and its
consequences, and they have been shown to have higher daytime and
nighttime blood pressure levels than white or Asian individuals.
Yano's team used information from the Jackson Heart Study to
investigate the associations of daytime and nighttime blood pressure
levels with cardiovascular disease events (heart attack, coronary
heart disease, and stroke) and death from any cause and whether such
associations are independent of blood pressure measured in the
clinic. The study included 1,034 African American adults taking
antihypertensive medication.
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Over the course of more than a decade, each 13.5-point increase in
daytime systolic blood pressure (the "top" number) compared to the
measurement in the clinic was associated with 53% higher risk of
cardiovascular disease events and 13% higher risk of death from any
cause, the researchers reported in JAMA Cardiology.
Similarly, every 15.5-point increase in nighttime blood pressure
compared to pressure in the clinic was associated with a 48% higher
risk of cardiovascular disease events and a 24% higher risk of death
from any cause.
Increased daytime and nighttime diastolic blood pressure (the
"bottom" number) were also associated with increased risks of
cardiovascular disease events and death from any cause.
The increased risk of cardiovascular disease events was higher for
people who were not taking their blood pressure medication than for
those who were taking their blood pressure medication.
After the researchers took other risk factors into account, high
daytime and nighttime blood pressure were still associated with an
increased risk of cardiovascular disease events but not with a
significantly increased risk of death from any cause.
"Measurement of daytime and nighttime blood pressure using
ambulatory monitoring during a 24-hour period may help identify
African American individuals who have an increased cardiovascular
disease risk," the researchers conclude.
SOURCE: http://bit.ly/2Z7OHwv JAMA Cardiology, online August 14,
2019.
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