Comparison of the association of masked hypertension defined by the 2017 ACC/AHA BP guideline versus the JNC7 guideline with left ventricular hypertrophy. Issue 8 (5th August 2022)

• Record Type: Journal Article
• Authors: Poudel, Bharat; Viera, Anthony J.; Shimbo, Daichi; Schwartz, Joseph E.; Shikany, James M.; Sakhuja, Swati; Lloyd-Jones, Donald M.; Muntner, Paul; Yano, Yuichiro
• Is Part Of: Journal of hypertension. Volume 40:Issue 8(2022)
• Page Start: 1597
• Page End: 1606
• Publication Date: 2022-08-05
• Subjects: ambulatory blood pressure -- masked hypertension -- left ventricular hypertrophy -- guideline; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000003192
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: Compared with the Seventh Report of the Joint National Committee (JNC7), the 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower BP thresholds to define hypertension and BP control. Methods: We pooled data from five US-based studies to compare the association of masked hypertension (MHT) and masked uncontrolled hypertension, defined using the 2017 ACC/AHA guideline ( n = 1653 without high office BP; <130/80 mmHg) versus the JNC7 guideline ( n = 2451 without high office BP; <140/90 mmHg), with left ventricular hypertrophy (LVH). MHT and masked uncontrolled hypertension were defined using office BP and awake BP alone and awake, asleep, or 24-h BP. LVH was assessed by echocardiography. Results: Among participants without high office BP not taking antihypertensive medication, the prevalence of MHT defined by the JNC7 guideline and the 2017 ACC/AHA BP guideline was 25.0 and 33.5% using awake BP only and 37.1 and 52.0% when using awake, asleep, or 24-h BP. The adjusted prevalence ratios for LVH associated with MHT versus sustained normotension defined by the JNC7 and 2017 ACC/AHA BP guidelines were 1.72 [95% confidence interval (CI): 1.12–2.64] and 1.56 (95% CI: 0.97–2.51), respectively, when using awake BP only and 2.16 (95% CI: 1.36–3.44) and 1.03 (95% CI: 0.58–1.82), respectively, when using awake, asleep or 24-h BP. There was no evidence that masked uncontrolled hypertension was associated with LVH when defined using the BP thresholds in either the JNC7 or the 2017 ACC/AHA BP guideline. Conclusion: The association of MHT with LVH may depend on the BP thresholds used.