Abstract P173: The Impact of Asleep Blood Pressure on the Prevalence of Masked Hypertension by Race/ethnicity: Analysis of Pooled Population- and Community-based Studies

Abstract

Introduction: Masked hypertension is defined as having hypertensive blood pressure (BP) outside of the office setting among adults with non-hypertensive BP when measured in the office. Some guidelines recommend defining out-of-office BP using awake measurements while other guidelines recommend using awake and asleep measurements. Hypothesis: We hypothesized that defining masked hypertension using the awake and asleep BP measurements would increase the prevalence of masked hypertension compared to using the awake period alone, and the magnitude of this difference would be greater among non-Hispanic blacks compared with non-Hispanic whites and Hispanics. Methods: We pooled previously collected data from 5 NHLBI-funded population- and community-based studies including the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study (total participants: 2,866). All participants had office systolic BP (SBP)<140mmHg and diastolic BP (DBP)<90mmHg and underwent ambulatory BP monitoring (ABPM) for 24 hours. Hypertensive awake BP was defined as SBP ≥135mmHg or DBP ≥85mmHg while awake, hypertensive asleep BP as SBP ≥120mmHg or DBP ≥70mmHg while asleep and hypertensive 24-hour BP as SBP ≥130mmHg or DBP ≥80mmHg over the entire ABPM period. Results: The prevalence of masked hypertension increased from 29% to 43% when defined using awake, asleep, or 24-hour BP versus using awake BP alone (Table). This increase was larger in non-Hispanic blacks (31-54%) compared with non-Hispanic whites (28-37%) and Hispanics (17-26%). The adjusted prevalence ratio (95% confidence interval) for having masked hypertension for non-Hispanic blacks compared with Non-Hispanic whites was higher from 1.20(1.05,1.37) to 1.33(1.20,1.47) when defined using awake, asleep and 24-hour BP versus awake BP only. Conclusions: Including asleep BP to define masked hypertension increased the prevalence of masked hypertension to a larger extent among non-Hispanic blacks compared to non-Hispanic whites and Hispanics.