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Hypertension: HELP
Articles by Joseph E. Schwartz
Based on 51 articles published since 2010
(Why 51 articles?)
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Between 2010 and 2020, J. E. Schwartz wrote the following 51 articles about Hypertension.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. 2019

Muntner, Paul / Shimbo, Daichi / Carey, Robert M / Charleston, Jeanne B / Gaillard, Trudy / Misra, Sanjay / Myers, Martin G / Ogedegbe, Gbenga / Schwartz, Joseph E / Townsend, Raymond R / Urbina, Elaine M / Viera, Anthony J / White, William B / Wright, Jackson T. · ·Hypertension · Pubmed #30827125.

ABSTRACT: The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.

2 Review Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. 2019

Muntner, Paul / Einhorn, Paula T / Cushman, William C / Whelton, Paul K / Bello, Natalie A / Drawz, Paul E / Green, Beverly B / Jones, Daniel W / Juraschek, Stephen P / Margolis, Karen L / Miller, Edgar R / Navar, Ann Marie / Ostchega, Yechiam / Rakotz, Michael K / Rosner, Bernard / Schwartz, Joseph E / Shimbo, Daichi / Stergiou, George S / Townsend, Raymond R / Williamson, Jeff D / Wright, Jackson T / Appel, Lawrence J / Anonymous7841116. ·Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: pmuntner@uab.edu. · Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland. · Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, Tennessee. · Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. · Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York. · Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, Minnesota. · Kaiser Permanente Washington Health Research Institute, Seattle, Washington. · Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. · Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. · HealthPartners Institute, Minneapolis, Minnesota. · Department of Medicine, Johns Hopkins University, Baltimore, Maryland. · Duke Clinical Research Institute, Durham, North Carolina. · National Center for Health Statistics of the Centers for Disease Control and Prevention, Hyattsville, Maryland. · American Medical Association, Chicago, Illinois. · Department of Medicine, Brigham's and Women's Hospital, Harvard University, Boston, Massachusetts. · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York. · The Hypertension Center, Columbia University Medical Center, New York, New York. · Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece. · Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Medicine, Wake Forest University, Winston-Salem, North Carolina. · Department of Medicine, Case Western Reserve University, Cleveland, Ohio. ·J Am Coll Cardiol · Pubmed #30678763.

ABSTRACT: The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.

3 Review Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions. 2014

Peacock, J / Diaz, K M / Viera, A J / Schwartz, J E / Shimbo, D. ·Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA. · Department of Family Medicine and Hypertension Research Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. · 1] Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA [2] Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, USA. ·J Hum Hypertens · Pubmed #24573133.

ABSTRACT: 'Masked hypertension' is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15-30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared with sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustained hypertension (elevated clinic and ambulatory BP). The confluence of increased cardiovascular risk and a failure to be diagnosed by the conventional approach of clinic BP measurement makes masked hypertension a significant public health concern. However, many important questions remain. First, the definition of masked hypertension varies across studies. Further, the best approach in the clinical setting to exclude masked hypertension also remains unknown. It is unclear whether home BP monitoring is an adequate substitute for ambulatory BP monitoring in identifying masked hypertension. Few studies have examined the mechanistic pathways that may explain masked hypertension. Finally, scarce data are available on the best approach to treating individuals with masked hypertension. Herein, we review the current literature on masked hypertension including definition, prevalence, clinical implications, special patient populations, correlates, issues related to diagnosis, treatment and areas for future research.

4 Review Cost-effectiveness of secondary screening modalities for hypertension. 2013

Wang, Y Claire / Koval, Alisa M / Nakamura, Miyabi / Newman, Jonathan D / Schwartz, Joseph E / Stone, Patricia W. ·Department of Health Policy and Management, Columbia Mailman School of Public Health, Stony Brook University, New York, NY, USA. ycw2102@columbia.edu ·Blood Press Monit · Pubmed #23263535.

ABSTRACT: BACKGROUND: Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. MATERIALS AND METHODS: We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). RESULTS: We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. CONCLUSION: Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

5 Article Association of Sleep Characteristics With Nocturnal Hypertension and Nondipping Blood Pressure in the CARDIA Study. 2020

Thomas, S Justin / Booth, John N / Jaeger, Byron C / Hubbard, Demetria / Sakhuja, Swati / Abdalla, Marwah / Lloyd-Jones, Donald M / Buysse, Daniel J / Lewis, Core E / Shikany, James M / Schwartz, Joseph E / Shimbo, Daichi / Calhoun, David / Muntner, Paul / Carnethon, Mercedes R. ·University of Alabama at Birmingham AL. · Columbia University New York NY. · Northwestern University Chicago IL. · University of Pittsburgh PA. · Stony Brook University, Stony Brook NY. ·J Am Heart Assoc · Pubmed #32188307.

ABSTRACT: Background Sleep characteristics and disorders are associated with higher blood pressure (BP) when measured in the clinic setting. Methods and Results We tested whether self-reported sleep characteristics and likelihood of obstructive sleep apnea (OSA) were associated with nocturnal hypertension and nondipping systolic BP (SBP) among participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who completed 24-hour ambulatory BP monitoring during the year 30 examination. Likelihood of OSA was determined using the STOP-Bang questionnaire. Global sleep quality, habitual sleep duration, sleep efficiency, and midsleep time were obtained from the Pittsburgh Sleep Quality Index. Nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or diastolic BP ≥70 mm Hg. Nondipping SBP was defined as a decline in awake-to-asleep SBP <10%. Among 702 participants, the prevalence of nocturnal hypertension and nondipping SBP was 41.3% and 32.5%, respectively. After multivariable adjustment including cardiovascular risk factors, the prevalence ratios (PRs) for nocturnal hypertension and nondipping SBP associated with high versus low likelihood of OSA were 1.32 (95% CI, 1.00-1.75) and 1.31 (95% CI, 1.02-1.68), respectively. The association between likelihood of OSA and nocturnal hypertension was stronger for white participants (PR: 2.09; 95% CI, 1.23-3.48) compared with black participants (PR: 1.11; 95% CI, 0.79-1.56). The PR for nondipping SBP associated with a 1-hour later midsleep time was 0.92 (95% CI, 0.85-0.99). Global sleep quality, habitual sleep duration, and sleep efficiency were not associated with either nocturnal hypertension or nondipping SBP. Conclusions These findings suggest that addressing OSA risk and sleep timing in a clinical trial may improve BP during sleep.

6 Article Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure. 2020

Jaeger, Byron C / Booth, John N / Butler, Mark / Edwards, Lloyd J / Lewis, Cora E / Lloyd-Jones, Donald M / Sakhuja, Swati / Schwartz, Joseph E / Shikany, James M / Shimbo, Daichi / Yano, Yuichiro / Muntner, Paul. ·Department of Biostatistics University of Alabama at Birmingham AL. · Department of Epidemiology University of Alabama at Birmingham AL. · Department of Population Health Sciences New York University School of Medicine New York NY. · Department of Preventive Medicine Northwestern University Evanston IL. · Department of Psychiatry Stony Brook School of Medicine Stony Brook NY. · Department of Medicine Columbia University Medical Center New York NY. · Division of Preventive Medicine Department of Medicine University of Alabama at Birmingham AL. · Department of Community and Family Medicine Duke University Durham NC. ·J Am Heart Assoc · Pubmed #31914878.

ABSTRACT: Background Nocturnal hypertension, defined by a mean asleep systolic blood pressure (SBP)/diastolic blood pressure (BP) ≥120/70 mm Hg, and nondipping SBP, defined by an awake-to-asleep decline in SBP <10%, are each associated with increased risk for cardiovascular disease. Methods and Results We developed predictive equations to identify adults with a high probability of having nocturnal hypertension or nondipping SBP using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study (n=787), JHS (Jackson Heart Study) (n=1063), IDH (Improving the Detection of Hypertension) study (n=395), and MHT (Masked Hypertension) study (n=772) who underwent 24-hour ambulatory BP monitoring. Participants were randomized to derivation (n=2511) or validation (n=506) data sets. The prevalence rates of nocturnal hypertension and nondipping SBP were 39.7% and 44.9% in the derivation data set, respectively, and 36.6% and 44.5% in the validation data set, respectively. The predictive equation for nocturnal hypertension included age, race/ethnicity, smoking status, neck circumference, height, high-density lipoprotein cholesterol, albumin/creatinine ratio, and clinic SBP and diastolic BP. The predictive equation for nondipping SBP included age, sex, race/ethnicity, waist circumference, height, alcohol use, high-density lipoprotein cholesterol, and albumin/creatinine ratio. Concordance statistics (95% CI) for nocturnal hypertension and nondipping SBP predictive equations in the validation data set were 0.84 (0.80-0.87) and 0.73 (0.69-0.78), respectively. Compared with reference models including antihypertensive medication use and clinic SBP and diastolic BP as predictors, the continuous net reclassification improvement (95% CI) values for the nocturnal hypertension and nondipping SBP predictive equations were 0.52 (0.35-0.69) and 0.51 (0.34-0.69), respectively. Conclusions These predictive equations can direct ambulatory BP monitoring toward adults with high probability of having nocturnal hypertension and nondipping SBP.

7 Article Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International Study. 2019

Reboldi, Gianpaolo / Verdecchia, Paolo / Saladini, Francesca / Pane, Marina / Beilin, Lawrence J / Eguchi, Kazuo / Imai, Yutaka / Kario, Kazuomi / Ohkubo, Takayoshi / Pierdomenico, Sante D / Schwartz, Joseph E / Wing, Lindon / Palatini, Paolo. ·University of Perugia, Perugia, Italy. · Hospital S. Maria della Misericordia, Perugia, Italy. · University of Padova, Padua, Italy. · University of Western Australia, Perth, Western Australia, Australia. · Jichi University, Tochigi, Japan. · Tohoku University, Sendai, Japan. · Shiga University of Medical Science, Otsu, Japan. · University of Chieti, Chieti, Italy. · Columbia University, New York City, New York. · Stony Brook University, New York City, New York. · Flinders University, Adelaide, South Australia, Australia. ·J Clin Hypertens (Greenwich) · Pubmed #31169986.

ABSTRACT: The prognostic value of uric acid (UA) for cardiovascular events (CVE) is still debated. Our purpose was to investigate the association between UA and CVE in 5243 participants of the ABP-International study with the main aim of identifying optimal sex-specific cut-points. In multivariable Cox analyses, the relationship between CVE and UA as a continuous variable was modeled by including both linear and nonlinear terms. Survival models were also estimated with UA as a categorical variable. Optimal UA cut-points were determined using an outcome-oriented approach. During a median follow-up of 5.9 years, there were 423 CVE (93 fatal). In age- and sex-adjusted Cox models, UA as a continuous variable was a significant predictor of CVE in all individuals and in men and women considered separately. The relationship between UA and CVE was linear (P-value for nonlinearity 0.54 and 0.80 for men and women, respectively). For each 1 mg/dL increase in UA, the relative hazard increase was 16% in men and 19% in women. In fully adjusted models, UA remained a significant predictor of CVE in the whole study cohort. The optimal cut-point best separating patients at low and high risk of CVE was 6.3 mg/dL for men and 4.4 mg/dL for women. Subjects with high UA had a 38% greater risk of CVE. In a sex-specific analysis, the association remained significant only in men (hazard ratio, 1.47; P < 0.01). In conclusion, high UA is an independent predictor for subsequent CVE and significantly improves risk discrimination and reclassification over the baseline multivariable model.

8 Article Pulse Wave Velocities Derived From Cuff Ambulatory Pulse Wave Analysis. 2019

Schwartz, Joseph E / Feig, Peter U / Izzo, Joseph L. ·From the Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook School of Medicine, NY (J.E.S.). · Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY (J.E.S.). · Department of Medicine, Weill Cornell Medical College, New York, NY (P.U.F.). · Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, NY (J.L.I.). ·Hypertension · Pubmed #31132952.

ABSTRACT: Pulse wave velocity (PWV), a measure of arterial stiffness, is an independent risk factor for cardiovascular morbidity and mortality. We investigated the relationship of ambulatory brachial cuff-based oscillometric PWV (oPWV) to 2 known correlates: age and brachial systolic blood pressure (SBP). In 234 participants in the Masked Hypertension Study, we analyzed 7284 validated hourly ambulatory SBP and oPWV readings using the Mobil-O-Graph monitor, which uses a proprietary pulse wave analysis algorithm to determine oPWV. Carotid-femoral PWV (cfPWV) was also measured. Mixed linear models were developed to estimate oPWV from age and ambulatory SBP. Participants were 34% male, with mean (SD) age 52.8 (9.9) years, SBP 123.8 (18.4) mm Hg, and oPWV 7.6 (1.3) m/s and cfPWV of 7.7 (1.7) m/s. The relationship of oPWV to age and SBP is given below: [Formula: see text] Age uniquely accounted for an estimated 75% of the total variation of oPWV, whereas SBP uniquely accounted for 20%; these findings were confirmed in an external validation dataset. Together, age and SBP accounted for 99.1% of the total variance of oPWV but (only) 40.2% of the variance of cfPWV. The correlation between oPWV and cfPWV was 0.58 but was only 0.11 after controlling for age and SBP. We conclude that the Mobil-O-Graph's oPWV is nearly completely explained by age and SBP and its relationship to cfPWV is because of their shared associations with age and SBP. Other hemodynamic variables derived from oscillometric pulse wave analysis may be useful and deserve additional scrutiny.

9 Article Race and sex differences in asleep blood pressure: The Coronary Artery Risk Development in Young Adults (CARDIA) study. 2019

Booth, John N / Anstey, D Edmund / Bello, Natalie A / Jaeger, Byron C / Pugliese, Daniel N / Thomas, Stephen Justin / Deng, Luqin / Shikany, James M / Lloyd-Jones, Donald / Schwartz, Joseph E / Lewis, Cora E / Shimbo, Daichi / Muntner, Paul. ·Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Medicine, Columbia University, New York, New York. · Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama. · Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Preventive Medicine, Northwestern University, Chicago, Illinois. · Department of Psychiatry, Stony Brook University, New York, New York. ·J Clin Hypertens (Greenwich) · Pubmed #30719843.

ABSTRACT: Nocturnal hypertension and non-dipping blood pressure are each associated with increased risk of cardiovascular disease. We determined differences in nocturnal hypertension and non-dipping systolic/diastolic blood pressure among black and white men and women who underwent 24-hour ambulatory blood pressure monitoring at the Coronary Artery Risk Development in Young Adults study Year 30 Exam in 2015-2016. Asleep and awake periods were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as mean asleep systolic/diastolic blood pressure ≥ 120/70 mm Hg. Non-dipping systolic and diastolic blood pressure, separately, were defined as a decline in awake-to-asleep blood pressure < 10%. Among 767 participants, the prevalence of nocturnal hypertension was 18.4% and 44.4% in white and black women, respectively, and 36.4% and 59.9% in white and black men, respectively. After multivariable adjustment and compared with white women, the prevalence ratio (95% confidence interval) for nocturnal hypertension was 1.65 (1.18-2.32) for black women, 1.63 (1.14-2.33) for white men, and 2.01 (1.43-2.82) for black men. The prevalence of non-dipping systolic blood pressure was 21.5% and 41.0% in white and black women, respectively, and 20.2% and 37.9% in white and black men, respectively. Compared with white women, the multivariable-adjusted prevalence ratio (95% confidence interval) for non-dipping systolic blood pressure was 1.66 (1.18-2.32), 0.91 (0.58-1.42) and 1.66 (1.15-2.39) among black women, white men, and black men, respectively. Non-dipping diastolic blood pressure did not differ by race-sex groups following multivariable adjustment. In conclusion, black women and men have a high prevalence of nocturnal hypertension and non-dipping systolic blood pressure.

10 Article Health Behaviors, Nocturnal Hypertension, and Non-dipping Blood Pressure: The Coronary Artery Risk Development in Young Adults and Jackson Heart Study. 2019

Sakhuja, Swati / Booth, John N / Lloyd-Jones, Donald M / Lewis, Cora E / Thomas, Stephen J / Schwartz, Joseph E / Shimbo, Daichi / Shikany, James M / Sims, Mario / Yano, Yuichiro / Muntner, Paul. ·University of Alabama at Birmingham, Birmingham, Alabama, USA. · Northwestern University, Chicago, Illinois, USA. · Columbia University, New York, USA. · Stony Brook University, Stony Brook, New York, USA. · University of Mississippi, Jackson, Mississippi, USA. · Duke University, Durham, North Carolina, USA. ·Am J Hypertens · Pubmed #30715142.

ABSTRACT: BACKGROUND: Several health behaviors have been associated with hypertension based on clinic blood pressure (BP). Data on the association of health behaviors with nocturnal hypertension and non-dipping systolic BP (SBP) are limited. METHODS: We analyzed data for participants with ambulatory BP monitoring at the Year 30 Coronary Artery Risk Development in Young Adults (CARDIA) study exam in 2015-2016 (n = 781) and the baseline Jackson Heart Study (JHS) exam in 2000-2004 (n = 1,046). Health behaviors (i.e., body mass index, physical activity, smoking, and alcohol intake) were categorized as good, fair, and poor and assigned scores of 2, 1, and 0, respectively. A composite health behavior score was calculated as their sum and categorized as very good (score range = 6-8), good (5), fair (4), and poor (0-3). Nocturnal hypertension was defined as mean asleep SBP ≥ 120 mm Hg or mean asleep diastolic BP ≥ 70 mm Hg and non-dipping SBP as < 10% awake-to-asleep decline in SBP. RESULTS: Among CARDIA study and JHS participants, 41.1% and 56.9% had nocturnal hypertension, respectively, and 32.4% and 72.8% had non-dipping SBP, respectively. The multivariable-adjusted prevalence ratios (95% confidence interval) for nocturnal hypertension associated with good, fair, and poor vs. very good health behavior scores were 1.03 (0.82-1.29), 0.98 (0.79-1.22), and 0.96 (0.77-1.20), respectively in CARDIA study and 0.98 (0.87-1.10), 0.96 (0.86-1.09), and 0.86 (0.74-1.00), respectively in JHS. The health behavior score was not associated non-dipping SBP in CARDIA study or JHS after multivariable adjustment. CONCLUSIONS: A health behavior score was not associated with nocturnal hypertension or non-dipping SBP.

11 Article Number of Measurements Needed to Obtain a Reliable Estimate of Home Blood Pressure: Results From the Improving the Detection of Hypertension Study. 2018

Bello, Natalie A / Schwartz, Joseph E / Kronish, Ian M / Oparil, Suzanne / Anstey, D Edmund / Wei, Ying / Cheung, Ying Kuen K / Muntner, Paul / Shimbo, Daichi. ·1 Department of Medicine Columbia University Irving Medical Center New York NY. · 2 Department of Psychiatry Stony Brook University Stony Brook NY. · 3 Department of Medicine University of Alabama at Birmingham AL. · 4 Department of Biostatistics Mailman School of Public Health New York NY. · 5 Department of Epidemiology University of Alabama at Birmingham AL. ·J Am Heart Assoc · Pubmed #30371272.

ABSTRACT: Background Obtaining out-of-clinic blood pressure ( BP ) measurements to confirm a diagnosis of hypertension is recommended before initiating treatment. There are few empiric data available on the number of measurements required to reliably estimate BP on home BP monitoring ( HBPM ). Methods and Results We analyzed data from 316 community-dwelling adults not taking antihypertensive medication from the IDH (Improving the Detection of Hypertension) study who performed HBPM for 14 days. The reliability of home BP measurements was assessed using the intraclass correlation coefficient and as the percentage of participants with an absolute difference in home BP <10 mm Hg between weeks. The reliability of home hypertension status was assessed by the κ statistic. In the IDH study, 13.6% of participants had clinic hypertension and 18.0% had home hypertension. Mean home systolic and diastolic BP exhibited excellent reliability and sufficient agreement using the average of 2 morning and 2 evening BP readings for a minimum of 2 days of HBPM and a single morning and single evening or 2 morning BP readings for a minimum of 3 days. For diagnosing home hypertension, there was good agreement with a minimum of 3 days of HBPM using the average of 2 morning and 2 evening measurements or a single morning and single evening BP reading. A greater number of days was required for the other HBPM strategies. Conclusions Using the average of morning and evening readings, 3 days of HBPM are needed to reliably estimate mean home BP and diagnose out-of-clinic hypertension.

12 Article Diagnosing Masked Hypertension Using Ambulatory Blood Pressure Monitoring, Home Blood Pressure Monitoring, or Both? 2018

Anstey, D Edmund / Muntner, Paul / Bello, Natalie A / Pugliese, Daniel N / Yano, Yuichiro / Kronish, Ian M / Reynolds, Kristi / Schwartz, Joseph E / Shimbo, Daichi. ·From Department of Medicine, Columbia University Medical Center, New York, NY (D.E.A, N.A.B, D.N.P, I.M.K., J.E.S., D.S.). · Department of Epidemiology, University of Alabama at Birmingham (P.M.). · Department of Community and Family Medicine, Duke University, Durham, NC (Y.Y.). · Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.). · Department of Psychiatry, Stony Brook University, New York, NY (J.E.S.). ·Hypertension · Pubmed #30354812.

ABSTRACT: Guidelines recommend measuring out-of-clinic blood pressure (BP) to identify masked hypertension (MHT) defined by out-of-clinic BP in the hypertensive range among individuals with clinic-measured BP not in the hypertensive range. The aim of this study was to determine the overlap between ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) for the detection of MHT. We analyzed data from 333 community-dwelling adults not taking antihypertensive medication with clinic BP <140/90 mm Hg in the IDH study (Improving the Detection of Hypertension). Any MHT was defined by the presence of daytime MHT (mean daytime BP ≥135/85 mm Hg), 24-hour MHT (mean 24-hour BP ≥130/80 mm Hg), or nighttime MHT (mean nighttime BP ≥120/70 mm Hg). Home MHT was defined as mean BP ≥135/85 mm Hg on HBPM. The prevalence of MHT was 25.8% for any MHT and 11.1% for home MHT. Among participants with MHT on either ABPM or HBPM, 29.5% had MHT on both ABPM and HBPM; 61.1% had MHT only on ABPM; and 9.4% of participants had MHT only on HBPM. After multivariable adjustment and compared with participants without MHT on ABPM and HBPM, those with MHT on both ABPM and HBPM and only on ABPM had a higher left ventricular mass index (mean difference [SE], 12.7 [2.9] g/m

13 Article Stress management in the workplace for employees with hypertension: a randomized controlled trial. 2018

Clemow, Lynn P / Pickering, Thomas G / Davidson, Karina W / Schwartz, Joseph E / Williams, Virginia P / Shaffer, Jonathan A / Williams, Redford B / Gerin, William. ·Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA. · Department of Family and Community Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. · Williams LifeSkills, Inc., Durham, NC, USA. · Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA. · Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA. ·Transl Behav Med · Pubmed #30202927.

ABSTRACT: While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.

14 Article A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Measurement Protocols. 2018

Kronish, Ian M / Edmondson, Donald / Shimbo, Daichi / Shaffer, Jonathan A / Krakoff, Lawrence R / Schwartz, Joseph E. ·Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, USA. · Department of Psychology, University of Colorado, Denver, Colorado, USA. · Cardiovascular Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA. · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA. ·Am J Hypertens · Pubmed #29897394.

ABSTRACT: BACKGROUND: The optimal approach to measuring office blood pressure (BP) is uncertain. We aimed to compare BP measurement protocols that differed based on numbers of readings within and between visits and by assessment method. METHODS: We enrolled a sample of 707 employees without known hypertension or cardiovascular disease, and obtained 6 standardized BP readings during each of 3 office visits at least 1 week apart, using mercury sphygmomanometer and BpTRU oscillometric devices (18 readings per participant) for a total of 12,645 readings. We used confirmatory factor analysis to develop a model estimating "true" office BP that could be used to compare the probability of correctly classifying participants' office BP status using differing numbers and types of office BP readings. RESULTS: Averaging 2 systolic BP readings across 2 visits correctly classified participants as having BP below or above the 140 mm Hg threshold at least 95% of the time if the averaged reading was <134 or >149 mm Hg, respectively. Our model demonstrated that more confidence was gained by increasing the number of visits with readings than by increasing the number of readings within a visit. No clinically significant confidence was gained by dropping the first reading vs. averaging all readings, nor by measuring with a manual mercury device vs. with an automated oscillometric device. CONCLUSIONS: Averaging 2 BP readings across 2 office visits appeared to best balance increased confidence in office BP status with efficiency of BP measurement, though the preferred measurement strategy may vary with the clinical context.

15 Article Evaluating different criteria for defining a complete ambulatory blood pressure monitoring recording: data from the Jackson Heart Study. 2018

Bromfield, Samantha G / Booth, John N / Loop, Matthew S / Schwartz, Joseph E / Seals, Samantha R / Thomas, Stephen J / Min, Yuan-I / Ogedegbe, Gbenga / Shimbo, Daichi / Muntner, Paul. ·Department of Epidemiology, Emory University, Atlanta, Georgia. · Department of Epidemiology. · Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. · Department of Medicine, Columbia University Medical Center. · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York. · Department of Mathematics and Statistics, University of West Florida, Pensacola, Florida. · Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. · Department of Population Health, New York University Langone Medical Center, New York. ·Blood Press Monit · Pubmed #29240564.

ABSTRACT: OBJECTIVE: We determined differences in the prevalence of blood pressure (BP) phenotypes and the association of these phenotypes with left ventricular hypertrophy (LVH) for individuals who fulfilled and did not fulfill various criteria used for defining a complete ambulatory blood pressure monitoring (ABPM) recording. METHODS: We analyzed data for 1141 participants from the Jackson Heart Study. Criteria evaluated included having greater than or equal to 80% of planned readings with more than or equal to one reading per hour (Spanish ABPM Registry criteria), more than or equal to 70% of planned readings with a minimum of 20 daytime and seven nighttime readings (2013 European Society of Hypertension criteria), greater than or equal to 14 daytime and greater than or equal to seven nighttime readings (2003 European Society of Hypertension criteria), more than or equal to 10 daytime and more than or equal to 5 nighttime readings (International Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcome criteria), and greater than or equal to 14 daytime readings (UK National Institute of Health and Clinical Excellence criteria). RESULTS: Between 45.0% (Spanish ABPM Registry) and 91.8% (UK National Institute of Health and Clinical Excellence) of the participants fulfilled the different criteria for a complete ABPM recording. Across the various criteria evaluated, 55.5-57.8% of participants had nocturnal hypertension and 62.8-66.8% had nondipping systolic BP. Among participants with clinic-measured systolic/diastolic BP of more than or equal to 140/90 mmHg, 22.9-26.5% had white-coat hypertension. The prevalence of daytime, 24-h, sustained, and masked hypertension differed by up to 2% for participants fulfilling each criterion. The association of BP phenotypes with LVH was similar for participants who fulfilled versus those who did not fulfill different criteria (each P>0.05). CONCLUSION: Irrespective of the criteria used for defining a complete ABPM recording, the prevalence of BP phenotypes and their association with LVH were similar.

16 Article Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment. 2018

Baird, Stacy W / Jin, Zhezhen / Okajima, Kazue / Russo, Cesare / Schwartz, Joseph E / Elkind, Mitchell S V / Rundek, Tatjana / Homma, Shunichi / Sacco, Ralph L / Di Tullio, Marco R. ·Department of Medicine, Columbia University, New York, NY, USA. · Department of Biostatistics, Columbia University, New York, NY, USA. · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, USA. · Departments of Neurology and Epidemiology, Columbia University, New York, NY, USA. · Department of Neurology, University of Miami, Miami, FL, USA. · Departments of Neurology and Human Genetics, University of Miami, Miami, FL, USA. · Department of Medicine, Columbia University, New York, NY, USA. md42@columbia.edu. ·J Hum Hypertens · Pubmed #29203908.

ABSTRACT: Epidemiologic studies assessing the relationship between blood pressure (BP), body mass, and cardiovascular events have primarily been based on office BP measurements, and few data are available in the elderly. The aim of the present study was to evaluate the relationship between body mass index (BMI) and BP values obtained by ambulatory blood pressure monitoring (ABPM) as compared to office BP measurements, and the effect of anti-hypertensive treatment on the relationship. The study population consisted of 813 subjects participating in the cardiovascular abnormalities and brain lesions (CABL) study who underwent 24-h ABPM. Office BP (mean of two measurements) was found to be associated with increasing BMI, for both SBP (p ≤ 0.05) and DBP (p ≤ 0.001). In contrast, there was no association seen of increasing BMI with ABPM parameters in the overall cohort, even after adjusting for age and gender. However, among subjects not on anti-hypertensive treatment, office SBP and DBP measurements were significantly correlated with increasing BMI (p ≤ 0.01) as were daytime SBP and 24-h SBP, although with a smaller spread across BMI subgroups compared with office readings. In treated hypertensives, there was only a trend toward increasing office DBP and increasing DBP variability with higher BMI. Our results suggest that body mass may have a less significant influence on BP values in the elderly when ABPM rather than office measurements are considered, particularly in patients receiving anti-hypertensive treatment.

17 Article Glomerular hyperfiltration is a predictor of adverse cardiovascular outcomes. 2018

Reboldi, Gianpaolo / Verdecchia, Paolo / Fiorucci, Gioia / Beilin, Lawrence J / Eguchi, Kazuo / Imai, Yutaka / Kario, Kazuomi / Ohkubo, Takayoshi / Pierdomenico, Sante D / Schwartz, Joseph E / Wing, Lindon / Saladini, Francesca / Palatini, Paolo. ·University of Perugia, Perugia, Italy. · Hospital of Assisi, Assisi, Italy. · University of Western Australia, Perth, Western Australia, Australia. · Jichi University, Tochigi, Japan. · Tohoku University, Sendai, Japan. · Tohoku University, Sendai, Japan; Shiga University of Medical Science, Otsu, Japan. · University of Chieti, Chieti, Italy. · Columbia University, New York, New York, USA; Stony Brook University, Stony Brook, New York, USA. · Flinders University, Adelaide, South Australia; Australia. · University of Padua, Padua, Italy. · University of Padua, Padua, Italy. Electronic address: palatini@unipd.it. ·Kidney Int · Pubmed #28935213.

ABSTRACT: The association between glomerular hyperfiltration and cardiovascular events is not well known. To investigate whether glomerular hyperfiltration is independently associated with risk of adverse outcome we analyzed 8794 participants, average age 52 years enrolled in 8 prospective studies. Of these, 89% had hypertension. Using the 5th and 95th percentiles of the age- and sex-specific quintiles of CKD-EPI-calculated estimated glomerular filtration rate (eGFR), we identified three participant groups with low, high and normal eGFR. The ambulatory pulse pressure interval was wider and nighttime blood pressure fall was smaller in both the low and high than in the normal eGFR participants. During a mean follow-up of 6.2 years, there were 722 cardiovascular events. Crude event rates were significantly higher for both high (1.8 per 100-person-year) and low eGFR groups (2.1 per 100 person-year) as compared with group with normal eGFR (1.2 per 100 person-year). In multivariable Cox models including age, sex, average 24-hour blood pressure, smoking, diabetes, and cholesterol, both high eGFR (hazard ratio 1.5 (95% confidence interval 1.2-2.1) and low eGFR (2.0 [1.5-2.6]) participants had a significantly higher risk of cardiovascular events as compared to those with normal eGFR. Addition of body mass index to the multivariable survival model did not change the magnitude of hazard estimates. Thus, glomerular hyperfiltration is a strong and independent predictor of cardiovascular events in a large multiethnic population of predominantly hypertensive individuals. Our findings support a U-shaped relationship between eGFR and adverse outcome.

18 Article The Association of Posttraumatic Stress Disorder With Clinic and Ambulatory Blood Pressure in Healthy Adults. 2018

Edmondson, Donald / Sumner, Jennifer A / Kronish, Ian M / Burg, Matthew M / Oyesiku, Linda / Schwartz, Joseph E. ·From the Center for Behavioral Cardiovascular Health, Columbia University Medical Center (Edmondson, Sumner, Kronish, Oyesiku, Schwartz), New York, New York · Section of Cardiovascular Medicine (Burg), Yale University School of Medicine, New Haven, Connecticut · and Department of Psychiatry and Behavioral Science (Schwartz), Stony Brook University, Stony Brook, New York. ·Psychosom Med · Pubmed #28872573.

ABSTRACT: OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with incident cardiovascular risk. We tested the association of PTSD with clinic and ambulatory blood pressure (ABP) in a sample of healthy participants and tested ABP reactivity to anxiety as a mechanism by which PTSD may influence blood pressure (BP). METHODS: Participants were originally enrolled during workplace BP screenings at three sites; approximately 6 years (standard deviation = 1.0) later, they completed nine clinic BP assessments within three visits, 1 week apart. Before the third visit, participants were screened for PTSD (≥33 on the PTSD Checklist-Civilian) and depression (Beck Depression Inventory) and then completed 24-hour ABP monitoring with electronic diary assessment of anxiety (0-100) at each awake reading. RESULTS: Of 440 participants, 92 (21%) screened positive for PTSD. In regression models adjusted for depression and demographic and clinical variables, PTSD was associated with greater mean systolic BP (3.8 mm Hg clinic [95% confidence interval {CI}] = 1.1-6.5, p = .006), 3.0 mm Hg awake ABP [95% CI = 0.1-5.9, p = .04], and a nonsignificant 2.1 mm Hg ABP during sleep [95% CI = -1.0 to 5.1, p = .18]). PTSD was associated with greater 24-hour median anxiety (p < .001), and changes in anxiety were positively associated with concurrent systolic ABP (p < .001). ABP reactivity to anxiety was greater in participants with PTSD, which partially explained the association of PTSD with ABP. CONCLUSIONS: PTSD is associated with greater systolic BP, partly because of greater anxiety, and systolic BP reactivity to anxiety throughout the day. Daily anxiety and related BP reactivity may be targets for interventions to reduce the cardiovascular risk associated with PTSD.

19 Article Race and sex differences in ambulatory blood pressure measures among HIV+ adults. 2017

Kent, Shia T / Schwartz, Joseph E / Shimbo, Daichi / Overton, Edgar T / Burkholder, Greer A / Oparil, Suzanne / Mugavero, Michael J / Muntner, Paul. ·Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. · Department of Psychiatry, Applied Behavioral Medicine Research Institute, Stony Brook University, Stony Brook, NY, USA; Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA. · Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA. · Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: pmuntner@uab.edu. ·J Am Soc Hypertens · Pubmed #28624171.

ABSTRACT: Ambulatory blood pressure monitoring (ABPM) can identify phenotypes that cannot be measured in the clinic. Determining race and sex disparities in ABPM measures among HIV+ individuals may improve strategies to diagnose and treat hypertension in this high-risk population. We compared ABPM measures between 24 African-American and 25 white HIV+ adults (36 men and 13 women). Awake systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar in African-Americans and whites. After multivariable adjustment, sleep SBP and DBP were 9.7 mm Hg (95% confidence interval [95% CI]: 4.7, 14.8) and 8.4 mm Hg (95% CI: 4.3, 12.5) higher, respectively, among African-Americans compared with whites. After multivariable adjustment, SBP and DBP dipping ratios were 5.2% (95% CI: 1.7%, 8.7%) and 6.1% (95% CI 2.0%, 10.3%) smaller among African-Americans compared with whites. After multivariable adjustment, awake and sleep SBP and DBP were higher in men compared to women. There was no difference in SBP or DBP dipping ratios comparing men and women. The prevalence of awake masked hypertension was 42% in men versus 17% in women, and the prevalence of sleep masked hypertension was 57% among African-Americans versus 18% among whites. These data suggest that ABPM measures differ by race and sex in HIV+ adults.

20 Article Variable selection in the functional linear concurrent model. 2017

Goldsmith, Jeff / Schwartz, Joseph E. ·Department of Biostatistics, Columbia Mailman School of Public Health, Columbia University, New York, U.S.A. · Department of Medicine, Columbia University Medical Center, Columbia University, New York, U.S.A. · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, U.S.A. ·Stat Med · Pubmed #28211085.

ABSTRACT: We propose methods for variable selection in the context of modeling the association between a functional response and concurrently observed functional predictors. This data structure, and the need for such methods, is exemplified by our motivating example: a study in which blood pressure values are observed throughout the day, together with measurements of physical activity, location, posture, affect or mood, and other quantities that may influence blood pressure. We estimate the coefficients of the concurrent functional linear model using variational Bayes and jointly model residual correlation using functional principal components analysis. Latent binary indicators partition coefficient functions into included and excluded sets, incorporating variable selection into the estimation framework. The proposed methods are evaluated in simulations and real-data analyses, and are implemented in a publicly available R package with supporting interactive graphics for visualization. Copyright © 2017 John Wiley & Sons, Ltd.

21 Article Prevalence of Masked Hypertension Among US Adults With Nonelevated Clinic Blood Pressure. 2017

Wang, Y Claire / Shimbo, Daichi / Muntner, Paul / Moran, Andrew E / Krakoff, Lawrence R / Schwartz, Joseph E. · ·Am J Epidemiol · Pubmed #28100465.

ABSTRACT: Masked hypertension (MHT), defined as nonelevated blood pressure (BP) in the clinic setting and elevated BP assessed by ambulatory monitoring, is associated with increased risk of target organ damage, cardiovascular disease, and mortality. Currently, no estimate of MHT prevalence exists for the general US population. After pooling data from the Masked Hypertension Study (n = 811), a cross-sectional clinical investigation of systematic differences between clinic BP and ambulatory BP (ABP) in a community sample of employed adults in the New York City metropolitan area (2005-2012), and the National Health and Nutrition Examination Survey (NHANES; 2005-2010; n = 9,316), an ongoing nationally representative US survey, we used multiple imputation to impute ABP-defined hypertension status for NHANES participants and estimate MHT prevalence among the 139 million US adults with nonelevated clinic BP, no history of overt cardiovascular disease, and no use of antihypertensive medication. The estimated US prevalence of MHT in 2005-2010 was 12.3% of the adult population (95% confidence interval: 10.0, 14.5)-approximately 17.1 million persons aged ≥21 years. Consistent with prior research, estimated MHT prevalence was higher among older persons, males, and those with prehypertension or diabetes. To our knowledge, this study provides the first estimate of US MHT prevalence-nearly 1 in 8 adults with nonelevated clinic BP-and suggests that millions of US adults may be misclassified as not having hypertension.

22 Article Masked tachycardia. A predictor of adverse outcome in hypertension. 2017

Palatini, Paolo / Reboldi, Gianpaolo / Beilin, Lawrence J / Casiglia, Edoardo / Eguchi, Kazuo / Imai, Yutaka / Kario, Kazuomi / Ohkubo, Takayoshi / Pierdomenico, Sante D / Schwartz, Joseph E / Wing, Lindon / Verdecchia, Paolo. ·aUniversity of Padova, Padua bUniversity of Perugia, Perugia, Italy cUniversity of Western Australia, Perth, Western Australia, Australia dJichi University, Shimotsuke, Tochigi eTohoku University, Sendai fTeikyo University School of Medicine, Tokyo, Japan gUniversity of Chieti, Chieti, Italy hColumbia University iStony Brook University, New York, New York, USA jFlinders University, Adelaide, South Australia, Australia kHospital of Assisi, Assisi, Italy. ·J Hypertens · Pubmed #27930441.

ABSTRACT: OBJECTIVE: The relative role of office heart rate (HR) and ambulatory HR for predicting major adverse cardiovascular events (MACEs) and mortality is not well known. Aim of this study was to investigate the association of white-coat tachycardia and masked tachycardia with MACE and mortality in hypertensive patients. METHODS: We performed 24-h ambulatory blood pressure and HR monitoring in 7602 hypertensive patients (4165 men) aged 52 ± 16 years enrolled in six prospective studies in Italy, Japan, and Australia. Participants were divided into four groups: normal office and normal night-time HRs (N = 5238), white-coat tachycardia (N = 998), masked tachycardia (N = 796), and sustained tachycardia (N = 570). Median follow-up was 5.0 years. RESULTS: In age-and-sex-adjusted Cox model, using the normal HRs group as a reference, white-coat tachycardia was not a significant predictor of excess MACEs or all-cause death. In contrast, both masked tachycardia [hazard ratio, 95% confidence interval (CI); 1.40, 1.11-1.77] and sustained tachycardia (1.86, 1.44-2.40) were associated with risk of excess MACE. In addition, masked tachycardia (hazard ratio, 95% CI; 1.62, 1.14-2.29) but not sustained tachycardia (1.35, 0.83-2.19) was a significant predictor of excess mortality. These relationships held true in multivariable parsimonious Cox models including major risk factors. In these models, masked tachycardia remained an independent predictor of excess MACE (hazard ratio, 95% CI; 1.34, 1.06-1.71) and all-cause mortality (1.68, 1.18-2.41). CONCLUSION: The current study confirms that measurement of HR adds to the risk stratification for MACE and mortality and shows that an elevated night-time HR confers an increased mortality risk to hypertensive patients who have normal office HR.

23 Article Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population: Results From the Masked Hypertension Study. 2016

Schwartz, Joseph E / Burg, Matthew M / Shimbo, Daichi / Broderick, Joan E / Stone, Arthur A / Ishikawa, Joji / Sloan, Richard / Yurgel, Tyla / Grossman, Steven / Pickering, Thomas G. ·From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.) · Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.) · USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.) · and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.). ·Circulation · Pubmed #27920072.

ABSTRACT: BACKGROUND: Ambulatory blood pressure (ABP) is consistently superior to clinic blood pressure (CBP) as a predictor of cardiovascular morbidity and mortality risk. A common perception is that ABP is usually lower than CBP. The relationship of the CBP minus ABP difference to age has not been examined in the United States. METHODS: Between 2005 and 2012, 888 healthy, employed, middle-aged (mean±SD age, 45±10.4 years) individuals (59% female, 7.4% black, 12% Hispanic) with screening BP <160/105 mm Hg and not taking antihypertensive medication completed 3 separate clinic BP assessments and a 24-hour ABP recording for the Masked Hypertension Study. The distributions of CBP, mean awake ABP (aABP), and the CBP-aABP difference in the full sample and by demographic characteristics were compared. Locally weighted scatterplot smoothing was used to model the relationship of the BP measures to age and body mass index. The prevalence of discrepancies in ABP- versus CBP-defined hypertension status-white-coat hypertension and masked hypertension-were also examined. RESULTS: Average systolic/diastolic aABP (123.0/77.4±10.3/7.4 mm Hg) was significantly higher than the average of 9 CBP readings over 3 visits (116.0/75.4±11.6/7.7 mm Hg). aABP exceeded CBP by >10 mm Hg much more frequently than CBP exceeded aABP. The difference (aABP>CBP) was most pronounced in young adults and those with normal body mass index. The systolic difference progressively diminished, but did not disappear, at older ages and higher body mass indexes. The diastolic difference vanished around age 65 and reversed (CBP>aABP) for body mass index >32.5 kg/m CONCLUSIONS: Contrary to a widely held belief, based primarily on cohort studies of patients with elevated CBP, ABP is not usually lower than CBP, at least not among healthy, employed individuals. Furthermore, a substantial proportion of otherwise healthy individuals with nonelevated CBP have masked hypertension. Demonstrated CBP-aABP gradients, if confirmed in representative samples (eg, NHANES [National Health and Nutrition Examination Survey]), could provide guidance for primary care physicians as to when, for a given CBP, 24-hour ABP would be useful to identify or rule out masked hypertension.

24 Article Evaluation of Criteria to Detect Masked Hypertension. 2016

Booth, John N / Muntner, Paul / Diaz, Keith M / Viera, Anthony J / Bello, Natalie A / Schwartz, Joseph E / Shimbo, Daichi. ·University of Alabama at Birmingham, Birmingham, AL. · Columbia University Medical Center, New York, NY. · Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. · Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY. · Columbia University Medical Center, New York, NY. ds2231@columbia.edu. ·J Clin Hypertens (Greenwich) · Pubmed #27126770.

ABSTRACT: The prevalence of masked hypertension (out-of-clinic daytime systolic/diastolic blood pressure (SBP/DBP) ≥135/85 mm Hg on ambulatory blood pressure monitoring [ABPM] among adults with clinic SBP/DBP <140/90 mm Hg) is high. It is unclear who should be screened for masked hypertension. The authors derived a clinic blood pressure (CBP) index to identify populations for masked hypertension screening. Index cut points corresponding to 75% to 99% sensitivity and prehypertension were evaluated as ABPM testing criterion. In a derivation cohort (n=695), the index was clinic SBP+1.3*clinic DBP. In an external validation cohort (n=675), the sensitivity for masked hypertension using an index ≥190 mm Hg and ≥217 mm Hg and prehypertension status was 98.5%, 71.5%, and 82.5%, respectively. Using National Health and Nutrition Examination Survey data (n=11,778), the authors estimated that these thresholds would refer 118.6, 44.4, and 59.3 million US adults, respectively, to ABPM screening for masked hypertension. In conclusion, the CBP index provides a useful approach to identify candidates for masked hypertension screening using ABPM.

25 Article Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis. 2016

Kent, Shia T / Bromfield, Samantha G / Burkholder, Greer A / Falzon, Louise / Oparil, Suzanne / Overton, Edgar T / Mugavero, Michael J / Schwartz, Joseph E / Shimbo, Daichi / Muntner, Paul. ·Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America. · Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America. · Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America. · Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, United States of America. · Applied Behavioral Medicine Research Institute, Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, United States of America. ·PLoS One · Pubmed #26882469.

ABSTRACT: INTRODUCTION: Abnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV+) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV+ individuals, a systematic literature review and meta-analysis were performed. METHODS: Medical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV+ individuals. Data were extracted by 2 reviewers and pooled differences between HIV+ and HIV-negative (HIV-) individuals in clinic BP and ABPM measures were calculated using random-effects inverse variance weighted models. RESULTS: Of 597 abstracts reviewed, 8 studies with HIV+ cohorts met the inclusion criteria. The 420 HIV+ and 714 HIV- individuals in 7 studies with HIV- comparison groups were pooled for analyses. The pooled absolute nocturnal systolic and diastolic BP declines were 3.16% (95% confidence interval [CI]: 1.13%, 5.20%) and 2.92% (95% CI: 1.64%, 4.19%) less, respectively, in HIV+ versus HIV- individuals. The pooled odds ratio for non-dipping systolic BP (nocturnal systolic BP decline <10%) in HIV+ versus HIV- individuals was 2.72 (95% CI: 1.92, 3.85). Differences in mean clinic, 24-hour, daytime, or nighttime BP were not statistically significant. I2 and heterogeneity chi-squared statistics indicated the presence of high heterogeneity for all outcomes except percent DBP dipping and non-dipping SBP pattern. CONCLUSIONS: An abnormal diurnal BP pattern may be more common among HIV+ versus HIV- individuals. However, results were heterogeneous for most BP measures, suggesting more research in this area is needed.

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