Defining Ambulatory Blood Pressure Thresholds for Decision Making in Hypertension
The Effect of Race and Methodology
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Article, see p 2470
African Americans are known to have higher levels of office blood pressure (BP) and prevalence of hypertension than whites, which starts earlier and poses higher cardiovascular risk.1,2 Several pathogenetic mechanisms have been identified to explain these racial differences, and differences in the response to BP-lowering drugs.3 Studies with ambulatory BP monitoring have shown that African Americans have higher average 24-hour BP levels and variability than whites, and patterns of masked and nocturnal hypertension and nondipping profile are more frequent.4,5 Because of these issues, 24-hour ambulatory BP monitoring appears to be an essential method for the evaluation of hypertension in African Americans as it unmasks clinically important phenomena that cannot be identified by any other BP measurement method. Thus, ambulatory BP monitoring deserves thorough investigation specifically in African Americans.
In this issue of Circulation, Ravenell et al6 report, for the first time, thresholds for ambulatory BP in African Americans. These data were derived from the Jackson Heart Study that included 1016 African Americans from a general population sample who had office and 24-hour ambulatory BP measurements and were followed for 10.8 years.6 BP distribution criteria, regression criteria (office-ambulatory BP), and outcome criteria (cardiovascular event probability similar to that of conventional office BP threshold) were used to define the ambulatory BP normalcy thresholds.6 It is interesting to note that the ambulatory BP thresholds identified for African Americans were higher than those currently recommended (Tables 1 and 2).6–12