We examined the feasibility and perception of cell-based (texting, voicemail [VM], and email/social media), health-related communication with adolescents in Genesee County, MI, where 22% reside below the poverty level. Results of an anonymous survey found that 86% of respondents owned a cell phone, 87% had data, 96% texted, 90.5% emailed/used social media, and 68% had VM. Most adolescents were interested in cell-based communication via texting (52%), VM (37%), and email/social media (31%). Interest in types of health communication included appointment reminders (99% texting; 94% VM; 95% email/social media), shot reminders (84.5% texting; 74.5% VM; 81% email/social media), call for test results (71.5% texting; 75% VM; 65% email/social media), medication reminders (63% texting; 54% VM; 58% e-mail/social media), and health tips (36% texting; 18.5% VM; 73% email/social media). Cell-based health-related communication with adolescents is feasible even within low socioeconomic status populations, primarily via texting. Health providers should embrace cell-based patient communication.

In Caucasian and Asian populations, evidence suggests that 24-h blood pressures (BP) are more predictive of long-term cardiovascular events than clinic BP. However, few long-term studies have evaluated the predictive value of 24-h BP phenotypes (24-h, daytime, nighttime) among African Americans (AA). The purpose of this study is to evaluate the added value of 24-h BP phenotypes compared to clinic BP in predicting the subsequent fatal and non-fatal cardiovascular/renal disease events in AA subjects. AA subjects (n = 270) were initially studied between 1994 and 2006 and standardized clinic BP measurements were obtained during screening procedures for a 3-day inpatient clinical study during which 24-h BP measurements were obtained. To assess the subsequent incidence of cardiovascular and renal disease events, follow-up information was obtained and confirmed by review of paper and electronic medical records between 2015 and 2017. During a mean follow-up of 14 ± 4 years, 50 subjects had one or more fatal or non-fatal cardiovascular/renal disease events. After adjustment for covariates, clinic systolic and diastolic BP were strongly associated with cardiovascular/renal disease events and all-cause mortality (p < 0.0001). Twenty-four-hour BP phenotypes conferred a small incremental advantage over clinic BP in predicting cardiovascular/renal events, which was limited to making a difference of one predicted event in 250-1,000 predictions depending on the 24-h BP phenotype. Nocturnal BP was no more predictive than the other 24-h BP phenotypes. In AA, 24-h BP monitoring provides limited added value as a predictor of cardiovascular/ renal disease events. Larger studies are needed in AA to confirm these findings.

For genetic studies of hypertension, between 1994 and 2006, we established a cohort of 2,639 African Americans (53% female), 51% of whom were hypertensive (H). The purpose of this report is twofold: a) to evaluate the relationship of baseline hypertension status and blood pressure (BP) level with subsequent mortality in this cohort; and b) to compare the relationship of clinic and 24-hour BPs with the subsequent incidence of fatal and non-fatal cardiovascular (CV) events in a subset of the original cohort. Clinic BP was obtained in triplicate in all 2,369 subjects as part of screening procedures for a 3-day inpatient clinical study of a sub-sample (n=266). BP medications were discontinued for 1-week after the screening visit and prior to inpatient study. Detailed phenotyping along with 24-hour BPs were obtained during the 3-day study. Compared to normotensives (N) at baseline, H had higher standardized clinic BP (145 ± 20 [SD] / 94 ± 13 vs 118 ± 10/ 76 ± 8 mm Hg), were slightly older (45 ± 7 vs 42 ± 7 years; p<0.0001), and had higher BMI (29 ± 6 vs 27 ± 5 kg/m 2 ; p<0.0001) in the overall cohort. Mortality data were obtained from the National Death Index. Average time from baseline to mortality was 12 ± 3 years. All-cause mortality was related to clinic systolic BP (p<0.03) and was greater in H than N (176 vs 70 deaths; p< 0.0002) after adjustment for age, sex, BMI, and duration of follow-up. CV mortality was also greater in H than N (52 vs 19 deaths; p<0.01). During a follow-up of 14 ± 4 years of the in-patient cohort, 49 subjects had a fatal (n=11) or non-fatal (n=38) CV event. After adjustment for covariates, clinic systolic and diastolic BPs were strongly associated with CV events (p<0.0001). The association of clinic BPs with CV events was as robust as the associations with overall 24-hour BP, day BP, and night BP. Average difference between day and night BP was 7 ± 8/5 ± 6 mm Hg (p< 0.0001), but day-night BP difference was not associated with CV events (p=0.45). In conclusion, in middle-aged African Americans, 24-hour BPs were no more predictive of CV events than BPs measured during a single outpatient visit. In addition, both all-cause mortality and CV mortality were related to the clinic BP. These results will require confirmation with larger sample sizes.