Ethnicity and Differences Between Clinic and Ambulatory Blood Pressure Measurements

Martin, Una; Haque, Sayeed; Wood, Sally; Greenfield, Sheila; Gill, Paramjit; Mant, Jonathan; Mohammed, Mohammed A.; Heer, Gurdip; Johal, Amanpreet; Kaur, Ramendeep; Schwartz, Claire; McManus, Richard J

doi:10.1093/ajh/hpu211

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…24,25 Other studies have suggested ethnic differences in WCE including a recent British study based on a primary care population. 26,27 One hypothesis for the difference may be that the mechanism of hypertension differs between different ethnic groups. Pathophysiologically, higher renin-angiotensin-aldosterone White coat effect in a UK hypertension clinic population O Thomas et al activity plays a major role in the causation and maintenance of primary hypertension in Caucasians, whereas in those of AfricanCaribbean origin, salt retention is more important.…”

Section: Subjectsmentioning

confidence: 99%

Prevalence and determinants of white coat effect in a large UK hypertension clinic population

et al. 2015

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White coat hypertension (WCH) is common and termed white coat effect (WCE) in those on treatment for hypertension. The UK guideline suggests that all patients in stage 1 and 2 hypertension, but not stage 3 hypertension, should have ambulatory blood pressure monitoring (ABPM) performed before commencing treatment. The relationship between office blood pressure (BP) and ABPM and the factors that influence the WCE were examined in a large British cohort (n=2056) from 2 hypertension clinics (1998-2011). Data were collected prospectively: the median age was 56 years: 53% were female, 76% Caucasian, 9% African Caribbean, 15% South Asian and 86% taking antihypertensives. Fifty-one percent had WCE and differences between clinic BP and ABPM measurements increased with the stage of hypertension varying from 2/4 (normotensive), 13/10 (stage 1 hypertension), 24/14 (stage 2) and 40/20 mm Hg (stage 3). The degree of difference is greater in this study than described in other populations. A positive correlation was found between clinic systolic and diastolic BP and the WCE (r=0.74 and r=0.56, respectively, P<0.0001). Significant (P<0.05) independent associations of systolic WCE were clinic systolic BP (β=0.707), Caucasian ethnicity (South Asian β=-0.06; African Caribbean β=-0.043), female gender (male β=-0.047), nonsmoking status (smoker β=-0.100) and reduced renal function (estimated glomerular filtration rate β=-0.036). Significant independent associations of diastolic WCH were clinic diastolic BP (β=0.624), age (β=0.207), female gender (male β=-0.104), Caucasian ethnicity (South Asian β=-0.052, African Caribbean β=-0.079) and being a nonsmoker (β=-0.082) or ex-smoker (β=0.046). The results support current UK guidelines but suggest those with stage 3 hypertension would also benefit from ABPM.

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Section: Subjectsmentioning

confidence: 99%

Prevalence and determinants of white coat effect in a large UK hypertension clinic population

et al. 2015

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“…5 One study assessed how differences in ethnicity affected the comparison between clinic BP and ABPM. 113 Results from the study found that when BP was measured carefully, the differences between the ethnic groups were small and unlikely to be clinically relevant but casual BP measurements were more likely to lead to inaccuracies particularly for Afro-Caribbean and South Asian individuals. 113 A US study investigated whether home monitoring varied by race, education, or income.…”

Section: A N a G E M E N T O F H T N I N S P E C I A L G R O U P Smentioning

confidence: 92%

“…113 Results from the study found that when BP was measured carefully, the differences between the ethnic groups were small and unlikely to be clinically relevant but casual BP measurements were more likely to lead to inaccuracies particularly for Afro-Caribbean and South Asian individuals. 113 A US study investigated whether home monitoring varied by race, education, or income. 114 The authors reported that there was no significant association between black, white, or Hispanic groups, but use of a home BP monitor was significantly associated with higher income and higher education.…”

Section: A N a G E M E N T O F H T N I N S P E C I A L G R O U P Smentioning

confidence: 92%

Modern Management and Diagnosis of Hypertension in the United Kingdom: Home Care and Self-care

Sheppard

Schwartz

Tucker

et al. 2016

Annals of Global Health

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The evidence supporting the use of out-of-office monitoring in all aspects of routine clinical care has increased substantially in recent years and is reflected in increased utilization by patients and clinicians alike. Several areas require further research but it is clear that out-of-office monitoring is here to stay and is fast becoming an important part of hypertension management in the United Kingdom.

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“…We also conducted supplementary analyses using daytime road noise (LAeq16 hour, . In addition to sex and age, we included smoking and ethnicity a priori given they are strongly associated with cardiovascular health (Martin et al 2015;Messner and Bernhard 2014), and may plausibly show spatial variability that could be associated with that of noise, given highly diverse composition of the London population, the spatial variability of ethnic groups within London and different smoking prevalences between different ethnic and social groups. Of other individual-level variables available, only marital status was found to be predictive of cIMT and associated with noise exposure and was not a potential intermediate, satisfying the definition of a confounder.…”

Section: Road Traffic Noisementioning

confidence: 99%

Associations of night-time road traffic noise with carotid intima-media thickness and blood pressure: The Whitehall II and SABRE study cohorts

Halonen

Dehbi

Hansell

et al. 2017

Environment International

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Word count (including references, figure legends and tables): 5926 2 Word count abstract: 250Running title: Traffic noise and carotid intima-media thickness AcknowledgementWe thank all participating women and men in the Whitehall II Study and the SABRE study, as well as all Whitehall II research scientists, study and data managers and clinical and administrative staff and the SABRE study team who made the study possible. Objectives To examine cross-sectional associations for long-term exposure to night-time noise with cIMT, systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension.Methods The study population consisted of 2592 adults from the Whitehall II and SABRE cohort studies living within Greater London who had cIMT, SBP and DBP measured. Exposure to night-time road traffic noise (A-weighted dB, referred to as dBA) was estimated at each participant's residential postcode centroid.Results Mean night-time road noise levels were 52dBA (SD=4). In the pooled analysis adjusted for cohort, sex, age, ethnicity, marital status, smoking, area-level deprivation and NOx there was a 9.1 µm (95% CI: -7.1, 25.2) increase in cIMT in association with 10dBA increase in night-time noise. Analyses by noise categories of 55-60dBA (16.2 µm, 95% CI: -8.7, 41.2), and >60dBA (21.2 µm, 95% CI: -2.5, 44.9) vs. <55dBA were also positive but non-significant, expect among those not using antihypertensive medication and exposed to >60dBA vs. <55dBA (32.6 µm, 95% CI: 6.2, 59.0). Associations for SBP, DPB and hypertension were close to null.Conclusions After adjustments, including for air pollution, the association between night-time road traffic noise and cIMT was only observed among non-medication users but associations with blood pressure and hypertension were largely null.

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Ethnicity and Differences Between Clinic and Ambulatory Blood Pressure Measurements

Abstract: BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.

Cited by 20 publications

References 34 publications

Prevalence and determinants of white coat effect in a large UK hypertension clinic population

Prevalence and determinants of white coat effect in a large UK hypertension clinic population

Modern Management and Diagnosis of Hypertension in the United Kingdom: Home Care and Self-care

Associations of night-time road traffic noise with carotid intima-media thickness and blood pressure: The Whitehall II and SABRE study cohorts

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