Research indicates that non-Hispanic black (NHB) patients, especially men, are at a greater risk of hypertension and hypertensive heart disease, and have worse outcomes and a higher risk of complications, when compared with patients with the same diagnosis in other ethnic groups. This is made all the more dangerous, Dr. Florian Rader, MD, MSc from the Cedars-Sinai Smidt Heart Institute explains, by higher rates of masked hypertension in NHB patients, with higher out-of-office blood pressure (BP) compared with clinic BP. Dr. Rader and colleagues conducted a study to better understand whether in-clinic or out-of-office BP measurements were more likely to be associated with left ventricular hypertrophy, a major manifestation of hypertensive heart disease.
For a study published in Hypertension, the research team assessed data on more than 2,000 NHB and white patients aged 30-64 to determine the association of in-office and out-of-office BP measurements with left ventricular hypertrophy through cardiac MRI. Participants underwent standard clinic and out-of-office (in-home) BP and left ventricular mass index by cardiac MRI assessment.
Out-of-office BP measurement was found to be a stronger indicator of left ventricular hypertrophy (odds ratio per 10 mm Hg, 1.48; 1.34–1.64 for out-of-office systolic BP and 1.15 [1.04–1.28] for clinic systolic BP; 1.71 [1.43–2.05] for out-of-office diastolic BP, and 1.03 [0.86–1.24] for clinic diastolic BP). “The implications here are that lowering out-of-office BP may be a much more important treatment target compared with the usual treatment target of clinic-measured BP,” says Dr. Rader. Other independent indicators of hypertrophy included NHB race/ethnicity, treatment status, and lower left ventricular ejection fraction.
“Our research suggests that reliance on office BP measurement alone may be a missed opportunity to reduce cardiovascular complications, especially in high-risk NHB hypertensives,” emphasizes Dr. Rader. “It also supports hypertension management programs that focus on hypertension diagnosis and treatment in the community, outside the doctor’s office.”
Dr. Rader believes, “A large randomized outcomes trial that focuses on BP reduction at participants’ homes compared with BP reductions in the clinic would definitively show whether this approach reduces hypertension-related complications and whether such an approach is more effective in reducing cardiac muscle mass.”
Superiority of Out-of-Office Blood Pressure for Predicting Hypertensive Heart Disease in Non-Hispanic Black Adults