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BackgroundSelf-reported experiences of discrimination have been linked to indices of cardiovascular disease. However, most studies have focused on healthy populations. Thus, we examined the association between experiences of everyday discrimination and arterial stiffness among patients with a history of myocardial infarction (MI).PurposeWe hypothesized that higher reports of discrimination would be associated with greater arterial stiffness and that associations would be more pronounced among Black women, in particular, relative to other race–gender groups, using an “intersectionality” perspective.MethodsData were from 313 participants (49.2% female, mean age: 50.8 years) who were 6 months post-MI in the Myocardial Infarction and Mental Stress 2 study. Data were collected via self-reported questionnaires, medical chart review, and a clinic visit during which arterial stiffness was measured noninvasively using pulse wave velocity.ResultsReports of discrimination were highest in Black men and women and arterial stiffness was greatest in Black and White women. After adjustment for demographics and relevant clinical variables, discrimination was not associated with arterial stiffness in the overall study sample. However, discrimination was associated with increased arterial stiffness among Black women but not White women, White men, or Black men.ConclusionsDespite no apparent association between discrimination and arterial stiffness in the overall study sample, further stratification revealed an association among Black women but not other race–gender groups. These data not only support the utility of an intersectionality lens but also suggest the importance of implementing psychosocial interventions and coping strategies focused on discrimination into the care of clinically ill Black women.

Introduction: Recent reports have demonstrated an association between Impella compared to IABP use with increased risk for short-term clinical outcomes, including stroke, bleeding, and mortality among patients with AMI and cardiogenic shock (CS) undergoing PCI. Data on long-term outcomes and cost are limited. Methods: This retrospective study analyzed administrative claims data from a large commercially insured population from 14 states. Patients undergoing PCI for AMI complicated by CS from 7/1/14 to 4/30/20 were included. Those who had both devices or other mechanical circulatory support were excluded. We performed a 1:1 propensity score-matched analysis in patients receiving an Impella versus IABP. The primary outcome was mortality, and secondary outcomes were stroke, bleeding, repeat revascularization, incident dialysis, and cost at 30-days and 1-year follow-up. Results: Of the 3,347 patients undergoing PCI for AMI complicated by CS, the mean (SD) age was 65.4 (12.5) years, 71% were men, and 32% had a cardiac arrest. Among 820 propensity-matched pairs, at 30-days use of the Impella was associated with a significantly higher mortality (Odds ratio [OR] 1.91; 95% Confidence interval [CI]: 1.54-2.37, P P =0.01), and mean difference in cost ($40,869, Interquartile range: $20,829-$64,200, P Figure ). Incident stroke, bleeding, and repeat revascularization were not different between groups ( P >0.05). At 1-year, mortality (Hazard ratio [HR] 1.58, 95% CI: 1.33-1.87, P P =0.001) remained higher in Impella. Conclusions: In patients undergoing PCI for AMI complicated by CS, use of Impella was associated with an increased 30-day and 1-year mortality, dialysis, and cost compared to IABP. There is need for additional evidence surrounding the optimal management of patients with AMI and CS undergoing PCI.

Intravascular microaxial left ventricular assist device (LVAD) compared with intra-aortic balloon pump (IABP) has been associated with increased risk of mortality and bleeding among patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). However, evidence on the association of device therapy with a broader array of clinical outcomes, including data on long-term outcomes and cost, is limited.To examine the association between intravascular LVAD or IABP use and clinical outcomes and cost in patients with AMI complicated by CS.This retrospective propensity-matched cohort study used administrative claims data for commercially insured patients from 14 states across the US. Patients included in the analysis underwent PCI for AMI complicated by CS from January 1, 2015, to April 30, 2020. Data analysis was performed from April to November 2021.Use of either an intravascular LVAD or IABP.The primary outcomes were mortality, stroke, severe bleeding, repeat revascularization, kidney replacement therapy (KRT), and total health care costs during the index admission. Clinical outcomes and cost were also assessed at 30 days and 1 year.Among 3077 patients undergoing PCI for AMI complicated by CS, the mean (SD) age was 65.2 (12.5) years, and 986 (32.0%) had cardiac arrest. Among 817 propensity-matched pairs, intravascular LVAD use was associated with significantly higher in-hospital (36.2% vs 25.8%; odds ratio [OR], 1.63; 95% CI, 1.32-2.02), 30-day (40.1% vs 28.3%; OR, 1.71; 95% CI, 1.37-2.13), and 1-year mortality (58.9% vs 45.0%; hazard ratio [HR], 1.44; 95% CI, 1.21-1.71) compared with IABP. At 30 days, intravascular LVAD use was associated with significantly higher bleeding (19.1% vs 14.5%; OR, 1.35; 95% CI, 1.04-1.76), KRT (12.2% vs 7.0%; OR, 1.88; 95% CI, 1.30-2.73), and mean cost (+$51 680; 95% CI, $31 488-$75 178). At 1 year, the association of intravascular LVAD use with bleeding (29.7% vs 24.3%; HR, 1.36; 95% CI, 1.05-1.75), KRT (18.1% vs 10.9%; HR, 1.95; 95% CI, 1.35-2.83), and mean cost (+$46 609; 95% CI, $22 126-$75 461) persisted.In this propensity-matched analysis of patients undergoing PCI for AMI complicated by CS, intravascular LVAD use was associated with increased short-term and 1-year risk of mortality, bleeding, KRT, and cost compared with IABP. There is an urgent need for additional evidence surrounding the optimal management of patients with AMI complicated by CS.

Title: Net Worth, Debt Stress, and Ambulatory Blood Pressure in African American Women Author Names: Telisa Spikes, RN, PHD, Raphiel Murden, MS, Izraelle McKinnon, MPH, Miriam Van Dyke, PhD, Samantha Bromfield, PhD, Renee Moore, PhD, Bianca Booker, MA, Frederic Rahbari-Oskoui MD, Arshed Quyyumi, MD, Viola Vaccarino, MD, PhD, Tené T. Lewis, PhD Background: Low socioeconomic status (SES) is an established predictor of higher cardiovascular disease (CVD) incidence and mortality. Research suggests that neither higher education nor income have been consistently associated with lower CVD risk or outcomes in African Americans (AAs). Net worth and debt stress are two underexamined indices of SES that may be more important for CVD risk, especially in AAs, due to attenuated returns of traditional indicators of SES on health, and the high rates of debt in this group. Objective: To examine the associations of net worth and debt stress, independent of education and income, with ambulatory blood pressure (ABP) in AA women. Methods: Participants were AA women (n=422), mean age 37±4.2 years from various sociodemographic backgrounds recruited from a large metropolitan southeastern region. Net worth was measured using a single item (“Suppose you and others in your household were to sell all of your major possessions including your home, turn all of your investments and other assets into cash, and pay off all of your debts. Would you have something left over, break even, or be in debt?”) with three response categories, left over , break-even , and debt . Debt stress was measured using the four-item Debt Stress Index (e.g. “Overall, how often do you worry about the total amount you and your spouse/partner owe in overall debt?”). ABP was assessed over 48 hours. Multiple linear regression was used to evaluate associations between SES indicators and continuous ABP outcomes adjusting for age, education, income, BMI, BP meds, and depressive symptoms. Results: Overall, 48% of the cohort was categorized as having a positive (“left over”) net worth, while 30% and 22% were categorized as having a neutral (“break-even”), and negative (“debt”) net worth, respectively. Compared to the positive net worth group, negative net worth was associated with higher daytime (ß=5.2; CI: 2.44-8.05 ) and nighttime systolic blood pressure (SBP) (ß=5.3; CI: 2.59-8.06 ) in unadjusted analyses. Findings remained significant for both daytime (ß=4.3; CI:1.38-7.24 ) and nighttime (ß=4.1; CI:1.26-6.90 ) SBP in fully adjusted models. There were no significant unadjusted or fully-adjusted associations between debt stress and daytime, or nighttime SBP. Discussion: Negative net worth was associated with a 4.3 mm Hg higher daytime, and 4.1 mm Hg nighttime SBP independent of education and income. Future research is needed to determine the prospective impact of net worth on long-term CVD risk in AA women.

Introduction: Stressful life events (SLE) have been associated with poor cardiovascular health but most studies have focused on stressors that directly impact the individuals under study, or personal stressors. Research suggests that women, particularly African-American women, may actually be more vulnerable to network stressors (e.g. SLE that impact important others, such as children, spouses and friends). However, few studies have examined this phenomenon. Hypothesis: We tested the hypothesis that greater exposure to network, versus personal stressors, would be associated with elevated clinic blood pressure (BP) as well as BP in daily life, assessed via 48-hour ambulatory monitoring. Methods: Participants were 395 African-American women aged 30-45 (Mean= 39.5 ±4.6 yrs) from a range of educational backgrounds recruited from a large southeastern metropolitan area. SLE were assessed using a 22-item Stressful Life Events checklist and further classified into personal (e.g. “major accident/assault/robbery happened to you”) or network (e.g. “serious physical illness, injury or drug/alcohol problem in someone family member/friend”) stressors and summed. Clinic and 48-hr ambulatory BP measurements were assessed and sustained hypertension (HTN) was defined as both clinic (≥130/80mmHg) and ambulatory HTN (≥130/80mmHg), using 2017 AHA/ACC guidelines. Logistic regression analyses were used to examine the associations between types of stressors and sustained HTN after adjusting for age, education, body mass index, and BP meds. Results: Approximately 51.2% (N=211) of women had clinic HTN and 29.9% (N=123) of women had sustained HTN (elevated in both clinic and in daily life). In unadjusted multivariable logistic regression analyses, each additional network stressor was associated with a greater likelihood of having elevated clinic (OR-1.21 [1.04-1.40]) and sustained HTN (OR- OR-1.22 [1.04-1.43]). Findings for clinic (OR-1.25, [1.06-1.48]) and sustained HTN (OR-1.23, [1.04-1.46]) remained significant after adjustment for covariates. There were no significant associations between reports of personal stressors and either clinic, or sustained HTN in unadjusted or adjusted analyses. Discussion: Network, but not personal stressors, were associated with elevated rates of HTN, both in clinic and daily life for African-American women. Future research is needed to determine whether interventions targeting stress management for network stressors specifically might impact BP in this high-risk population.

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.

It is unclear whether black patients with chronic kidney disease (CKD) vs those without CKD who take antihypertensive medication have an increased risk for apparent treatment-resistant hypertension (aTRH). The authors analyzed 1741 Jackson Heart Study participants without aTRH taking antihypertensive medication at baseline. aTRH was defined as uncontrolled blood pressure while taking three antihypertensive medication classes or taking four or more antihypertensive medication classes, regardless of blood pressure level. CKD was defined as an albumin to creatinine ratio ≥30 mg/g or estimated glomerular filtration rate

Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99–1.40), 1.49 (95% confidence interval, 1.19–1.87), and 2.04 (95% confidence interval, 1.56–2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication.

Introduction: Self-reported experiences of discrimination have been linked to indices of cardiovascular disease (CVD). However most studies have focused on healthy populations. Thus, we examined the association between experiences of everyday discrimination and arterial stiffness (a known correlate of adverse outcomes among clinically ill and healthy populations) among Black and White patients with a history of myocardial infarction (MI). Hypothesis: We hypothesized that higher reports of discrimination would be associated with greater arterial stiffness; and that associations would be more pronounced among Blacks overall, and Black women in particular, potentially due to a “double-jeopardy” effect. Methods: Data were from 253 participants (48.6% female, mean age: 50.8 years) who were 6 months post-MI in the Myocardial Infarction and Mental Stress 2 study. Data were collected via self-reported questionnaires, medical chart review, and a clinic visit during which pulse wave velocity was measured noninvasively following a standardized protocol. Results: Reports of discrimination were highest in Black men and women (p=0.008) and arterial stiffness was greatest in Black and White women (p=0.290). After adjustment for demographics and relevant clinical variables, discrimination was not associated with arterial stiffness in the overall cohort, or among Blacks. However, discrimination was associated with increased arterial stiffness among Black women but not White women, White men, or Black men (Table 1). Conclusions: In conclusion, despite no apparent association between discrimination and arterial stiffness in the overall study sample, further stratification revealed an association among Black women but not other race-gender groups. These data not only support the double-jeopardy hypothesis, but also suggest the importance of implementing psychosocial interventions and coping strategies into the care of clinically ill Black women.

Ambulatory blood pressure monitoring (ABPM) can detect phenotypes associated with increased cardiovascular disease (CVD) risk. Diabetes is associated with increased CVD risk but few data are available documenting whether blood pressure (BP) phenotypes, detected by ABPM, differ between individuals with versus without diabetes. We conducted a cross-sectional analysis of 567 participants in the Jackson Heart Study, a population-based study of African Americans, taking antihypertensive medication to evaluate the association between diabetes and ABPM phenotypes. Two clinic BP measurements were taken at baseline following a standardized protocol. ABPM was performed for 24 h following the clinic visit. ABPM phenotypes included daytime, sustained, nocturnal and isolated nocturnal hypertension, a non-dipping BP pattern, and white coat, masked and masked isolated nocturnal hypertension. Diabetes was defined as fasting glucose greater than or equal to126 mg dl−1, haemoglobin A1c greater than or equal to6.5% (48 mmol mol−1) or use of insulin or oral hypoglycaemic medications. Of the included participants (mean age 62.3 years, 71.8% female), 196 (34.6%) had diabetes. After multivariable adjustment, participants with diabetes were more likely to have daytime hypertension (prevalence ratio (PR): 1.32; 95% confidence interval (CI): 1.09–1.60), masked hypertension (PR: 1.46; 95% CI: 1.11–1.93) and masked isolated nocturnal hypertension (PR: 1.39; 95% CI: 1.02–1.89). Although nocturnal hypertension was more common among participants with versus without diabetes, this association was not present after adjustment for daytime systolic BP. Diabetes was not associated with the other ABPM phenotypes investigated. This study highlights the high prevalence of ABPM phenotypes among individuals with diabetes taking antihypertensive medication.

The aim of the study was to identify the association of systolic blood pressure (SBP) levels with cardiovascular events, all-cause mortality, and falls among elderly persons taking antihypertensive medication.US adults ≥ 45 years of age taking antihypertensive medication enrolled in the REGARDS study were categorized into 3 age groups: 55-64, 65-74 and ≥ 75 years old and baseline on-treatment SBP levels. Our primary analyses focused on incident cardiovascular disease (CVD) (n=9787) and all-cause mortality (n=13,948).During follow-up, 530 (5.4%) participants had CVD events and 2095 (15%) participants died. After multivariable adjustment among participants ≥ 75, the incidence of CVD per 1000 person-years (95% confidence interval) was 16.9 (11.1-25.7), 13.4 (9.2-19.7), 11.6 (7.6-17.7), 17.8 (11.2-27.5) and 36.7 (26.6-50.8) at SBP levels of120, 120-129, 130-139, 140-149, and ≥ 150 mmHg, respectively. For the same SBP categories, the adjusted CVD incidence rates were 9.3 (7.2-12.0), 10.0 (8.1-12.3), 9.4 (7.5-11.8), 14.0 (11.0-17.8), and 16.4 (12.5-21.4), respectively, among participants 55-64 years, and 16.5 (13.6-21.5), 17.4 (14.8-20.6), 19.2 (16.4-22.5), 22.3 (18.6-26.9), and 27.6 (22.7-33.4), respectively, for participants 65-74 years. Among participants aged 55-64 and 65-74 years, a linear association was present between higher SBP categories and all-cause mortality risk (each p-trend0.001). In contrast, for participants ≥ 75 years no association was present between SBP and all-cause mortality (p-trend=0.319). No association was observed between SBP and falls among participants in all age groups.Among adults aged ≥ 55 taking antihypertensive medication, SBP between 120 and 139 mmHg was significantly associated with a reduced risk for cardiovascular and all-cause mortality outcomes.

AIM: To explore the relationship between injury risk among child occupants involved in motor vehicle collisions according to the age of the vehicle driver. METHODS: The National Automotive Sampling System Crashworthiness Data System 2000-2009 (n = 10 797) was used to identify demographic, vehicle-, collision- and injury-related characteristics among motor vehicle collision occupants ≤15 years of age. The association between the age of the driver (older vs. younger, defined as individuals RESULTS: Of the child occupants in motor vehicle collisions, 2.9% were driving with an older driver, and approximately 2.9% were injured while driving with a younger driver (odds ratio 1.03; 95% confidence interval 0.55-1.91). After adjusting for child occupant age, gender, restraint use, seat position and vehicle type, there remained no significant association between the age of the driver (older vs. younger) and the risk of injury (odds ratio 0.92; 95% confidence interval 0.49-1.74). CONCLUSIONS: These findings add to the body of literature indicating no difference in injury risk found among children when considering the age of the driver. Research is needed to ascertain the association and further evaluate characteristics more specific to the relationship being explored in this study. Language: en

To determine the prevalence, types and characteristics associated with complementary and alternative medicine (CAM) use to treat eye-related diseases and conditions.The 2002 and 2007 National Health Interview Survey (NHIS) was used to identify participants, 18 years of age and older, who completed the Adult Alternative Health/Complementary and Alternative Medicine questionnaire. Characteristics for those who reported CAM use for eye diseases and conditions and those who did not were compared; the types of CAM and the eye diseases and conditions for their use were also reported.In 2002, an estimated 0.1% of US adults reported using at least one of eight CAM therapies for eye-related problems; in 2007 the prevalence of CAM use for eye diseases and conditions had increased to 0.3%. In both 2002 and 2007, those who reported CAM use for eye diseases and conditions were more likely to be older, female, white and married. In both 2002 and 2007, the most common types of CAM therapies used were natural herbs and vitamin supplements. Macular degeneration was the most common condition for which CAM therapies were used.The study suggests that there is a small and perhaps increasing proportion of the US population that uses CAM for eye diseases and conditions. Further research is needed to determine the use and effectiveness of CAM for ophthalmologic purposes.

The 2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) raised the systolic blood pressure (SBP) threshold for treatment initiation and goal attainment to 150 mmHg in adults 60 years and older without a history of diabetes or chronic kidney disease (CKD). Using data from the nationwide Reasons for Geographic and Racial Difference in Stroke (REGARDS) study, we examined the association between SBP levels and cardiovascular disease (CVD), coronary heart disease (CHD), and stroke among adults ≥60 years of age. We excluded participants with a history of diabetes, CKD, and diastolic blood pressure (DBP) ≥90 mmHg. Baseline REGARDS data were collected during telephone interviews and in-home study visits in 2003 through 2007 and included two blood pressure measurements following a standardized protocol. SBP was categorized as

Masked hypertension is associated with increased risk for cardiovascular disease. Identifying modifiable risk factors for masked hypertension could provide approaches to reduce its prevalence. Life’s Simple 7 is a measure of cardiovascular health developed by the American Heart Association that includes body mass index, physical activity, diet, cigarette smoking, blood pressure (BP), cholesterol, and glucose. We examined the association between cardiovascular health and masked daytime hypertension in the Jackson Heart Study, an exclusively African American cohort. Life’s Simple 7 factors were assessed during a study visit and categorized as poor, intermediate, or ideal. Ambulatory BP monitoring was performed after the study visit. Using BP measured between 10:00 am and 8:00 pm on ambulatory BP monitoring, masked daytime hypertension was defined as mean clinic systolic BP/diastolic BP

Falls are common and associated with adverse outcomes in patients on dialysis. Limited data are available in earlier stages of CKD.We analyzed data from 8744 Reasons for Geographic and Racial Differences in Stroke Study participants ≥65 years old with Medicare fee for service coverage. Serious fall injuries were defined as a fall-related fracture, brain injury, or joint dislocation using Medicare claims. Hazard ratios (HRs) for serious fall injuries were calculated by eGFR and albumin-to-creatinine ratio (ACR). Among 2590 participants with CKD (eGFR60 ml/min per 1.73 m(2) or ACR≥30 mg/g), cumulative mortality after a serious fall injury compared with age-matched controls without a fall injury was calculated.Overall, 1103 (12.6%) participants had a serious fall injury over 9.9 years of follow-up. The incidence rates per 1000 person-years of serious fall injuries were 21.7 (95% confidence interval [95% CI], 20.3 to 23.2), 26.6 (95% CI, 22.6 to 31.3), and 38.3 (95% CI, 31.2 to 47.0) at eGFR levels ≥60, 45-59, and45 ml/min per 1.73 m(2), respectively, and 21.3 (95% CI, 20.0 to 22.8), 31.7 (95% CI, 27.5 to 36.5), and 42.2 (95% CI, 31.3 to 56.9) at ACR levels30, 30-299, and ≥300 mg/g, respectively. Multivariable adjusted HRs for serious fall injuries were 0.91 (95% CI, 0.76 to 1.09) and 1.09 (95% CI, 0.86 to 1.37) for eGFR=45-59 and45 ml/min per 1.73 m(2), respectively, versus eGFR≥60 ml/min per 1.73 m(2) and 1.31 (95% CI, 1.11 to 1.54) and 1.81 (95% CI, 1.30 to 2.50) for ACR=30-299 and ≥300 mg/g, respectively, versus ACR30 mg/g. Among participants with CKD, cumulative 1-year mortality rates among patients with a serious fall and age-matched controls were 21.0% and 5.5%, respectively.Elevated ACR but not lower eGFR was associated with serious fall injuries. Evaluation for fall risk factors and fall prevention strategies should be considered for older adults with elevated ACR.

Several ambulatory blood pressure monitoring (ABPM) phenotypes including masked hypertension are associated with an increased risk for cardiovascular disease (CVD). Diabetes is associated with CVD risk as well as a higher prevalence of hypertension. However, little is known about whether ABPM phenotypes differ between individuals with versus without diabetes. We evaluated the association between diabetes and ABPM phenotypes including clinic hypertension, awake hypertension, sustained hypertension, nocturnal hypertension, non-dipping pattern, white coat hypertension, and masked hypertension in the Jackson Heart Study (JHS). Baseline data collection included two clinic blood pressure measurements using standardized protocols. ABPM measurements were taken in the 24 hours following the baseline visit. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or use of diabetes medications. Of the 1,032 JHS participants with valid ABPM data (67.7% female, mean age 59.2 years), 253 (24.5%) had diabetes. The prevalence of clinic hypertension was similar for participants with and without diabetes (Table 1). After multivariable adjustment, diabetes was associated with an increased prevalence ratio of awake, sustained, and masked hypertension and a lower prevalence ratio of white coat hypertension compared with individuals without diabetes. In summary, there was an increased prevalence of adverse blood pressure phenotypes among individuals with versus those without diabetes that was not captured in the clinic setting alone. The role of ABPM for identifying high risk individuals with diabetes should be further investigated.

Blood pressure (BP) can differ substantially when measured in the clinic versus outside of the clinic setting. Few population-based studies with ambulatory blood pressure monitoring (ABPM) include African Americans. We calculated the prevalence of clinic hypertension and ABPM phenotypes among 1,016 participants in the population-based Jackson Heart Study, an exclusively African-American cohort. Mean daytime systolic BP was higher than mean clinic systolic BP among participants not taking antihypertensive medication (127.1[standard deviation 12.8] versus 124.5[15.7] mmHg, respectively) and taking antihypertensive medication (131.2[13.6] versus 130.0[15.6] mmHg, respectively). Mean daytime diastolic BP was higher than clinic diastolic BP among participants not taking antihypertensive medication (78.2[standard deviation 8.9] versus 74.6[8.4] mmHg, respectively) and taking antihypertensive medication (77.6[9.4] versus 74.3[8.5] mmHg, respectively). The prevalence of daytime hypertension was higher than clinic hypertension for participants not taking antihypertensive medication (31.8% versus 14.3%) and taking antihypertensive medication (43.0% versus 23.1%). A high percentage of participants not taking and taking antihypertensive medication had nocturnal hypertension (49.4% and 61.7%, respectively), white coat hypertension (30.2% and 29.3%, respectively), masked hypertension (25.4% and 34.6%, respectively), and a non-dipping BP pattern (62.4% and 69.6%, respectively). In conclusion, these data suggest hypertension may be misdiagnosed among African Americans without using ABPM.

The authors examined trends in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the prevalence, awareness, treatment, and control of hypertension in 1988–1994 (n=1164), 1999–2004 (n=1,026), and 2005–2010 (n=1048) among US adults 80 years and older in serial National Health and Nutrition Examination Surveys. Hypertension was defined as SBP ≥140 mm Hg, DBP ≥90 mm Hg, or use of antihypertensive medication. Awareness and treatment were defined by self-report and control as SBP/DBP

It has been long recognized that hypertension is an important risk factor for cardiovascular disease and mortality.(1) Traditionally, a high burden of hypertension and its adverse consequences has been mistakenly thought to be an affliction of only economically developed countries.(2) However, studies over the past two decades have reported the majority of people in many economically developing countries have blood pressure above the levels considered optimal with a high prevalence of hypertension present.(3–5) Although a high prevalence of hypertension in all world regions has been previously reported, a recent publication from the Global Burden of Disease (GBD) Study has placed a renewed focus on the heavy toll high blood pressure is having in all regions of the world.(6,7)

To explore the relationship between age-related macular degeneration (AMD) and hypothyroidism in a population-based sample of adults 50 years and older in the United States.Participants aged 50 years and older (N = 9,677). Of this total, 356 participants reported having AMD and 9321 reported not having AMD.Information pertaining to self-reported thyroid disease (specifically hypothyroidism) and AMD was obtained from the 2008 National Health Interview Survey. The association between self-reported data on hypothyroidism and AMD was estimated using logistic regression adjusting for the potentially confounding influence of demographic, behavioral, and health-related characteristics.Of the 356 people with AMD, 20.9% reported hypothyroidism compared to 11.2% of those 9,321 without AMD (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.69-3.21). After adjusting for the confounding influence of age, sex, smoking, and race, the association between AMD and hypothyroidism remained significant (OR 1.59; 95% CI 1.10-2.30).The results of this study add to the small body of literature indicating a possible relationship between AMD and hypothyroidism. As many of the risk factors for AMD are also risk factors for hypothyroidism, future studies are warranted to ascertain the relationship between the two diseases.

IntroductionAbnormal 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.MethodsMedical 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.ResultsOf 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 ConclusionsAn 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.