Associations of Awake and Asleep Blood Pressure and Blood Pressure Dipping with Abnormalities of Cardiac Structure: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

Objectives:

To evaluate the associations of high awake blood pressure (BP), high asleep BP, and non-dipping BP, determined by ambulatory BP monitoring (ABPM), with left ventricular (LV) hypertrophy (LVH) and geometry.

Methods:

Black and white participants (n=687) in the Coronary Artery Risk Development in Young Adults (CARDIA) study underwent 24-hour ABPM and echocardiography at the Year 30 Exam in 2015–2016. The prevalence and prevalence ratios (PR) of LVH were calculated for high awake systolic BP (≥ 130 mmHg), high asleep systolic BP (≥ 110 mmHg), the cross-classification of high awake and asleep systolic BP, and non-dipping systolic BP (percentage decline in awake-to-asleep systolic BP < 10%). Odds ratios (ORs) for abnormal LV geometry associated with these phenotypes were calculated.

Results:

Overall, 46.0% and 49.1% of study participants had high awake and asleep systolic BP, respectively, and 31.1% had non-dipping systolic BP. After adjustment for demographics and clinical characteristics, high awake systolic BP was associated with a PR for LVH of 2.79, (95% confidence interval [95% CI] 1.63–4.79). High asleep systolic BP was also associated with a PR for LVH of 2.19 (95% CI 1.25–3.83). There was no evidence of an association between non-dipping systolic BP and LVH (PR 0.70, 95% CI 0.44–1.12). High awake systolic BP with or without high asleep systolic BP was associated with a higher OR of concentric remodeling and hypertrophy.

Conclusion:

Awake and asleep systolic BP, but not the decline in awake-to-asleep systolic BP, were associated with increased prevalence of cardiac end-organ damage.

Condensed Abstract

In a cross-sectional analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, we examined the associations of high awake blood pressure (BP), high asleep BP, and non-dipping BP with left ventricular hypertrophy (LVH) and geometry. High awake systolic BP and high asleep systolic BP were associated with a higher prevalence of LVH after multivariable adjustment. There was no evidence of an association between non-dipping systolic BP and LVH. High awake systolic BP was also associated with concentric remodeling and hypertrophy.