Blood Pressure Phenotypes Defined by Ambulatory Blood Pressure Monitoring and Carotid Artery Changes in Community-Dwelling Older Japanese Adults: The Ohasama Study

Blood Pressure Phenotypes Defined by Ambulatory Blood Pressure Monitoring and Carotid Artery Changes in Community-Dwelling Older Japanese Adults: The Ohasama Study

AYAMI FUJITA,¹ AZUSA HARA,^1,2 MASAHIRO KIKUYA,^3,4 KEI ASAYAMA,^3,5 MICHIHIRO SATOH,⁶ KAORI ASAKURA,¹ YORIKO SHINTANI,⁷ SHINYA UCHIDA,³ YUKO TAKATSUJI,³ TAKAHISA MURAKAMI,⁶ TAKUO HIROSE,^8,9 MEGUMI TSUBOTA-UTSUGI,¹⁰ RYUSUKE INOUE,¹¹ KYOKO NOMURA,¹² HIROHITO METOKI,^4,6 ATSUSHI HOZAWA,^4,13 SEIKO MIYAZAKI,¹ YUTAKA IMAI⁵ and TAKAYOSHI OHKUBO,^3,5

¹Department of Social Pharmacy and Regulatory Science, Showa Pharmaceutical University, Tokyo, Japan
²Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
³Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
⁴Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
⁵Tohoku Institute for Management of Blood Pressure, Sendai, Miyagi, Japan
⁶Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
⁷Fukuoka Institute of Health and Environmental Sciences, Dazaifu, Fukuoka, Japan
⁸Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
⁹Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
¹⁰Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
¹¹Department of Medical Information Technology Center, Tohoku University Hospital, Sendai, Miyagi, Japan
¹²Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
¹³Department of Personalized Prevention and Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan

White coat hypertension is defined as elevated blood pressure in the office, but a normal blood pressure out-of-office, whereas masked hypertension is defined as elevated blood pressure in the office, but normal out-of-office blood pressure. The objective was to investigate the associations between these blood pressure phenotypes and carotid artery changes. Conventional blood pressure, ambulatory blood pressure, and carotid ultrasonography were evaluated in 851 Ohasama residents (31.8% men; mean age 66.3 years). The blood pressure phenotypes were defined by the ordinary thresholds (140/90 mmHg for conventional blood pressure, 135/85 mmHg for daytime blood pressure) and then by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) thresholds for hypertension (130/80 mmHg for both conventional and daytime blood pressure), irrespective of antihypertensive medication treatment status. Blood pressure phenotypes were linearly associated with the mean intima-media thickness of the carotid artery in ascending order for sustained normal blood pressure, white coat hypertension, masked hypertension, and sustained hypertension according to the ordinary thresholds and the 2017 ACC/AHA thresholds (both linear trends P < 0.0001) after adjustments for possible confounding factors. The odds ratios for the presence of carotid plaques showed similar linear trends with the blood pressure phenotypes according to the 2017 ACC/AHA thresholds (linear trend P < 0.0191). In conclusion, there was a close relationship between blood pressure phenotypes and carotid artery changes, suggesting that blood pressure phenotypes as defined by ambulatory blood pressure are potentially useful for risk stratification of carotid artery changes in the Japanese general population.

Keywords —— ambulatory blood pressure; carotid intima-media thickness; carotid plaque; masked hypertension; white coat hypertension

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Tohoku J. Exp. Med., 2020 252, 269-279.

Correspondence: Masahiro Kikuya, M.D., Ph.D., Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.

e-mail: Kikuyam@med.teikyo-u.ac.jp