All ETDs from UAB

Advisory Committee Chair

Paul Muntner

Advisory Committee Members

April Carson

Gary Cutter

Suzanne Oparil

Daichi Shimbo

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Hypertension and diabetes are common and are known risk factors for cardiovascular disease (CVD). Several blood pressure (BP) phenotypes, identified by ambulatory BP monitoring (ABPM), have been reported to be associated with an increased risk for CVD. However, there are few data on ABPM phenotypes among individuals with diabetes. Identifying modifiable factors that improve cardiovascular health may reduce CVD events and the prevalence of ABPM phenotypes, such as masked hypertension. Given the ability of ABPM to identify unconventional BP phenotypes that provide prognostic information beyond clinic BP, it is important to understand the optimal number of 24-hour ABPM readings necessary to detect these phenotypes. However, there are no empirical data for comparing previously used criteria for considering a 24-hour ABPM reading complete. The goal of this dissertation was to determine factors, such as diabetes and overall cardiovascular health, that may increase or reduce the occurrence of ABPM phenotypes and to evaluate outcomes associated with the presence of these phenotypes in the Jackson Heart Study (JHS). We observed a higher prevalence of daytime, masked, and masked isolated nocturnal hypertension among those with compared to without diabetes. We found that better cardiovascular health and separately, better diet, not smoking, and having ideal clinic BP was associated with a lower prevalence of masked daytime hypertension. Finally, in a study comparing previously used criteria to consider a 24-hour ABPM reading complete, we did not observe a difference in the prevalence of ABPM phenotypes when compared by criteria. Additionally when stratified by criteria, there was no significant difference in mean left ventricular mass index (LVMI) or in the prevalence of LV hypertrophy (LVH) among those with compared to without ABPM phenotypes. In conclusion, this dissertation highlights the importance of ABPM by examining the association between diabetes and overall cardiovascular health with unconventional BP phenotypes. This work compared the prevalence of unconventional BP phenotypes and the association between these BP phenotypes with LVMI, and separately LVH by criteria to consider a 24-hour ABPM reading complete. Evaluating these BP phenotypes may help inform hypertension treatment guidelines.

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