All ETDs from UAB

Advisory Committee Chair

Paul Muntner

Advisory Committee Members

Byron C Jaeger

Cora E Lewis

James M Shikany

Yuichiro Yano

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


High mean blood pressure (BP) on ambulatory BP monitoring (ABPM) is a strong risk factor for left ventricular hypertrophy (LVH), an early manifestation of hypertension-related cardiovascular disease (CVD). Typically, 48-72 systolic and diastolic BP (SBP and DBP) readings are obtained on a 24-hour ABPM recording. The large number of readings from ABPM allows for the estimation of parameters beyond mean BP that capture level and fluctuation in BP over 24-hours, which may be useful for identifying individuals at high risk for CVD. The measures of BP level other than mean BP obtained from ABPM recording include BP load (percentage of BP readings in hypertensive range) and peak or maximum BP, and measures of BP fluctuation that include BP variability and peak increase in BP (i.e., difference in peak BP and mean BP). Additionally, Black adults have higher levels of mean BP over 24-hours of ABPM as compared to White adults. However, there are limited data examining racial differences in the other measures of level and fluctuation in BP on ABPM. The goal of this dissertation was to examine the association of ABPM parameters beyond mean BP with LVH, and to compare the racial differences in these parameters using a pooled cohort of five US-based studies. Among 2,892 participants who underwent complete ABPM, higher measures of level for awake and asleep SBP and DBP were associated with a higher prevalence of LVH. In addition, higher awake mean, load and peak SBP were iv each associated with a higher prevalence of LVH among participants with and without 24-hour hypertension. However, there was no evidence of association between measures of fluctuation in SBP and DBP with LVH. Among 2,580 Black and White participants in the pooled cohort, Black compared with White participants were more likely to have higher measures of level for asleep mean, load and peak SBP and DBP, and higher measures of fluctuation for awake variability and peak increase in DBP. These results can help formulate strategies to identify high-risk individuals who may be over-looked when only using mean BP on ABPM and intervene for early detection and/or prevention of CVD.

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