Evidence map›Paper›PMID 27920072›Full record

ArticleCirculation2016

Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population: Results From the Masked Hypertension Study.

Joseph E Schwartz, Matthew M Burg, Daichi Shimbo, Joan E Broderick, Arthur A Stone, Joji Ishikawa, Richard Sloan, Tyla Yurgel, Steven Grossman, Thomas G Pickering

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06592209 (Body Electric), which is not on this map. Cited by 54 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 2 pooled it
8.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06592209 nacompletednot on this mapstarted 2023, after this paper: background citation

Body Electric: a Pragmatic Trial Evaluating Movement Breaks As a Public Health Strategy to Mitigate the Harms of Prolonged Sedentary Behavior

TypeinterventionalSponsorColumbia UniversityRan2023 to 2023Enrolled20,217ConditionsSedentary BehaviorArmsSedentary Breaks
3 · Its place in the literature

Who cites it

54 citing papers in PubMed, 2 syntheses or guidelines pooled it, 84 citations in OpenAlex.

  1. Pooled it
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  8. Network stressors, personal stressors, and ambulatory blood pressure in African-American women-Does superwoman schema play a role?Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2023
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  17. Historical Loss: Implications for Health of American Indians in the Blackfeet Community.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Joseph E SchwartzFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.). joseph.schwartz@stonybrookmedicine.edu.
Matthew M BurgFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Daichi ShimboFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Joan E BroderickFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Arthur A StoneFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Joji IshikawaFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Richard SloanFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Tyla YurgelFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Steven GrossmanFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Thomas G PickeringFrom Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
Stony Brook University · USUniversity of Southern California · USYale University · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
CTSA INFRASTRUCTURE FOR PEDIATRIC RESEARCHUL1RR024156 · NCRR · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2006 to 2011
$53.0M
WORKSITE BLOOD PRESSURE STUDYP01HL047540 · NHLBI · WEILL MEDICAL COLLEGE OF CORNELL UNIV · PI SCHWARTZ, JOSEPH E · 1993 to 2014
$27.7M
Clinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2M
World Trade Center Worker and Volunteer Medical Screening ProgramM01RR010710 · NCRR · STATE UNIVERSITY NEW YORK STONY BROOK · PI BAHOU, WADIE F · 1998 to 2009
$17.6M
NCATS NIH HHS UL1 TR000040NCATS NIH HHS UL1 TR001863NCRR NIH HHS M01 RR010710NCRR NIH HHS UL1 RR024156NHLBI NIH HHS P01 HL047540
6 · The paper itself

Abstract

backgroundAmbulatory blood pressure (ABP) is consistently superior to clinic blood pressure (CBP) as a predictor of cardiovascular morbidity and mortality risk. A common perception is that ABP is usually lower than CBP. The relationship of the CBP minus ABP difference to age has not been examined in the United States.

methodsBetween 2005 and 2012, 888 healthy, employed, middle-aged (mean±SD age, 45±10.4 years) individuals (59% female, 7.4% black, 12% Hispanic) with screening BP <160/105 mm Hg and not taking antihypertensive medication completed 3 separate clinic BP assessments and a 24-hour ABP recording for the Masked Hypertension Study. The distributions of CBP, mean awake ABP (aABP), and the CBP-aABP difference in the full sample and by demographic characteristics were compared. Locally weighted scatterplot smoothing was used to model the relationship of the BP measures to age and body mass index. The prevalence of discrepancies in ABP- versus CBP-defined hypertension status-white-coat hypertension and masked hypertension-were also examined.

resultsAverage systolic/diastolic aABP (123.0/77.4±10.3/7.4 mm Hg) was significantly higher than the average of 9 CBP readings over 3 visits (116.0/75.4±11.6/7.7 mm Hg). aABP exceeded CBP by >10 mm Hg much more frequently than CBP exceeded aABP. The difference (aABP>CBP) was most pronounced in young adults and those with normal body mass index. The systolic difference progressively diminished, but did not disappear, at older ages and higher body mass indexes. The diastolic difference vanished around age 65 and reversed (CBP>aABP) for body mass index >32.5 kg/m

conclusionsContrary to a widely held belief, based primarily on cohort studies of patients with elevated CBP, ABP is not usually lower than CBP, at least not among healthy, employed individuals. Furthermore, a substantial proportion of otherwise healthy individuals with nonelevated CBP have masked hypertension. Demonstrated CBP-aABP gradients, if confirmed in representative samples (eg, NHANES [National Health and Nutrition Examination Survey]), could provide guidance for primary care physicians as to when, for a given CBP, 24-hour ABP would be useful to identify or rule out masked hypertension.

Indexed as

Blood Pressure Monitoring, AmbulatoryAdultAgedBlood PressureBody Mass IndexFemaleHumansMaleMasked HypertensionMiddle AgedPhenotypeUnited Statesblood pressureblood pressure monitoring, ambulatorymasked hypertension

Identifiers

PMID27920072
PMCPMC5151173
OpenAlexW2567329484

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.