Thursday, May 15, 2025 5/15/2025

Automated clinic blood pressure assessment and detection of white coat and masked hypertension study in African Americans

Award Number: R01HL146636
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Automated clinic blood pressure assessment and detection of white coat and masked hypertension study in African Americans - Blood pressure (BP) measurement by a provider in the clinic, “attended clinic BP”, is the primary method for diagnosing and managing hypertension (HTN). BP may differ inside versus outside of clinic. Ambulatory BP monitoring (ABPM) measures out-of-clinic BP. Compared with attended clinic BP, BP during the awake period on ABPM (“awake BP”) is a better predictor of cardiovascular (CVD) risk. Guidelines recommend ABPM to identify white coat HTN (having high clinic BP but not having high awake BP) and masked HTN (not having high clinic BP but having high awake BP). In most ABPM studies, white coat HTN is not associated with an increased risk of target organ damage and CVD, whereas masked HTN is associated with a two times increased risk of target organ damage and CVD. African Americans have a high prevalence of white coat and masked HTN. A question has arisen: is there a better approach to measure clinic BP without the need to conduct ABPM. One approach is to use an automated oscillometric device to measure clinic BP without a provider present (“unattended clinic BP”). In prior studies, compared to attended clinic BP, unattended clinic BP has been closer to awake BP, suggesting that unattended clinic BP may reduce the likelihood of white coat HTN. However, these studies had several methodological limitations: the order of clinic BP measurements was not randomized; attended and unattended clinic BP were not measured in the same individuals; attended clinic BP measurement was not performed according to guidelines; and samples were small, did not include African Americans, and only included those with high clinic BP. Scarce data also exist on whether unattended clinic BP reduces the likelihood of masked HTN. The goal of the study is to determine whether unattended versus attended clinic BP is closer to awake BP on ABPM, and whether unattended versus attended BP reduces the likelihood of white coat and masked HTN. We will enroll 2,775 adults from the fourth exam of the Jackson Heart Study (JHS), an African American cohort. Unattended and attended clinic BP measurement will be performed in random order using the same oscillometric device with attended BP performed according to guidelines; 24-hour ABPM will be conducted. Left ventricular hypertrophy (LVH) and chronic kidney disease (CKD) will be assessed. In Primary Aim 1, we will compare the mean absolute within-individual difference between clinic BP and awake BP on ABPM when clinic BP is measured unattended versus attended. In Primary Aim 2, we will compare the group prevalence of white coat HTN and masked HTN when clinic BP is measured unattended versus attended. In Primary Aim 3, we will determine whether masked HTN, defined using unattended clinic BP, is associated with LVH and CKD. This study will provide high quality empiric evidence which may impact future HTN guidelines. If unattended versus attended clinic BP is closer to awake BP on ABPM, and the likelihood of both white coat and masked HTN are reduced, then unattended BP should be the primary method of clinic BP measurement and ABPM may no longer be necessary.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $669,280 )
2025	2025	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	000	5	1/28/2025	NON-COMPETING CONTINUATION	$669,280
														Subtotal = $669,280

Issue Date FY: 2024 ( Subtotal = $727,389 )
2024	2024	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	000	4	4/16/2024	NON-COMPETING CONTINUATION	$668,011
2024	2024	THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	001	4	6/13/2024	NON-COMPETING CONTINUATION	$59,378
														Subtotal = $727,389

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, THE	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	000	3	5/31/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $757,496 )
2022	2022	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, THE	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	000	3	1/29/2022	NON-COMPETING CONTINUATION	$681,747
2022	2022	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, THE	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	001	3	5/31/2022	NON-COMPETING CONTINUATION	$75,749
														Subtotal = $757,496

Issue Date FY: 2021 ( Subtotal = $761,266 )
2021	2021	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, THE	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	000	2	1/29/2021	NON-COMPETING CONTINUATION	$685,140
2021	2021	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, THE	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	001	2	5/24/2021	NON-COMPETING CONTINUATION	$76,126
														Subtotal = $761,266

Issue Date FY: 2020 ( Subtotal = $792,860 )
2020	2020	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	630 W 168TH ST FL 4	NEW YORK	NY	10032	NEW YORK	USA	Cardiovascular Diseases Research	000	1	2/10/2020	NEW	$792,860
														Subtotal = $792,860

Grand Total All Awards = $3,708,291

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Automated clinic blood pressure assessment and detection of white coat and masked hypertension study in African Americans

Award Number: R01HL146636

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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