Herman Taylor, Jr, MD, MPH on the Jackson Heart Study Key Takeaways: The Importance of Blood Pressure Control

In this video, Herman Taylor, Jr, MD, MPH, highlights the importance of blood pressure control among African Americans. It was one of the takeaways from his keynote address on the Jackson Heart Study that he presented during the American Society for Preventive Cardiology’s Virtual Summit.

Additional Resource:

• Jackson Heart Study. Jackson Heart Study. Accessed October 1, 2020. https://www.jacksonheartstudy.org/

Herman Alfred Taylor, Jr, MD, MPH, is a professor of medicine and the director of the Cardiovascular Research Institute at the Morehouse School of Medicine. Previously, he led the Jackson Heart Study.

TRANSCRIPT:

Hello, everyone. This is Herman Taylor. I’m a cardiologist at the Morehouse School of Medicine where I direct the Cardiovascular Research Institute. Prior to taking that role, however, I had the great pleasure of career of running the Jackson Heart Study.

Now, in terms of some of the particular messages of the Jackson Heart Study, there are so many that we could enumerate. I’ll pull just a very select few as I try to address in my recent keynote address to the American Society for Preventive Cardiology.

I would naturally and importantly highlight the continued importance of blood pressure control and the hypertension problem in general. Generations of physicians now have almost automatically associated hypertension and African Americans’ racial status in their practice because it, unfortunately, is highly prevalent. We found that in Jackson of course.

In Jackson, by the time a man reaches age 60, that African American man has an 80% chance of already being a hypertension patient.

That type of prevalence is a real scourge and of course, as you know, sets up all kinds of problems for not only cardiovascular system but for renal function and other aspects of health that really can determine length of life and quality of life quite importantly.

The prevalence was documented in our early studies that were cross‑sectional in nature. As time has gone on and as the events have occurred among the cohort of the Jackson Heart Study, we got a much stronger impression, if you will, of the incidents even among those who were not hypertensive at the beginning of the study.

What we found was a striking incidence as time was going on related to a number of variables, importantly the popularly used Life’s Simple 7 global assessment of cardiovascular health. We found that the more of the ideal cardiovascular health components of people had at baseline, the more likely they were to avoid hypertension development. They had the lowest risk. Those who lacked 6 out of the 7 or 7 out of 7 ideal components were almost certain to get hypertension over the 8 years of follow‑up that the study included.

Incidence is a big problem even with the high levels of awareness that African Americans have, and the Jackson Heart Study actually had even higher than national averages of national studies looking into prevalence awareness and treatment studies.

Also, the importance of hypertension that is not apparent to the physician on a typical clinic visit, very important aspect of management that really needs attention, particularly when you consider that among the individuals that were judged just to have no problem with high blood pressure.

That is either they didn’t have it at all or was controlled because the blood pressure was in the normal range or at target when they were examined in the study. Nearly 50% or in the range of 50% of those individuals were not normal at home.

In other words, 24‑hour blood pressure monitoring suggested that 50% of the people who were normal at our clinical assessment had masked hypertension or had non-dipping patterns in their blood pressure. This is a very critical reservoir of added morbidity for African Americans.

We need to pay attention then as we go forward as to the increasing evidence of the importance of either 24‑hour ambulatory blood pressure monitoring or, at the very least, home blood pressure monitoring as an important part of what we consider when we manage hypertensive patients in general but particularly for African Americans.

These masked hypertensives have dramatically increased risk, as I think most of you know, in the range of 2.5 times the event rates for cardiovascular disease.