Lifestyle behaviors among adults recommended for ambulatory blood pressure monitoring according to the 2017 ACC/AHA blood pressure guideline.

Background The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline recommends ambulatory BP monitoring (ABPM) to exclude white coat hypertension (WCH) among adults with office systolic BP (SBP)/diastolic BP (DBP) of 130-159/80-99 mmHg, and masked hypertension (MHT) among adults with office SBP/DBP of 120-129/75-79 mmHg after a 3-month trial of lifestyle modification. We estimated the proportion of individuals with ideal lifestyle factors among those who meet these office BP criteria for being recommended ABPM. Methods We analyzed data from participants not taking antihypertensive medication in the Coronary Artery Risk Development in Young Adults (CARDIA) and Jackson Heart Study (JHS) who met the office BP criteria for screening for WCH (CARDIA n=490, JHS n=873) and MHT (CARDIA n=486, JHS n=614). We estimated the prevalence of lifestyle factors including ideal body mass index (BMI), physical activity, diet and alcohol use among participants who met office BP criteria for WCH screening and for MHT screening. Results Among participants who met office BP criteria for WCH screening, 15.5% in CARDIA and 3.6% in JHS had 3 or more ideal lifestyle factors. Among participants who met office BP criteria for MHT screening, 22.6% in CARDIA and 4.7% in JHS had 3 or more ideal lifestyle factors. Ideal BMI, diet, and physical activity was present in less than half of participants in each sample who met office BP criteria for WCH or MHT screening. Conclusions Few participants who met office BP criteria for the screening of WCH or MHT had ideal lifestyle factors.