BackgroundGlobally hypertension is stabilising, but in sub-Saharan Africa the incidence
of hypertension remains on an increase. Although this might be attributed to
poor healthcare and ineffective antihypertensive treatment, there is a
limited understanding of population and individual-specific cardiovascular
pathophysiology – necessary for effective prevention and treatment
strategies in Africa. As there is a lack of longitudinal studies tracking
the early pathophysiological development of hypertension in black
populations, the African-PREDICT study was initiated. The purpose of this
paper is to describe the detailed methodology and baseline cohort profile of
the study.Methods and resultsFrom 2013 to 2017, the study included 1202 black (N = 606)
and white (N = 596) men and women (aged 20–30 years) from
South Africa – screened to be healthy and clinic normotensive. At baseline,
and each 5-year follow-up examination, detailed measures of health
behaviours, cardiovascular profile and organ damage are taken. Also,
comprehensive biological sampling for the ‘omics’ and biomarkers is
performed. Overall, the baseline black and white cohort presented with
similar ages, clinic and 24-hour blood pressures, but black adults had lower
socioeconomic status and higher central systolic blood pressure than white
individuals.ConclusionsThe prospective African-PREDICT study in young black and white adults will
contribute to a clear understanding of early cardiovascular disease
development.
Already at very young ages (6-8 years), with a high proportion of prehypertension, black boys in our study have increased arterial stiffness in all sections of the arterial tree, along with higher DBP, carotid intima-media thickness and AGEs. This phenotype underlines the increasing trend of early-onset vascular aging among black populations.
The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring nighttime blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events. We analyzed nighttime blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the J-HOP study (Japan Morning Surge-Home Blood Pressure). During a follow-up period of 7.6±3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive, and 80.7% of participants were using antihypertensive medication. Nighttime home systolic blood pressure (SBP) was higher compared to nighttime ambulatory SBP (123.0±14.6 versus 120.3±14.4 mm Hg,
P
<0.001). Nocturnal hypertension was defined as nighttime home or ambulatory SBP of ≥120 mm Hg. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events: total cardiovascular events (coronary artery disease and stroke events; 1.78 [1.00–3.15]) and stroke (2.65 [1.14–6.20]), independent of office SBP. These results were absent with nocturnal hypertension defined by ABPM. This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP) is a predictor of future cardiovascular events.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.