Genetics of Hypertension in African Americans and Others of African Descent

Zilbermint, Mihail; Hannah‐Shmouni, Fady; Stratakis, Constantine A.

doi:10.3390/ijms20051081

Cited by 58 publications

(39 citation statements)

References 106 publications

(133 reference statements)

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“…African American patients have a low renin phenotype leading to a suppressed renin-angiotensin-aldosterone system. This theoretically confers a benefit in terms of developing acute respiratory distress syndrome, which is associated with angiotensin-1 (AT1) receptor activation [ 12 ]. However, given their high prevalence of comorbidities, including heart failure, chronic kidney disease, diabetes, and hypertension, they are also at very high risk of developing COVID-19-related complications, including AKI [ 8 , 9 , 10 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Pelayo

Bhargav

et al. 2020

Cardiorenal Med

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Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO 2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Pelayo

Bhargav

et al. 2020

Cardiorenal Med

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“…These and other pathways of immune-mediated inflammatory disease are in contrast to infection-related cytokine storms (refs). It is also well understood that genetic variants with different allele frequencies in human populations are a result of a group’s ancestral history, some of which have direct relevance to human health and population-specific risk for disease [ 13 ]. Together, assuming that such factors are revealed, what remains as a critical gap is a thorough understanding of the complex interactions between the sociological, psychological, and biological human domains that alter disease susceptibility.…”

Section: Introductionmentioning

confidence: 99%

The Perfect Storm: COVID-19 Health Disparities in US Blacks

Phillips

Park

Robinson

et al. 2020

J. Racial and Ethnic Health Disparities

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Coronavirus disease 2019 (COVID-19) accounts for over 180,000 deaths in the USA. Although COVID-19 affects all racial ethnicities, non-Hispanic Blacks have the highest mortality rates. Evidence continues to emerge, linking the disproportion of contagion and mortality from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a result of adverse social determinants of health. Yet, genetic predisposition may also play a credible role in disease transmission. SARS-CoV-2 enters cells by interaction between SARS-CoV-2 spike protein and the receptor molecule angiotensin converting enzyme 2 (ACE2) expressed on the surface of the target cells, such that polymorphisms and the expression level of ACE2 influence infectivity and consequent pathogenesis of SARS-CoV-2. Genetic polymorphisms in other multiple genes, such as acetylcholinesterase (AChE) and interleukin-6, are also closely associated with underlying diseases, such as hypertension and type 2 diabetes mellitus, which substantially raise SARS-CoV-2 mortality. However, it is unknown how these genetic polymorphisms contribute to the disparate mortality rates, with or without underlying diseases. Of particular interest is the potential that genetic polymorphisms in these genes may be influencing the disparity of COVID-19 mortality rates in Black communities. Here, we review the evidence that biological predisposition for high-risk comorbid conditions may be relevant to our ability to fully understand and therefore address health disparities of COVID-19 deaths in Blacks. Electronic supplementary material The online version of this article (10.1007/s40615-020-00871-y) contains supplementary material, which is available to authorized users.

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“…Emerging research reveals a new role for neutrophils in hypertension [ 58 ]. The presence of a salt-sensitive gene that regulates vascular resistance and renal sodium transport in African Americans increases the risk of developing high blood pressure [ 59 ]. This particular gene is a variant of the angiotensin-converting enzyme that enhances the release of AT-II, a vasoconstrictor.…”

Section: African Americans Are Disproportionately Affected By Inflammmentioning

confidence: 99%

Do free radical NETwork and oxidative stress disparities in African Americans enhance their vulnerability to SARS-CoV-2 infection and COVID-19 severity?

Kalyanaraman¹

2020

Redox Biology

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This review focuses on the hypothetical mechanisms for enhanced vulnerability of African Americans to SARS-CoV-2 infection, COVID-19 severity, and increased deaths. A disproportionately higher number of African Americans are afflicted with autoimmune and inflammatory diseases ( e.g. , diabetes, hypertension, obesity), and SARS-CoV-2 has helped expose these health disparities. Several factors including socioeconomic status, inferior health care, and work circumstances contribute to these disparities. Identifying potential inflammatory biomarkers and decreasing basal levels in high-risk individuals with comorbidities through preventive measures is critical. Immune cells, particularly neutrophils, protect us against pathogens (bacteria, fungi, and viruses) through increased generation of free radicals or oxidants and neutrophil extracellular traps (NETs) that ensnare pathogens, killing them extracellularly. However, continued generation of NETs coupled with the lack of prompt removal pose danger to host cells. NET levels are increased during pro-inflammatory diseases. COVID-19 patients exhibit elevated NET levels, depending upon disease severity. Conceivably, high-risk individuals with elevated basal NET levels would exhibit hyper-inflammation when infected with SARS-CoV-2, amplifying disease severity and deaths. Drugs inhibiting oxidant formation and vitamin supplements decreased NET formation in mice models of inflammation. Thus, it is conceivable that preventive treatments lowering NET levels and inflammation in high-risk individuals could mitigate SARS-CoV-2-induced complications and decrease mortality.

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Genetics of Hypertension in African Americans and Others of African Descent

Cited by 58 publications

References 106 publications

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

The Perfect Storm: COVID-19 Health Disparities in US Blacks

Do free radical NETwork and oxidative stress disparities in African Americans enhance their vulnerability to SARS-CoV-2 infection and COVID-19 severity?

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