Racial Differences in Arterial Stiffness are Mainly Determined by Blood Pressure Levels: Results From the ELSA‐Brasil Study

Abstract

BackgroundBlack people have a higher risk of developing hypertension and presenting higher vascular stiffening. Our aim was to investigate whether the association between race and aortic stiffness could be explained by differences in the primary risk factors.Methods and ResultsWe analyzed data from 11 472 adults (mean age, 51.9±8.9; 53.8% female) self‐reported as white (n=6173), brown (n=3364), or black (n=1935). Their carotid‐to‐femoral pulse wave velocity (cf‐PWV) as well as clinical and anthropometric parameters were measured. cf‐PWV was higher in blacks than in whites or browns (men: white, 9.63±1.81; brown, 9.63±1.88; black, 9.98±1.99; women: white, 8.84±1.64; brown, 9.02±1.68; black, 9.34±1.91; P<0.05). However, this difference disappeared after adjustments for age, mean arterial pressure, heart rate, waist circumference, fasting glucose, and glomerular filtration rate (men: white, 9.68±1.54; brown, 9.68±1.50; black, 9.73±1.52; women: white, 8.93±1.32; brown, 8.98±1.29; black, 9.02±1.32; P>0.05). The association between race and arterial stiffness was significant for brown and black women in the highest cf‐PWV quartile, even after controlling for covariates. There were no differences in the age‐related increase in cf‐PWV among the racial groups after adjustment, confirming the strong effect of age and mean arterial pressure on cf‐PWV revealed by the multiple linear regression.ConclusionsRacial differences in cf‐PWV were mainly attributed to differences in mean arterial pressure and age, although they cannot fully explain the association between race and cf‐PWV in women in the highest cf‐PWV values. This suggests that therapeutic approaches to overcome the effects of aging on the vascular system should focus on blood pressure control, especially in the black population.

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes

“…Some other important studies, however, have evaluated patients with resistance to the treatment of SAH, defining them as resistant or apparent refractory hypertensive individuals and have found relevant associations. 10,36,37 The classification of individuals according to skin color was self-reported, as recommended in studies in Brazilian populations that involve this variable, 38 could lead to bias, due to the great ethnic mix of the Brazilian population. However, the ethnic profile of the sample studied is consistent with that of the local population and that of those who historically attend the health unit where the study was conducted.…”

Arterial stiffness in black adults from Angola and Brazil

“…Distance between the two sites of pulse recording was measured with an inelastic tape. The PWV was automatically calculated as the distance travelled by the pulse wave between the two points (in meters) divided by the time interval (in seconds) between the two pulse waves 6 . The same equipment (Complior) was used in the two studied groups.…”

“…Other factors include diabetes, uric acid, obesity, smoking habit, sedentary lifestyle, albuminuria, increased salt intake, and race 4 . It is known that race influence blood pressure (BP) levels and several studies have shown that black individuals have higher BP levels than any other race/ethnic groups 5,6 . Some studies have suggested that black individuals show a steeper increase of PWV associated with the aging process 7,8 .…”

Arteriosclerosis in Brazil. Findings from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…1 Here, we aim to describe the findings relating to arteriosclerosis or, more precisely aortic stiffness as measured through the pulse-wave velocity. 5,6 Figure 1 shows the cf-PWV according to age among 2158 apparently healthy men and women and indicates that it has a monotonic association with age. Among those subjects, men had higher values than women.…”

“…There were no differences in the slope of cf-PWV versus age according to ethnicity/skin color after adjustment, thus confirming that age and mean arterial pressure have a substantial effect on pulse-wave velocity. 5 Other classical risk factors have been seen to slightly influence the slope of the "pulse-wave velocity versus age" curve, such as diabetes, obesity and smoking, but the most influential risk factor is blood pressure. Nonetheless, the impact of these risk factors is marginal compared with the influence of aging, with a mean elevation of 0.05 m/s for each year of age, compared with 0.1 m/s per year for the whole ELSA-Brasil cohort including people with cardiovascular risk factors.…”