Racial variation in cardiovascular morbidity and mortality in essential hypertension

Abstract

Objectives-To perform a longitudinal comparison of morbidity and mortality among white, south Asian and Afro-Caribbean hypertensive patients in relation to baseline demographic characteristics and clinic and ambulatory blood pressure variables. Design-Observational follow up study. Setting-District general hospital and community setting in Harrow, England. Patients-528 white, 106 south Asian, and 54 Afro-Caribbean subjects with essential hypertension who had undergone 24 hour ambulatory intra-arterial blood pressure monitoring. Interventions-Follow up for assessment of all cause morbidity and mortality over a mean (SD) of 9.2 (4.1) years. Main outcome measures-Non-cardiovascular death, coronary death, cerebrovascular death, peripheral vascular death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularisation. Results-South Asians had the highest all cause event rate of 3.46, compared with 2.50 (NS) and 0.90 (p = 0.002) events/100 patient-years for whites and Afro-Caribbeans, respectively. This was because of an excess of coronary events (2.86 v 1.32 events/100 patient-years in south Asians v whites, respectively; p = 0.002). Age (p < 0.001), sex (p < 0.001), race (south Asians : whites, hazard ratio 1.79; p = 0.008), diabetes (p = 0.05), previous history of cardiovascular disease (p < 0.001), and 24 hour ambulatory systolic blood pressure (p = 0.006) were independent predictors of time to a first event. Clinic blood pressure did not provide additional prognostic information. Conclusions-South Asian origin was an independent predictor of all cause events, mainly because of an excess of coronary events in this group. Ambulatory but not clinic blood pressure was of additional value in predicting subsequent morbidity and mortality. (Heart 2000;83:267-271)

Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data

“…In three studies of clinically selected adults [17][18][19] (hence excluded from the tables), two reported higher hypertension prevalence rates 17,18 and one reported similar BP levels 19 in people from African descent compared to white adults. Table 2 First author surname and date of publication (continued)…”

Is the blood pressure of South Asian adults in the UK higher or lower than that in European white adults? A review of cross-sectional data

“…While the lower blood pressure in Bangladeshis was associated with lower BMI, differences in obesity clearly did not account for much of the ethnic variation. Three studies [15][16][17] on adults, which were excluded from this review because they were based on clinically selected patients study, reported lower blood pressure levels in the South Asian population than in the white population.…”

Does using ethnic specific criteria improve the usefulness of the term metabolic syndrome? controversies and suggestions

“…In the UK, multiple researchers have noted higher prevalence rates of hypertension in populations of African ancestry but lower rates of CVD mortality when compared to their hypertensive white and South Asian cohorts. 71,72 These mismatches between hypertension and CVD risk in ethnic subgroups suggest that the MetS hypertension criteria should be altered by either changing the cutoffs for different populations or weighting the individual criteria based on their risk contribution to CVD in each population. In the extreme case, one could also argue for the omission of hypertension from the MetS criteria in ethnic groups where the relationship between hypertension and CVD risk is poor.…”