The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

Stewart, Simon; Libhaber, Elena; Carrington, Melinda; Damasceno, Albertino; Abbasi, Haroon; Hansen, Claus D.; Wilkinson, David; Sliwa, Karen

doi:10.1016/j.ijcard.2009.05.061

Cited by 43 publications

(39 citation statements)

References 25 publications

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“…Our group and others have clearly documented that urban-dwelling black South Africans suffer from alarming increases in hypertension, resulting in soaring rates of hypertensive heart disease and stroke. [18][19][20] Importantly, the need for effective and affordable markers of early cardiovascular deterioration as part of a prevention scheme is imperative in this population group, as poverty hinders successful treatment programs.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Schutte

Huisman

et al. 2011

Hypertens Res

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The prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention. The need for early markers of cardiovascular dysfunction is imperative in black South Africans who have a significant risk for cardiovascular disease. We therefore compared 24-h BP variability with various traditional and advanced BP measurements, regarding their association with sub-clinical organ damage in black and white South Africans. The study included 409 African and Caucasian teachers aged 25-60 yrs. We measured office BP, 1-min continuous (finger) BP, ambulatory BP, BP reactivity and determined weighted 24-h BP variability. Albumin-to-creatinine ratio, Cornell product and carotid cross-sectional wall area (CSWA) were measures of organ damage. Africans had higher 24-h BP, BP variability, BP reactivity and sub-clinical organ damage (Po0.001). Correlations of BP variability with organ damage were overall weak when compared with other BP measurements. In normotensive groups, we found an independent association of 24-h systolic BP (SBP) variability with Cornell product only in Africans (r¼0.37; P¼0.01), confirmed in multiple regression models, with 24-h SBP included in the model. Only in hypertensive Caucasians, a significant correlation between CSWA and 24-h SBP variability was evident (r¼0.30; P¼0.01), although CSWA indicated stronger correlations with office or 24-h SBP than 24-h SBP variability. To conclude, 24-h SBP variability could potentially be an effective measure for the early detection of normotensive Africans at increased risk for the development of cardiovascular complications. Its usefulness based on associations with target organ damage in hypertensive groups seems to be less than traditional office or 24-h BP measurements. Hypertension Research (2011Research ( ) 34, 1127Research ( -1134 doi:10.1038/hr.2011; published online 28 July 2011Keywords: albumin-to-creatinine ratio; ethnicity; intima-media thickness; left ventricular hypertrophy INTRODUCTIONThe prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention in the literature. [1][2][3][4][5][6][7][8][9][10] Where some papers emphasize the importance of BP variability in prediction of risk of vascular events, 1,2,6,9 others question its prediction of cardiovascular outcome. 4,5,10 Despite this upsurge of recent papers, consistent evidence over the past three decades lends support that both target organ damage and the rate of cardiovascular events of hypertensive patients are significantly and independently related to the degree of BP variability. [11][12][13][14][15] A limitation of many of these papers is that either BP variability alone was investigated, or various measures of BP variability (such as s.d. of 24-h BP, average real variability index 16 and weighted 24-h BP s.d. 17 ) were being compared, regarding the strength of their association with target organ damage.The question therefore arises how BP variability would benchmark against a comprehensive range of both traditional and advanced

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Section: Introductionmentioning

confidence: 99%

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Schutte

Huisman

et al. 2011

Hypertens Res

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“…This, together with the fact that high blood pressure was ranked second among mortality risk factors (Norman et al, 2007), makes the significant improvement in hypertension in the current study noteworthy. The percentage of participants from the 2016 cohort diagnosed with hypertension (4.5%) was notably lower than the 16.6% (Coetsee, 2007), 34% (Tibarazwa et al, 2009) and 37% (Stewart et al, 2011). The average age of the cohort studied by Tibarazwa et al (2009) and Stewart et al (2011) may have contributed to the higher percentage reported.…”

Section: Discussionmentioning

confidence: 83%

“…The percentage of participants from the 2016 cohort diagnosed with hypertension (4.5%) was notably lower than the 16.6% (Coetsee, 2007), 34% (Tibarazwa et al, 2009) and 37% (Stewart et al, 2011). The average age of the cohort studied by Tibarazwa et al (2009) and Stewart et al (2011) may have contributed to the higher percentage reported. The results resemble those of other researchers, who found an improvement in blood pressure with urbanization, which contradicts speculations by others that moves to the towns by Black Africans predisposes them to the development of hypertension (Norman et al, 2007;Hendriks, Wit, & Roos, 2012).…”

Section: Discussionmentioning

confidence: 83%

“…Urbanization and westernization among Black women in South Africa continue to play a significant role in changing the pattern of CHD risk factors (Vorster et al, 2007;Tibazarwa et al, 2009;Stewart, Libhaber, Carrington, Damasceno, Abbasi, Hansen, Wilkinson, & Sliwa 2011). In developing countries, and South Africa in particular, where modifiable risk factors have previously been low, urbanization caused an increase in CHD risk factors (Ntuli, Maimela, Alberts, Choma, & Dikotope, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…The results of the Interheart Africa study, conducted during 1999-2003, indicated that the CVD risk profile of Black Africans illustrates a population in the early stages of a CVD epidemic implying that in order to prevent a CVD epidemic, lifestyle modification, early diagnosis, and cost-effective treatment of CVD risk factors are of utmost importance (Steyn, Sliwa, Hawken, Commerford, Onen, Damasceno, & Yusuf, 2005;Stewart et al, 2011). Despite reports on the trends in the manifestation of CVD risk factors and some research articles from South Africa (Coetsee, 2007;Sliwa et al, 2008;Stewart et al, 2011), there is a paucity of research to indicate the stage of the CVD epidemic and the impact thereof in the country, particularly in the Black South African female population. It is within the broad context described above that the study reported here was designed to acknowledge any change in modifiable CHD risk factors in Black South Africa women over a 10-year period to monitor trends and adjust prevention and control programs to avert further mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Modifiable Coronary Heart Disease Risk Factors Trends in Urban Black South African Females and the Implications for Health Promotion Interventions

Grace¹

2017

GJHS

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Background: Multiple risk factors can contribute to the development of coronary heart disease (CHD) in an individual, yet any change in the modifiable CHD risk status of Black South African females in recent times is unknown. Aim:The researcher aimed to establish the current CHD risk status of urban Black African females and to report on any trends over a 10-year period with the purpose to direct health promotion programs. Significantly fewer participants (4.5% vs. 16.6%; p < 0.05) were hypertensive and significantly more women had hypercholesterolemia (5.6% vs. 23.9%; p < 0.05) in 2016. The multiple CHD risk profile showed that 42.4% had at least one CHD risk factor (an increase of 25%) and significantly fewer (27.3% vs. 45.2%; p < 0.05) had two CHD risk factors in 2016. Conclusion:A sedentary lifestyle and obesity were the highest CHD risk factors. Also, the multiple CHD risk profile of Black African women changed over a period of 10 years from higher to lower and normal risk. Health promotion strategies must be directed towards weight reduction, increasing physical activity levels and be tailored for the population for which the health promotion programs have been designed.

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The Heart of Africa

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The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

Cited by 43 publications

References 25 publications

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Blood pressure variability is significantly associated with ECG left ventricular mass in normotensive Africans: The SABPA Study

Modifiable Coronary Heart Disease Risk Factors Trends in Urban Black South African Females and the Implications for Health Promotion Interventions

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