Abstract
In a population of 56,242 individuals living in France, we showed that individuals born in France have significantly different levels of blood pressure (BP) and cardiovascular (CV) risk factors than African and Asian populations born in their own country but living long-term in France (average duration of stay, 5–10 years). The objective of our study was to investigate the impact of country of birth on BP and CV risk factors in a subpopulation of 9245 patients selected solely on the diagnosis of hypertension, either alone or with simultaneous type 2 diabetes. In the subgroup of individuals with hypertension alone, brachial systolic, diastolic, mean and pulse pressure (PP), heart rate (HR), augmentation index and PP amplification were significantly higher in African-born than French- and Asian-born populations. In the subgroup of individuals with both hypertension and diabetes, only augmentation index, PP amplification and brachial and central PP, but not brachial systolic, diastolic, mean BP, and HR, were elevated when the African-born subgroup was compared to the French- and Asian-born populations. Increased body mass index (BMI), waist-hip ratio (WHR), and deprivation scores, but not increased plasma lipids or glycemia, were consistently associated with the African-born population. The combination of diabetes and hypertension in African populations was associated with increased aortic stiffness and PP, together with greater body weight and WHR. In individuals with increased PP and hence systolic hypertension, increased PP requires systolic BP to be reduced whereas notable reductions in diastolic BP may have deleterious consequences.
Highlights
National health statistics and prospective epidemiological studies, mainly from the United States, have consistently established that hypertensive cardiovascular (CV) disease, stroke, and coronary heart disease are considerably more prevalent in black than in white populations, with a higher prevalence of cardiac and renal failure in the black population (Chrysant et al, 1979; Dunn et al, 1983; Nichols and O’Rourke, 2006; Carson et al, 2011; Chirinos et al, 2011; Frohlich, 2011)
Country of birth is an appropriate parameter by which different populations living in France in the same environment can be studied to identify potential differences between individuals born in France, in Asia or in Africa
Compared with people born in France, the impact of country of birth on blood pressure (BP) levels and metabolic factors that influence CV risk is markedly greater in individuals born in Africa and lower or identical in those born in Asia
Summary
National health statistics and prospective epidemiological studies, mainly from the United States, have consistently established that hypertensive cardiovascular (CV) disease, stroke, and coronary heart disease are considerably more prevalent in black than in white populations, with a higher prevalence of cardiac and renal failure in the black population (Chrysant et al, 1979; Dunn et al, 1983; Nichols and O’Rourke, 2006; Carson et al, 2011; Chirinos et al, 2011; Frohlich, 2011). Interesting results were obtained on this subject in a multi-ethnic study of atherosclerosis (Carson et al, 2011), to date, little has been studied in large populations on the possible consequences of combined chronic treatment of hypertension and type 2 diabetes. This is an important consideration because approximately 50% of diabetic individuals have hypertension and 20% of hypertensive patients have diabetes mellitus (Safar et al, 2013). This is a important goal of the present study
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