Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis.

BackgroundWe investigated the relationship between the severity and presence of coronary artery disease (CAD) and a difference in systolic and diastolic blood pressure (SBP and DBP) between arms or between lower limbs.MethodsWe enrolled 277 patients who underwent coronary angiography. We calculated the absolute (|right BP (rt. BP) - left BP (lt. BP)|) and relative (rt. BP - lt. BP) differences in SBP or DBP between arms or between lower limbs, and assessed the severity of CAD in terms of the Gensini score.ResultsThe absolute difference in DBP between arms in the CAD group was significantly lower than that in the non-CAD group, whereas the absolute difference in DBP between lower limbs in the CAD group was significantly higher. There were no differences in the absolute or relative difference in SBP between arms or lower limbs between the groups. The absolute difference in DBP between arms decreased as the Gensini score increased. In a logistic regression analysis, the presence of CAD was independently associated with the absolute difference in DBP between arms, in addition to male, family history, dyslipidemia, diabetes mellitus and hypertension.ConclusionThe absolute difference in DBP between arms in addition to traditional factors may be a critical risk factor for the presence of CAD.

Blunted day–night difference in blood pressure (BP) is an independent cardiovascular risk factor, although there is limited information on determinants of diurnal variation in BP. We investigated determinants of day–night difference in systolic (SBP) and diastolic (DBP) BP and how these compared with determinants of daytime and night-time SBP and DBP. We analysed the association of mean daytime, mean night-time and mean day–night difference (defined as (mean daytime−mean night-time)/mean daytime) in SBP and DBP with clinical, lifestyle and biochemical parameters from 1562 adult individuals (mean age 38.6) from 509 nuclear families recruited in the GRAPHIC Study. We estimated the heritability of the various BP phenotypes. In multivariate analysis, there were significant associations of age, sex, markers of adiposity (body mass index and waist–hip ratio), plasma lipids (total and low-density lipoprotein cholesterol and triglycerides), serum uric acid, alcohol intake and current smoking status on daytime or night-time SBP and/or DBP. Of these, only age (P=4.7 × 10−5), total cholesterol (P=0.002), plasma triglycerides (P=0.006) and current smoking (P=3.8 × 10−9) associated with day–night difference in SBP, and age (P=0.001), plasma triglyceride (P=2.2 × 10−5) and current smoking (3.8 × 10−4) associated with day–night difference in DBP. 24-h, daytime and night-time SBP and DBP showed substantial heritability (ranging from 18–43%). In contrast day–night difference in SBP showed a lower heritability (13%) while heritability of day–night difference in DBP was not significant. These data suggest that specific clinical, lifestyle and biochemical factors contribute to inter-individual variation in daytime, night-time and day–night differences in SBP and DBP. Variation in day–night differences in BP is largely non-genetic.

PP080. Blood pressure in the offspring of experimental preeclamptic and normotensive baboon pregnancies

BackgroundCompared to UK white European adults, UK black African-Caribbean adults have higher mean systolic (SBP) and diastolic (DBP) blood pressure; UK South Asian adults have higher mean DBP but lower...

Oral microflora associated with periodontal disease (PD) has been proposed to be a causal factor for cardiovascular disease (CVD).Data from NHANES I and its 21-year follow-up were used to test this hypothesis.Baseline periodontal status was categorized into (1)no PD, (2)gingivitis, (3)periodontitis, and (4) edentulousness.CVD events during follow-up were ascertained by hospital records for non-fatal events and death certificates for fatal events.Relative risk (RR) and 95% confidence interval (CI) were derived from Cox regression after adjusting for demographic variables and several well-established CVD risk factors.9,962 people were free from coronary heart disease (CHD), heart failure, and cancer at baseline.2,844 CVD, 1,468 CHD, and 803 stroke events occurred during the follow-up.Compared to no PD, RRs (CI) of CVD were 1.05 (0.93-1.18) for gingivitis, 1.17 (1.04-1.31)for periodontitis, and 1.22 (1.10-1.34)for edentulousness.RRs (CI) at similar PD levels for CHD were 1.03 (0.87-1.21), 1.14 (0.98-1.34), and 1.13 (0.98-1.32), and for stroke were 1.03 (0.81-1.31), 1.33 (1.07-1.66),and 1.30 (1.06-1.60),respectively.Analyses stratified by age group indicated that elevated risk for CVD associated with PD is manifested mainly in those aged 25-54 years at baseline.Among this age group, RRs (CI) of CVD were 1.13 (0.96-1.33) for gingivitis, 1.40 (1.16-1.68)for periodontitis, and 1.36 (1.11-1.68)for edentulousness in comparison to no PD; RRs (CI) of CHD were 1.13 (0.80-1.29), 1.33 (1.03-1.72),and 1.25 (0.93-1.67); and RRs (CI) of stroke were 0.96 (0.64-1.46), 1.57 (1.05-2.36),and 1.46 (0.92-2.33), respectively.This study suggests that periodontal disease is a significant risk factor for CVD, CHD, and stroke especially in adults aged 25-54. P2 Stress in the workplace and early atherosclerosis. The Los Angeles

Blood pressure (BP) and hypertension prevalence differences between UK South Asians (Bangladeshis, Indians and Pakistanis) and White Europeans exist in childhood and adulthood. This meta-analysis sought to quantify these differences. We searched MEDLINE (1946-2017), EMBASE (1974-2017) and GLOBAL HEALTH (1973-2017) for comparative studies and pooled the data with Revman (Cochrane Collaboration). Twenty-two studies were included-fourteen on adults and eight on children. South Asian adults had lower systolic and slightly lower diastolic BP. However, stark heterogeneity existed between South Asian subgroups: Bangladeshis had markedly lower systolic BP (mean difference: -11.7 mmHg in men and women), Indians slightly lower (-2.0 mmHg in men and -4.5 mmHg in women) and Pakistanis intermediately lower (-7.9 mmHg in men and -8.6 mmHg in women), compared to White Europeans. However, South Asian children did not have lower systolic or diastolic BP compared to White children, and their BP was often higher. This intergenerational change in BP difference mirrored the change in body mass index difference, particularly in Bangladeshis. We conclude that ethnicity-related BP differences are heterogeneous and dependent on age, sex and South Asian subgroup. South Asian children do not have lower BP than White Europeans in contrast to their adult counterparts. There is concern that this pattern may continue into adulthood, worsening the already high cardiovascular disease burden in South Asians in future years. Further research is needed to ascertain the causes of this evolving issue.

Pulse wave velocity, a common metric of arterial stiffness, is an established predictor for cardiovascular events and mortality. However, its intrinsic pressure-dependency complicates the discrimination of acute and chronic impacts of increased blood pressure on arterial stiffness. Cardio-ankle vascular index (CAVI) represented a significant step towards the development of a pressure-independent arterial stiffness metric. However, some potential limitations of CAVI might render this arterial stiffness metric less pressure-independent than originally thought. For this reason, we later introduced CAVI0. Nevertheless, advantages of one approach over the other are left debated. This review aims to shed light on the pressure (in)dependency of both CAVI and CAVI0. By critically reviewing results from studies reporting both CAVI and CAVI0 and using simple analytical methods, we show that CAVI0 may enhance the pressure-independent assessment of arterial stiffness, especially in the presence of large inter-individual differences in blood pressure.

It is unclear whether the sex difference that is known to occur in blood pressure (BP) is similar in some South Asian populations. This study presents a meta-analysis of the sex difference in BP, hypertension and the role of body mass index (BMI) in South Asian diaspora compared with populations of European descent. We systematically searched for studies that reported BP and hypertension among South Asian descent populations living in Europe and North America. Weighted mean differences in BP and risk ratios (RR) for hypertension were calculated for men and women. We included 11 studies in this meta-analysis. In general, men had a higher BP and prevalence of hypertension than women, for example, systolic BP was higher in men than in women among the Indian (7.21 mm Hg, 95% confidence interval (CI): 4.46-9.95) and European populations (6.12 mm Hg, 95% CI: 4.45-7.80). The difference was less in the Pakistani population (4.00 mm Hg, 95% CI: 2.65-5.36). The Bangladeshi population showed a comparatively small sex difference in systolic (2.93 mm Hg, 95% CI: 1.20-4.66) and diastolic BP (0.68 mm Hg, 95% CI: -1.76 to 3.12) and prevalence of hypertension (RR 1.28, 95% CI: 0.66-2.46). Sex differences in BMI for the South Asian populations were greater than those in Europeans. The Indian population had similar sex differences in BP and hypertension compared with Europeans, but Pakistani and Bangladeshi had smaller sex differences. Sex differences in BMI might relate to the blunted sex differences in BP in Pakistani and Bangladeshi populations. Further research should focus on factors that underlie this intriguing sex difference among South Asian populations.

Excess total body fat (TBF) and visceral fat (VF) are major risk factors of hypertension. Blood pressure (BP) increases with age, as do TBF and VF. Here we investigated whether TBF and VF contribute to BP differences between adolescents and adults. A population-based sample of adolescents (n=933, 12-18 years) and their parents (n=429, 38-65 years) was studied as part of the Saguenay Youth Study. In all participants, beat-by-beat values of SBP, DBP and underlying hemodynamic parameters (heart rate, stroke volume [SV] and total peripheral resistance) were obtained with a Finometer during a 52-minute protocol mimicking daily life activities and including posture and math-stress tests. TBF was assessed by bioelectrical impedance and VF was examined by magnetic resonance imaging. SBP was higher in parents than adolescents by an average of 10.2±0.3 mmHg in males and 9.1±0.3 mmHg in females (p<0.0001 for both sexes). DBP differed minimally throughout the protocol (p=0.3 and 0.1, respectively). In males and females, respectively, the ‘generation’ differences in SBP were reduced to 6.0±0.1 and 4.3±0.1 mmHg when adjusted for height and TBF (p<0.0001 for both), and were further reduced to 1.9±0.1 and 2.5±0.2 mmHg when additionally adjusted for VF (p=0.1 and 0.02). Of the underlying hemodynamic parameters, only SV was higher in parents than adolescents (by 46±2 ml in males and 39±2 ml in females, p<0.0001 for both). Again, the ‘generation’ differences in SV were reduced to 23±1 (males) and 20±1 ml (females) when adjusted for height and TBF (p<0.0001 for both sexes), and were further reduced to 11.8±0.6 and 15.7±0.8 ml when additionally adjusted for VF (p<0.0001 for both sexes). These results suggest that the transition from adolescence to middle-aged adulthood is associated with an increase in SBP (but not DBP), which is driven mainly by SV augmentation. They also suggest that VF contributes to the generational differences in both SBP and SV above and beyond the contribution of TBF, despite VF being a relatively small fraction of TBF. The co-occurrence of these differences in VF, SV and SBP may be related to sympathoactivation and renal handling of sodium and water reabsorption; further research is required to confirm this possibility.

All Thiazide‐Like Diuretics Are Not Chlorthalidone: Putting the ACCOMPLISH Study Into Perspective

Background: Orthostatic hypotension (OH), defined as a decrease of blood pressure (BP) of 20/10 mm Hg (systolic/diastolic) on change in posture from supine to standing is seldom assessed in routine practice because of logistical constraints. A recent study reported a sit-to-stand decrease of 15/7 mm Hg as also having good diagnostic yield. We measured the prevalence & risk factors associated with OH with the new threshold of sit-to- stand of either ≥ 15 mm Hg in systolic (SBP) or ≥ 7 mm Hg in diastolic BP (DBP). Methods: We reviewed medical charts of patients being followed at Renal Hypertension Center, a referral centre for difficult to control hypertension. Sitting BP is measured after 5 minutes of resting, as an average of 5 measurements with an automated device. Standing BP is measured three times at one minute intervals and averaged. OH was determined on the basis of the difference in either average SBP or DBP. Demographic characteristics, comorbidities, medication details, laboratory values and BP measurements were extracted. Results: Data from 219 patients was extracted (see table). The overall difference in SBP (sitting - standing)was 0.94 and DBP was 2.1 mm Hg. 190 patients (87%) did not have OH, whereas 29 (13%) had OH using either SBP or DBP thresholds. The difference in SBP and DBP was 17 mm and 6 mm Hg in those with OH, versus 1.6 and 3 mm Hg amongst those without OH respectively. Higher SBP was significantly associated with OH; age, gender, diabetes, number and hypertension drug class were not. Conclusion: Amongst referred patients to a specialist hypertension clinic, the prevalence of OH using a threshold of 15/7 mm Hg was 13%. The new diagnostic threshold allows for easy assessment of OH.

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

To investigate the role of vitamin D in explaining ethnic differences in blood pressure among three ethnic groups in the Netherlands (ethnic Dutch, African Surinamese, and south Asian Surinamese). Data were derived from the 'Surinamese in the Netherlands: study on ethnicity and health' study, a population-based observational study. We included 1420 participants (505 ethnic Dutch, 330 south Asian Surinamese, and 585 African Surinamese), aged 35-60 years, in whom serum vitamin D (25-hydroxyvitamin D) and SBP and DBP were measured. Data were analyzed by using linear (SBP, DBP) and logistic (hypertension) regression analyses, using ethnicity as independent variable and adjusting for potential confounders. To study the impact of vitamin D, we additionally adjusted for vitamin D in a final model. South Asian Surinamese had a 5.6 mmHg higher SBP and 4.9 mmHg higher DBP as compared with the Dutch after adjustment for age, sex, season, physical activity, smoking, education, and BMI. Further adjustment for vitamin D explained 14 and 6% of these SBP and DBP differences, respectively. African Surinamese had an 8.9 mmHg higher SBP and 6.8 mmHg higher DBP as compared with the Dutch. Variation in vitamin D explained 7 and 4% of these SBP and DBP differences. South Asian Surinamese and African Surinamese had 2.2 (1.5-3.2) and 3.3 (2.4-4.6) times higher odds of having hypertension compared with ethnic Dutch. Vitamin D explained 25 and 17% of the variations in SBP and DBP, respectively, resulting in odds ratio of 1.9 (1.3-2.9) and 2.9 (2.0-4.3), respectively. Higher blood pressures and higher hypertension risk in south Asian Surinamese and African Surinamese were partly explained by their poorer vitamin D status. However, even after adjustment, significant ethnic blood pressure differences persisted.

Compared to UK white European adults, UK black African-Caribbean adults have higher mean SBP and DBP; UK South Asian adults have higher mean DBP but lower SBP. Information on blood pressure (BP) in UK children from different ethnic groups is limited. The aim of this study was to compare BP levels in UK children of black African-Caribbean, South Asian and white European origin. BP and body build were measured in 5666 children in a cross-sectional study of UK primary school children of South Asian, black African-Caribbean and white European origin aged 9-10 years. Ethnic and socioeconomic differences in BP were obtained from multilevel linear regression models. After adjustment for height and adiposity, black African-Caribbean children had lower mean SBP than white Europeans [difference 1.62 mmHg, 95% confidence interval (CI) 0.86-2.38 mmHg], whereas mean DBP was similar (difference 0.58 mmHg, 95% CI -0.12 to 1.28 mmHg). The lower SBP was particularly marked in black African rather than Caribbean children (P = 0.002). South Asian children had lower mean SBP (difference 1.10 mmHg, 95% CI 0.34-1.86 mmHg) than white Europeans and higher mean DBP (difference 1.07 mmHg, 95% CI 0.37-1.76 mmHg). The higher mean DBP was particularly marked among Indian and Bangladeshi, rather than Pakistani, children (P = 0.01). BP was unrelated to socioeconomic circumstances; ethnic differences in BP were not affected by socioeconomic adjustment. A BP pattern similar to that in adults is present in UK South Asian but not in UK black African-Caribbean children at 9-10 years.

Previous studies report lower systemic blood pressures in patients with sickle cell disease (SCD) than in appropriate controls. The etiology of the lower systolic and diastolic blood pressures (SBP and DBP) remains uncertain. Blood pressure measurements from patients followed at our center (UNC cohort) were compared with values obtained from the Cooperative Study of Sickle Cell Disease (CSSCD) and healthy control subjects. Associations of SBP and DBP with clinical and laboratory covariates were performed in the UNC cohort. Patients in the UNC cohort were significantly older and had a higher BMI than those in the CSSCD (p <0.0001). There were no differences in the SBP and DBP between SCD patients in the UNC cohort and control subjects. In the SS/SD/Sβ0 thalassemia group, SBP was higher in the UNC cohort than in the CSSCD (p < 0.0001). On multivariate analysis, significant correlations were noted between SBP and age, BMI, history of hypertension and absolute neutrophil count. Compared with historic controls, SBP was significantly higher in our SCD patient cohort. There was no difference when blood pressure was compared between our patient cohort and control subjects. Age, BMI and neutrophil count may contribute to the modulation of SBP in SCD.