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Ethnic differences in vascular stiffness and relations to hypertensive target organ damage

Chaturvedi, Nisha; Bulpitt, Christopher Jb; Leggetter, Sandraa; Schiff, Rebekahb; Nihoyannopoulos, Petrosc; Strain, W Davida; Shore, Angela Cd; Rajkumar, Chakravarthib

Original papers: Blood vessels
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Objective People of Black African descent have greater risks of hypertensive target organ damage than would be anticipated for given levels of blood pressure. Arterial stiffness may further account for ethnic differences in risk.

Design Cross-sectional study.

Setting Population based, London, UK.

Participants One hundred and three Europeans and 99 African Caribbeans aged 40–64 years.

Methods We measured resting and ambulatory blood pressure, and pulse wave velocity (PWV) of elastic and muscular arteries. Echocardiography measured interventricular septal thickness (IVST).

Main outcome measures PWV, IVST.

Results Carotid–femoral PWV was 12.7 m/s [95% confidence interval (CI) 12.3, 13.1] in African Caribbeans and 11.2 m/s (10.9, 11.6) in Europeans (P< 0.0001). This difference persisted on adjustment for resting and ambulatory blood pressure, 12.4 versus 11.5 m/s (P = 0.003). The greater IVST in African Caribbeans (9.6 mm) compared to Europeans (9.1 mm, P = 0.0005), could only in part be accounted for by differences in carotid–femoral PWV. Stiffness in the muscular carotid–radial segment did not differ by ethnicity, but was positively associated with systolic pressure in Europeans (β regression coefficient 0.033, P = 0.04), and negatively associated in African Caribbeans (0.036, P = 0.04, and P = 0.02 for interaction).

Conclusions Aortic stiffness is increased in African Caribbeans compared to Europeans, even when higher blood pressures are accounted for. It is most closely related to IVST, but contributes little to explaining ethnic differences. Stiffness of the upper limb muscular arteries did not differ by ethnicity, but remained favourable in the presence of hypertension in African Caribbeans, while being increased in Europeans. We suggest that this is due to ethnic differences in vascular remodelling.

aDepartment of Epidemiology and Public Health, Faculty of Medicine, Imperial College London at St Mary's, Norfolk Place, London, bCare of the Elderly, cCardiology Department, Faculty of Medicine, Imperial College London at the Hammersmith Hospital, Du Cane Road, London and dInstitute of Biomedical and Clinical Science, Peninsula Medical School (Exeter), Barrack Road, Exeter, UK.

Sponsorship: Grant support for the study was provided by the British Heart Foundation (PG/99119).

Correspondence and requests for reprints to Professor Nish Chaturvedi, Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College at St Mary's, Norfolk Place, London, W2 1PF, UK. Tel: +44 (0) 207 594 3381; fax: +44 (0) 207 594 3392: e-mail: n.chaturvedi@imperial.ac.uk

Received 18 November 2003 Revised 31 March 2004 Accepted 26 April 2004

This work was presented in part at the American Society for Hypertension, May 2003.

© 2004 Lippincott Williams & Wilkins, Inc.