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Wave reflections in hypertension

role of sex, metabolic, and ethnic factors

Thomas, Frédériquea; Pannier, Brunoa,b; Danchin, Nicolasa,c; Safar, Michel E.d

doi: 10.1097/HJH.0000000000001928

Objectives: Although the links between pulsatile hemodynamics and age are widely acknowledged in hypertension, the interactions of sex, ethnicity, and metabolic factors with hemodynamic parameters remain largely unknown. We investigated the effects of body weight, glycemia, and cholesterolemia on the carotid augmentation index (CAI) and potential changes over time, with particular focus on the roles of sex and ethnicity.

Methods: Baseline (V1) and repeat (V2) measurements (at ∼1.7 years) of wave reflections (calculated from CAI), brachial and carotid pulse pressure, and heart rate were assessed in 2530 normotensive and hypertensive men and women living in Paris but born in either France, Africa, or Asia.

Results: At V1, and in comparison with French-born individuals, African-born individuals had significantly higher CAI, cardiovascular risk, and body weight, whereas Asian-born individuals had similar CAI but lower body weight, and higher cardiovascular risk, triglyceridemia, and heart rate. Stepwise multiple regression showed similar effects of cholesterolemia on CAI in all populations, whereas only French-born individuals (insulin-resistant men and women) showed associations between hyperglycemia and potential CAI dysfunction. Repeat (V2) measurements highlighted significant interactions (P < 0.008) of sex and ethnicity with changes in CAI over time. In men, CAI changes did not differ as a function of ethnicity, whereas in African-born women, they were lesser than those of Asian-born (P < 0.03) and French-born (P < 0.02) women.

Conclusion: In the French-born population, CAI changes are affected by diabetes and possibly insulin-resistance, independently of sex. In African-born and Asian-born populations, CAI is sex-specific. Elevated CAI in African-born women calls for close monitoring of cardiovascular risk.

aCenter for Preventive and Clinical Investigations (IPC), Paris

bInserm U970, Manhès Hospital, Fleury-Mérogis

cUniversité Paris-Descartes, European Georges Pompidou Hospital

dParis Descartes University, AP-HP, Diagnostic and Therapeutic Center, Hôtel-Dieu Hospital, Paris, France

Correspondence to Michel E. Safar, MD, Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel-Dieu, 1 place du Parvis Notre-Dame, 75181 Paris Cedex 04, France. Tel: +33 1 42 34 80 25; fax: +33 1 42 34 86 32; e-mail:

Abbreviations: CAI, carotid augmentation index; C/B-PP, carotid/brachial pulse pressure; CNIL, Comité National d’Informatique et des Libertés (French Data Protection Authority); EPICES, Evaluation de la précarité et des inegalités de santé dans les Centres d’Examen de Santé (Evaluation of Deprivation and Inequalities of Health in Healthcare Centers); MBP, mean blood pressure; PP, pulse pressure; PWV, pulse wave velocity; LV, left ventricular; SD, standard deviation

Received 23 March, 2018

Accepted 3 August, 2018

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