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. 2015 Dec;44(6):1814-22.
doi: 10.1093/ije/dyu199. Epub 2014 Oct 24.

Cohort Profile: Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) prospective cohort study

Leoné Malan  1 , Mark Hamer  2 , Nancy Frasure-Smith  3 , Hendrik S Steyn  4 , Nicolaas T Malan  5
Affiliations

Cohort Profile: Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) prospective cohort study

Leoné Malan et al. Int J Epidemiol. 2015 Dec.

Abstract

Adapting to an over-demanding stressful urban environment may exhaust the psychophysiological resources to cope with these demands, and lead to sympathetic nervous system dysfunction. The evidence that an urban-dwelling lifestyle may be detrimental to the cardiometabolic health of Africans motivated the design of the Sympathetic activity and Ambulatory Blood Pressure in African Prospective cohort study. We aimed to determine neural mechanistic pathways involved in emotional distress and vascular remodelling. The baseline sample included 409 teachers representing a bi-ethnic sex cohort from South Africa. The study was conducted in 2008-09 and repeated after 3-year follow-up in 2011-12, with an 87.8% successful follow-up rate. Seasonal changes were avoided and extensive clinical assessments were performed in a well-controlled setting. Data collection included sociodemographics, lifestyle habits, psychosocial battery and genetic analysis, mental stress responses mimicking daily life stress (blood pressure and haemostatic, cardiometabolic, endothelial and stress hormones). Target organ damage was assessed in the brain, heart, kidney, blood vessels and retina. A unique highly phenotyped cohort is presented that can address the role of a hyperactive sympathetic nervous system and neural response pathways contributing to the burden of cardiometabolic diseases in Africans.

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Figures

Figure 1.
Figure 1.
Geographical location of Klerksdorp and Potchefstroom in the North-West Province, South Africa.
Figure 2.
Figure 2.
The Sympathetic activity and Ambulatory Blood pressure in Africans (SABPA) prospective cohort study population.
Figure 3.
Figure 3.
Mean temperature over the 4-month data collection periods of the SABPA Prospective cohort study during late summer-late autumn.
Figure 4.
Figure 4.
Obtaining anthropometric (4a) and 24h ambulatory blood pressure and 24h ECG (including heart rate variability) measures (4b) during the SABPA Prospective Cohort study data collection phases.
Figure 5.
Figure 5.
Cardiometabolic risk markers presenting change in risk over 3 years in the SABPA Prospective cohort. Heart rate variability (HRV) suggests increased autonomic dysfunction (standard deviation R-R interval, 50-100 ms); Waist circumference, Joint Interim Statement.
See this image and copyright information in PMC

References

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    1. Malan L, Schutte AE, Malan NT, et al. Specific coping strategies of Africans during urbanization: comparing cardiovascular responses and perception of health data. Biol Psych 2006;72:305–10. - PubMed
    1. Malan L, Malan NT, Wissing MP, Seedat YK. Coping with urbanization: A cardiometabolic risk? Biol Psych 2008;79:323–28. - PubMed
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    1. Schommer N, Helhammer DH, Kirschbaum C. Dissociation between reactivity of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary system to repeated psychosocial stress. Psychosom Med 2003;65:450–60. - PubMed

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