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. 2015 Sep;66(3):481-8.
doi: 10.1161/HYPERTENSIONAHA.115.05672. Epub 2015 Jul 13.

Ethnic Differences in Associations Between Blood Pressure and Stroke in South Asian and European Men

Sophie V Eastwood  1 , Therese Tillin  2 , Nish Chaturvedi  2 , Alun D Hughes  2
Affiliations

Ethnic Differences in Associations Between Blood Pressure and Stroke in South Asian and European Men

Sophie V Eastwood et al. Hypertension. 2015 Sep.

Abstract

It is unknown whether associations between blood pressure (BP) and stroke vary between Europeans and South Asians, despite higher stroke rates in the latter. We report findings from a UK cohort study of 1375 European and 1074 South Asian men, not receiving antihypertensive medication, aged 40 to 69 years at baseline (1988-1991). Assessment included BP, blood tests, anthropometry, and questionnaires. Incident stroke was established at 20 years from death certification, hospital and primary care records, and participant report. South Asians had higher systolic BP, diastolic BP, and mean arterial pressure than Europeans, and similar pulse pressure. Associations between systolic BP or diastolic BP and stroke were stronger in South Asians than Europeans, after adjustment for age, smoking status, waist/hip ratio, total/high-density lipoprotein-cholesterol ratio, diabetes mellitus, fasting glucose, physical activity, and heart rate (systolic BP: Europeans [odds ratio, 1.22; 95% confidence interval, 0.98-1.51], South Asians [1.56; 1.24-1.95]; ethnic difference P=0.04; diastolic BP: Europeans [0.90; 0.71-1.13], South Asians [1.68; 1.32-2.15]; P<0.001). Hemodynamic correlates of stroke risk differed by ethnicity: in combined models, mean arterial pressure but not pulse pressure was detrimentally associated with stroke in South Asians, whereas the converse was true for Europeans. The combination of hyperglycemia and hypertension appeared particularly detrimental for South Asians. There are marked ethnic differences in associations between BP parameters and stroke. Undue focus on systolic BP for risk prediction, and current age and treatment thresholds may be inappropriate for individuals of South Asian ancestry.

Keywords: blood pressure; diabetes mellitus; fasting glucose; heart rate; stroke.

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Figures

Figure 1
Figure 1
Follow-up of the Southall and Brent Revisited (SABRE) cohort 1988 to 2011.
Figure 2
Figure 2
Proportions of incident stroke by blood pressure and glycated haemoglobin (HbA1c) categories in European and South Asian men: for (A) systolic blood pressure (SBP) in Europeans, (B) SBP in South Asians, (C) diastolic BP (DBP) in Europeans, and (D) DBP in South Asians. Excludes participants with baseline stroke or receipt of antihypertensive medication.
See this image and copyright information in PMC

Comment in

References

    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–254. - PMC - PubMed
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913. - PubMed
    1. Lawes CM, Bennett DA, Parag V, Woodward M, Whitlock G, Lam TH, Suh I, Rodgers A, Asia Pacific Cohort Studies Collaboration Blood pressure indices and cardiovascular disease in the Asia Pacific region: a pooled analysis. Hypertension. 2003;42:69–75. doi: 10.1161/01.HYP.0000075083.04415.4B. - PubMed
    1. Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, McKeigue PM, Chaturvedi N. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited) – a prospective population-based study. J Am Coll Cardiol. 2013;61:1777–1786. doi: 10.1016/j.jacc.2012.12.046. - PMC - PubMed
    1. Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, Kelemen L, Yi C, Lonn E, Gerstein H, Hegele RA, McQueen M. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE) Lancet. 2000;356:279–284. - PubMed

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