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Nyárády BB, Dósa E, Kőhidai L, Pállinger É, Gubán R, Szőnyi Á, Kiss LZ, Bagyura Z. Associations between Various Inflammatory Markers and Carotid Findings in a Voluntary Asymptomatic Population Sample. Int J Mol Sci 2024; 25:9656. [PMID: 39273602 PMCID: PMC11394953 DOI: 10.3390/ijms25179656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/28/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and atherosclerosis is the key factor promoting its development. Carotid intima-media thickening and the presence of carotid plaques are important indices of cardiovascular risk. In addition, inflammation is a major and complex factor in the development of atherosclerosis. The relationships between carotid atherosclerosis and certain inflammatory markers have rarely been studied in healthy individuals. Therefore, we aimed to investigate the associations between subclinical carotid atherosclerosis and various inflammatory biomarkers in a large Caucasian population free of evident CVD. In addition to recording study participants' demographic characteristics, anthropometric characteristics, and atherosclerotic risk factors, laboratory tests were performed to measure levels of hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein, and inflammatory cytokines/chemokines, including interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon (IFN)-α2, IFN-γ, tumor necrosis factor-α, and monocyte chemoattractant protein (MCP)-1. This study included 264 asymptomatic individuals with a median age of 61.7 years (interquartile range, 54.5-67.5 years); 45.7% of participants were male. Participants were divided into two groups according to their carotid status: the normal carotid group, comprising 120 participants; and the pathological carotid group, comprising 144 participants. Compared with the normal carotid group, hypertension and diabetes mellitus were significantly more common and serum levels of HbA1c, IL-8, and MCP-1 were significantly higher in the pathological carotid group. Multivariate regression analysis revealed significant positive associations between pathological carotid findings and serum levels of IL-8 (highest tertile, OR: 2.4, p = 0.030) and MCP-1 (highest tertile, OR: 2.4, p = 0.040). Our results suggest that IL-8 and MCP-1 may serve as early indicators of subclinical atherosclerosis, thereby helping to identify individuals at increased risk of CVD before the onset of clinical symptoms.
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Affiliation(s)
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - László Kőhidai
- Department of Genetics, Cell and Immunobiology, Semmelweis University, 1089 Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell and Immunobiology, Semmelweis University, 1089 Budapest, Hungary
| | - Renáta Gubán
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Ádám Szőnyi
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Loretta Zsuzsa Kiss
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
- Institute for Clinical Data Management, Semmelweis University, 1085 Budapest, Hungary
| | - Zsolt Bagyura
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
- Institute for Clinical Data Management, Semmelweis University, 1085 Budapest, Hungary
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Monocyte chemoattractant protein-1 and hypertension: An overview. HIPERTENSION Y RIESGO VASCULAR 2021; 39:14-23. [PMID: 34969653 DOI: 10.1016/j.hipert.2021.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The association between hypertension and cardiovascular disease (CVD) has been increasingly studied through early inflammatory biomarkers. The monocyte chemoattractant protein-1 (MCP-1) is the main chemokine implicated in the inflammatory endothelial process, attracting monocytes and macrophages to the atherosclerotic plaque. METHODS We reviewed the main observational studies that have analyzed serum MCP-1 in patients with hypertension regardless of CVD, relating them to target organ damage (TOD). RESULTS As endothelial dysfunction continues and TOD accumulates, MCP-1 has been perpetuated at higher levels. The relationship between this chemokine and the increase in comorbidities, such as chronic kidney disease, dyslipidaemia, diabetes, and coronary artery disease, became clearer from the observational studies. However, patients with such morbidities use medications with potential anti-inflammatory effects. CONCLUSION There is no normal threshold of MCP-1 for the healthy population, nor a uniform curve pattern, due to a balance between genetic factors, age, gender, comorbidities, TOD, and anti-inflammatory effects of drugs. In fact, MCP-1 seems to have a promising role as a tool for further improvement in cardiovascular risk stratification, as prognostic studies have demonstrated an association with fatal and non-fatal cardiovascular outcomes, regardless of other clinical and laboratory predictors.
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Para I, Albu A, Porojan MD. Adipokines and Arterial Stiffness in Obesity. ACTA ACUST UNITED AC 2021; 57:medicina57070653. [PMID: 34202323 PMCID: PMC8305474 DOI: 10.3390/medicina57070653] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
Adipokines are active molecules with pleiotropic effects produced by adipose tissue and involved in obesity-related metabolic and cardiovascular diseases. Arterial stiffness, which is a consequence of arteriosclerosis, has been shown to be an independent predictor of cardiovascular morbidity and mortality. The pathogenesis of arterial stiffness is complex but incompletely understood. Adipokines dysregulation may induce, by various mechanisms, vascular inflammation, endothelial dysfunction, and vascular remodeling, leading to increased arterial stiffness. This article summarizes literature data regarding adipokine-related pathogenetic mechanisms involved in the development of arterial stiffness, particularly in obesity, as well as the results of clinical and epidemiological studies which investigated the relationship between adipokines and arterial stiffness.
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Affiliation(s)
- Ioana Para
- 4th Department of Internal Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania;
| | - Adriana Albu
- 2nd Department of Internal Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania;
- Correspondence:
| | - Mihai D. Porojan
- 2nd Department of Internal Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania;
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Botha D, Breet Y, Schutte AE. Comparing the associations of clinic vs. ambulatory blood pressure with subclinical organ damage in young healthy adults: the African-PREDICT study. Hypertens Res 2021; 44:840-849. [PMID: 33564179 DOI: 10.1038/s41440-021-00627-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 01/20/2023]
Abstract
Raised blood pressure (BP) causes pathophysiological cardiovascular changes resulting in target organ damage. Although ambulatory and central BP relate more strongly to outcomes than clinical brachial BP in the elderly population, it is unknown which measure of BP is most strongly associated with markers of organ damage in younger populations. We compared the strength of associations between different BPs and measures of subclinical organ damage and investigated whether ethnic differences exist between these associations. The design was a cross-sectional analysis of the African-PREDICT study, including young black and white men and women (aged 20-30, N = 1202). We obtained clinic, ambulatory, and central BP readings, as well as measures of subclinical organ damage: central retinal arteriolar equivalent (CRAE) from fundus images, echocardiography to determine left ventricular mass index (LVMi), carotid intima media thickness (CIMT), carotid-femoral pulse wave velocity (PWV), and albumin-to-creatinine ratio (ACR) determined from spot urine samples. Overall, weak correlations were evident between CIMT, ACR, and BP, whereas CRAE, LVMi, and PWV correlated strongly with BP. In the total group, clinic brachial BP had stronger associations with CRAE, LVMi, and PWV (all p < 0.001) than ambulatory and central BP. Although the ethnic groups showed similar correlations between CRAE, LVMi, CIMT, and the various BPs, PWV correlated more strongly with ambulatory systolic BP (p < 0.001) in white participants. In young healthy adults, clinic brachial BP correlated more strongly with measures of early target organ damage than central or ambulatory BP. No differences were observed between correlations of BP and measures of target organ damage in the two ethnic groups.
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Affiliation(s)
- Dimoné Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. .,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa. .,School of Population Health, University of New South Wales; The George Institute for Global Health, Sydney, NSW, Australia.
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Möller C, Schutte AE, Smith W, Botha-Le Roux S. Von Willebrand factor, its cleaving protease (ADAMTS13), and inflammation in young adults: The African-PREDICT study. Cytokine 2020; 136:155265. [PMID: 32927287 DOI: 10.1016/j.cyto.2020.155265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of inflammation in the early development of vascular dysfunction remains complex. Interleukin-6 (IL-6) and C-reactive protein (CRP) can cause an acute imbalance in the von Willebrand factor (vWF)-ADAMTS13 interaction, indicating a possible link between markers of haemostasis and low-grade inflammation. To better understand these inter-relationships in the early phases of disease development, we investigated whether vWF and ADAMTS13 associate with the pro-inflammatory markers, IL-6 and CRP in healthy young adults. We considered the role of blood types, sex and race on these relationships. METHODS In healthy black and white men and women (n = 1113; 24 ± 5 years; no previous diagnosis or medication use for chronic diseases) we analysed von Willebrand factor antigen (vWFag), ADAMTS13, IL-6 and CRP, and grouped blood types as non-O (A, B and AB) and O. Covariates included socioeconomic status, age, estimated glomerular filtration rate, 24-hour systolic blood pressure, waist circumference, glucose, total cholesterol, platelet count, γ-glutamyl transferase and total energy expenditure. RESULTS In the total group, vWFag was highest in the third tertile of both IL-6 and CRP (p ≤ 0.014), while ADAMTS13 was lowest in the third compared to the first IL-6 tertile (p = 0.006). In multivariate regression, vWFag associated positively with IL-6 (Adj R2 = 0.169; β = 0.123; p = 0.001) and CRP (Adj R2 = 0.163; β=0.094; p = 0.019) in the total group, in the O blood group (all p ≤ 0.051) and white men (all p ≤ 0.035). ADAMTS13 associated negatively with IL-6 (Adj R2 = 0.053; β = -0.154; p = 0.015) and CRP (Adj R2 = 0.055; β = -0.177; p = 0.009), only in the O blood group. CONCLUSIONS Markers of haemostasis associated independently with low-grade inflammation in the O type blood group and white men. An interplay between the haemostatic and inflammatory systems may already exist in young healthy adults and is dependent on blood groups, sex and race. This extends our understanding on the role of inflammation in the early development of vascular dysfunction prior to cardiovascular compromise.
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Affiliation(s)
- Christine Möller
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Faculty of Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Shani Botha-Le Roux
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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6
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Schutte AE, Gona PN, Delles C, Uys AS, Burger A, Mels CM, Kruger R, Smith W, Fourie CM, Botha S, Lammertyn L, van Rooyen JM, Gafane-Matemane LF, Mokwatsi GG, Breet Y, Kruger HS, Zyl TV, Pieters M, Zandberg L, Louw R, Moss SJ, Khumalo IP, Huisman HW. The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): Design, recruitment and initial examination. Eur J Prev Cardiol 2019; 26:458-470. [PMID: 30681377 PMCID: PMC6423686 DOI: 10.1177/2047487318822354] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Globally hypertension is stabilising, but in sub-Saharan Africa the incidence
of hypertension remains on an increase. Although this might be attributed to
poor healthcare and ineffective antihypertensive treatment, there is a
limited understanding of population and individual-specific cardiovascular
pathophysiology – necessary for effective prevention and treatment
strategies in Africa. As there is a lack of longitudinal studies tracking
the early pathophysiological development of hypertension in black
populations, the African-PREDICT study was initiated. The purpose of this
paper is to describe the detailed methodology and baseline cohort profile of
the study. Methods and results From 2013 to 2017, the study included 1202 black (N = 606)
and white (N = 596) men and women (aged 20–30 years) from
South Africa – screened to be healthy and clinic normotensive. At baseline,
and each 5-year follow-up examination, detailed measures of health
behaviours, cardiovascular profile and organ damage are taken. Also,
comprehensive biological sampling for the ‘omics’ and biomarkers is
performed. Overall, the baseline black and white cohort presented with
similar ages, clinic and 24-hour blood pressures, but black adults had lower
socioeconomic status and higher central systolic blood pressure than white
individuals. Conclusions The prospective African-PREDICT study in young black and white adults will
contribute to a clear understanding of early cardiovascular disease
development.
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Affiliation(s)
- Aletta E Schutte
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Philimon N Gona
- 3 Department of Exercise and Health Sciences, University of Massachusetts Boston, USA
| | - Christian Delles
- 4 Institute of Cardiovascular and Medical Sciences (ICAMS), University of Glasgow, UK
| | - Aletta S Uys
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Adele Burger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Catharina Mc Mels
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Ruan Kruger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Wayne Smith
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Carla Mt Fourie
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Shani Botha
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Leandi Lammertyn
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Johannes M van Rooyen
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Lebo F Gafane-Matemane
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Gontse G Mokwatsi
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Yolandi Breet
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - H Salome Kruger
- 2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.,5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Tertia van Zyl
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Marlien Pieters
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Lizelle Zandberg
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Roan Louw
- 6 Human Metabolomics, North-West University, South Africa
| | - Sarah J Moss
- 7 Physical activity, Sport and Recreation Research Focus Area, North-West University, South Africa
| | | | - Hugo W Huisman
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
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Strauss M, Smith W, Wei W, Fedorova OV, Schutte AE. Marinobufagenin is related to elevated central and 24-h systolic blood pressures in young black women: the African-PREDICT Study. Hypertens Res 2018; 41:183-192. [PMID: 29335615 PMCID: PMC6015745 DOI: 10.1038/s41440-017-0009-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 12/28/2022]
Abstract
Marinobufagenin (MBG) is an endogenous steroidal α1-Na+K+-ATPase inhibitor. Because of its role in sodium handling, MBG has been associated with both antihypertensive and prohypertensive effects in normal physiology and pathology. MBG is positively associated with blood pressure in Dahl salt-sensitive rats exhibiting a similar hypertensive phenotype to black populations, characterized by impaired urinary Na+ excretion. However, clinical studies exploring blood pressure (BP)-related effects of MBG in black populations are scant. We determined whether the MBG/Na+ ratio (assessing the effectiveness of Na+ excretion resistance to MBG) is related to systolic BP (SBP) in young black men and women, compared to whites. We included 331 apparently healthy participants (20-30 years) (42.9% black, 43.8% men) on a habitual diet. We obtained 24-h and central SBP, and 24-h urinary Na+ and MBG levels. We found no ethnic differences in MBG, Na+ or MBG/Na+. MBG excretion correlated positively with Na+ excretion in all groups and to SBP in white men and black women (p ≤ 0.011). In black women only SBP related positively to MBG/Na+ in single and multi-variable adjusted regression models: central SBP (R2 = 0.26; ß = 0.28; p = 0.039), 24-h SBP (R2 = 0.46; ß = 0.30; p = 0.011), daytime (R2 = 0.38; ß = 0.28; p = 0.023) and nighttime SBP (R2 = 0.38; ß = 0.33; p = 0.009). In contrast, inverse associations of MBG/Na+ with nighttime SBP were evident in white women (r = -0.20; p = 0.038) but lost significance after multiple adjustments (R2 = 0.36; ß = -0.13; p = 0.12). We found independent positive associations of SBP with MBG/Na+ in black women. This data supports the concept that reduced MBG-mediated Na+ excretion can contribute to adverse hemodynamics.
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Affiliation(s)
- Michél Strauss
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Wen Wei
- National Institute on Aging, NIH, Baltimore, MD, USA
| | | | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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8
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Schutte AE, Botha S, Fourie CMT, Gafane-Matemane LF, Kruger R, Lammertyn L, Malan L, Mels CMC, Schutte R, Smith W, van Rooyen JM, Ware LJ, Huisman HW. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 2017; 31:491-500. [PMID: 28332510 DOI: 10.1038/jhh.2017.18] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
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Affiliation(s)
- A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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