Racial variation in cardiovascular morbidity and mortality in essential hypertension

Area of Science:

• Cardiovascular Medicine
• Public Health
• Epidemiology

Background:

• Hypertension affects diverse ethnic groups with varying cardiovascular disease (CVD) risks.
• Understanding ethnic disparities in hypertension outcomes is critical for targeted interventions.

Purpose of the Study:

• To longitudinally compare morbidity and mortality in white, South Asian, and Afro-Caribbean hypertensive patients.
• To assess the predictive value of demographic factors and blood pressure measurements (clinic vs. ambulatory) on CVD events.

Main Methods:

• An observational follow-up study involving 528 white, 106 South Asian, and 54 Afro-Caribbean patients with essential hypertension.
• 24-hour ambulatory intra-arterial blood pressure monitoring was performed.
• Outcomes including all-cause mortality, non-fatal myocardial infarction, and stroke were assessed over a mean of 9.2 years.

Main Results:

• South Asians exhibited the highest all-cause event rate (3.46 events/100 patient-years), primarily due to excess coronary events (2.86 vs. 1.32 in whites).
• Independent predictors of adverse events included age, sex, South Asian ethnicity, diabetes, prior CVD, and 24-hour ambulatory systolic blood pressure.
• Clinic blood pressure measurements did not offer additional prognostic information.

Conclusions:

• South Asian origin is an independent predictor of cardiovascular events, largely driven by a higher incidence of coronary events.
• Ambulatory blood pressure monitoring provides valuable prognostic information for hypertensive patients, surpassing the utility of clinic-based readings.