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Double product and end-organ damage in African and Caucasian men: the SABPA study
A J Schultz1, A E Schutte, R Schutte
1Hypertension in Africa Research Team, School for Physiology, Nutrition, and Consumer Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
Insights
Systolic blood pressure, not double product, is a better indicator of cardiovascular risk in African men. This study highlights differences in cardiovascular risk factors between African and Caucasian men.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Urbanization in sub-Saharan Africa is linked to rising cardiovascular disease rates.
- Africans exhibit higher blood pressure and hypertension-related morbidity/mortality than Caucasians.
- Cardiac workload, measured by double product (systolic blood pressure × heart rate), is explored as a risk factor.
Purpose of the Study:
- To investigate double product as a cardiovascular risk factor in African and Caucasian men.
- To compare cardiovascular risk markers between urbanised African and Caucasian men.
Main Methods:
- Study included 101 urbanised African and 101 Caucasian male school teachers.
- Measured 24-hour ambulatory blood pressure, carotid cross-sectional wall area, and left ventricular hypertrophy (Cornell product).
- Analyzed urinary albumin-to-creatinine ratio for end-organ damage markers.
Main Results:
- Africans showed higher 24-hour blood pressure, heart rate, and double product than Caucasians.
- Markers of end-organ damage (albumin-to-creatinine ratio, left ventricular hypertrophy) were elevated in Africans.
- In Africans, 24-hour systolic blood pressure correlated with end-organ damage markers, unlike double product or heart rate.
Conclusions:
- Systolic blood pressure, not double product, is a stronger predictor of cardiovascular risk in African men.
- Findings suggest differing cardiovascular risk profiles between African and Caucasian men, emphasizing systolic blood pressure's importance.
Background:
Increasing urbanisation in sub-Saharan African countries is causing a rapid increase in cardiovascular disease. Evidence suggests that Africans have higher blood pressures and a higher prevalence of hypertension-related cardiovascular morbidity and mortality, compared to Caucasians. We investigated double product (systolic blood pressure × heart rate), a substantial measure of cardiac workload, as a possible cardiovascular risk factor in African and Caucasian men.
Material And Methods:
The study consisted of 101 urbanised African and 101 Caucasian male school teachers. We measured 24h ambulatory blood pressure and the carotid cross-sectional wall area, and determined left ventricular hypertrophy electrocardiographically by means of the Cornell product. Urinary albumin and creatinine were analysed to obtain the albumin-to-creatinine ratio.
Results:
Africans had higher 24h, daytime and nighttime systolic- and diastolic blood pressure, heart rate and resultant double product compared to the Caucasians. In addition, markers of end-organ damage, albumin-to-creatinine ratio and left ventricular hypertrophy were higher in the Africans while cross-sectional wall area did not differ. In Africans after single partial and multiple regression analysis, 24h systolic blood pressure, but not double product or heart rate, correlated positively with markers of end-organ damage (cross-sectional wall area: β=0.398, P=0.005; left ventricular hypertrophy: β=0.455, P<0.001; albumin-to-creatinine ratio: β=0.280, P=0.012). No associations were evident in Caucasian men.
Conclusions:
Double product may not be a good marker of increased cardiovascular risk when compared to systolic blood pressure in African and Caucasian men.
