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Low grade inflammation and ECG left ventricular hypertrophy in urban African males: The SABPA study
Carel van der Walt1, Leoné Malan, Aletta S Uys
1Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom, 2520, South Africa.
Insights
In African men, high blood pressure and low-grade inflammation together predict left ventricular hypertrophy (LVH). This study highlights a combined risk for cardiovascular structural changes in this population.
Area of Science:
- Cardiology
- Vascular Biology
- Inflammation Research
Background:
- Hypertension and vascular hyperresponsiveness are linked to structural heart abnormalities in Black Africans.
- The additive effect of low-grade inflammation on these abnormalities remains unclear.
- This study investigates the combined impact of inflammation and pressure overload on ECG-determined left ventricular hypertrophy (LVH).
Purpose of the Study:
- To assess the additive association of inflammation and pressure overload with ECG-determined left ventricular hypertrophy (LVH).
- To compare these associations between African and Caucasian men.
Main Methods:
- Included 75 African and 87 Caucasian males.
- Ambulatory blood pressure monitoring and resting 12-lead ECG for LVH determination (Cornell product formula).
- High-sensitivity C-reactive protein (hs-CRP) levels analyzed to stratify participants into low (≤3 mg/L) and high (>3 mg/L) inflammation groups.
Main Results:
- African men exhibited higher ambulatory blood pressure levels than Caucasian men, irrespective of hs-CRP levels.
- Systolic blood pressure (SBP) was positively associated with ECG LVH in all African men.
- In African men with high hs-CRP levels, SBP and pulse pressure significantly predicted ECG LVH.
Conclusions:
- Hyperdynamic blood pressure and inflammation act synergistically to promote structural wall abnormalities in African men.
- These factors represent potential contributing elements to cardiovascular remodeling in this demographic.
Background:
Hypertension and vascular hyperresponsiveness have been associated with structural wall abnormalities in black Africans. Whether low grade inflammation would have an additive effect is uncertain. Therefore, a novel investigation aimed to assess whether inflammation and pressure overload would have an additive association with ECG left ventricular hypertrophy (LVH).
Methods:
We included 75 African and 87 Caucasian males. Ambulatory blood pressure monitoring was done in the working week. A resting 12-lead ECG recording was used for the determination of LVH with the Cornell product formula. Fasting blood samples were obtained for high sensitivity C-reactive protein (hs-CRP) analyses after a controlled overnight stay. Men were stratified into low (≤3 mg/L) and high (>3 mg/L) hs-CRP groups.
Results:
African men revealed higher ambulatory blood pressure levels compared to Caucasian men independent of hs-CRP levels after adjustment for age, physical activity, cotinine, log γ-GT and body surface area. In forward stepwise linear regression analyses, SBP was positively associated with ECG LVH in all Africans. Considering low grade inflammatory status (>3 mg/L hs-CRP), SBP [Adj R(2)=0.49 (β=0.99, 0.45, 1.44), p≤0.01] and pulse pressure [Adj R(2)=0.61 (β=0.0.34, 0.88), p≤0.01] respectively, predicted ECG LVH in African but not in Caucasian men.
Conclusions:
Hyperdynamic blood pressure and inflammation acted in tandem as possible promoting factors to structural wall abnormalities in African men.
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