ORCID Profile
0000-0001-9217-4937
Current Organisations
George Institute for Global Health
,
University of New South Wales
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Publisher: Wiley
Date: 08-02-2016
DOI: 10.1111/JCH.12782
Publisher: Frontiers Media SA
Date: 31-07-2020
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.ATHEROSCLEROSIS.2013.12.025
Abstract: Insulin-like growth factor-1 (IGF-1) has potent endothelial-protective, anti-platelet and anti-thrombotic activities, and also exerts mitogenic and proliferatory actions on vascular smooth muscle cells. Conflicting reports exist regarding the role of IGF-1 in vascular protection and atherogenesis. We therefore investigated the relationships of ambulatory blood pressure (BP) and carotid intima-media thickness (cIMT) with a range of components of the IGF-1 axis in a bi-ethnic population. We included black (N = 86) and white (N = 101) men and measured growth hormone, total IGF-1, insulin-like growth factor binding protein-3 (IGFBP-3), and pregnancy-associated plasma protein-A (PAPP-A) levels. Ambulatory BP was almost 10 mmHg higher in black men (137/88 mmHg versus 128/80 mmHg both p < 0.001), accompanied by an adverse profile of the IGF-axis for all measured components (all p < 0.01), including reduced bioavailable IGF-1 (IGF-1/IGFBP-3 p = 0.006) and tissue IGF-1 accessibility index as represented by IGF-1.PAPP-A/IGFBP-3 (p < 0.001). Single, partial and multiple regression analyses confirmed an independent inverse association between ambulatory systolic BP and bioavailable IGF-1 in black men (R(2) = 0.24 β = -0.22 p = 0.035). cIMT was similar in the ethnic groups (p = 0.34), and was negatively associated with bioavailable IGF-1 in white men (R(2) = 0.42 β = -0.17 p = 0.039) prior to adjustment for γ-glutamyl transferase (R(2) = 0.45 β = -0.10 p = 0.25). Ambulatory systolic BP is inversely related to bioavailable IGF-1 in black men who displayed low IGF-1 concentrations. An inverse relation was found between cIMT and IGF-1 in white men, which disappeared after correction for γ-glutamyl transferase - opposing reports of a detrimental role of IGF-1 in the early stages of atherogenesis.
Publisher: Clinics Cardive Publishing
Date: 19-12-2019
Publisher: Ubiquity Press, Ltd.
Date: 13-07-2021
DOI: 10.5334/GH.913
Publisher: Springer Science and Business Media LLC
Date: 17-06-2020
Publisher: Elsevier BV
Date: 11-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 09-2017
Publisher: Oxford University Press (OUP)
Date: 12-2008
DOI: 10.1038/AJH.2008.287
Abstract: The increasing prevalence of hypertension and vascular-related morbidity and mortality among Africans emphasizes the need to identify markers for the early detection of vascular disease. Caucasian-based studies demonstrate that the von Willebrand factor (vWf) is a useful marker of vascular dysfunction. We investigated whether associations between this marker and markers of cardiovascular function in Caucasian women are comparable with African women. The study consisted of apparently healthy African (n = 99) and Caucasian (n = 114) women (mean age, 31.0 years), in idually matched for age and body mass index. We measured blood pressure and arterial compliance noninvasively, and vWf in serum. We assessed univariate and multivariate-adjusted associations of blood pressure and arterial compliance with vWf. Although no ethnic difference existed for mean vWf levels, Caucasian and African women showed opposite associations of blood pressure and arterial compliance with vWf after single, partial, and multiple regression analyses. In Caucasians, after full adjustment, systolic (beta = +0.179 P < 0.05) and diastolic (beta = +0.190 P < 0.05) blood pressure correlated positively and arterial compliance negatively (beta = -0.197 P 99% power existed, significance disappeared after excluding these subjects (beta = -0.071 P = 0.46). Associations of vWf with blood pressure and arterial compliance were not comparable between Caucasian and African women, suggesting that the vWf may not be a useful marker of vascular alterations in African women.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2019
DOI: 10.1038/S41371-018-0121-7
Abstract: In the article "Morning blood pressure surge in young black and white adults: The African-PREDICT Study" by Gontse Gratitude Mokwatsi, Aletta Elisabeth Schutte, Catharina Martha Cornelia Mels and Ruan Kruger which appeared in 'Journal of Human Hypertension' (2018) volume 32, DOI 10.1038/s41371-018-0089-3, the authors regret that they mentioned erroneously that none of their study participants had an exaggerated morning blood pressure surge. They would like to point out that 40 participants in their study population had an exaggerated sleep-trough surge whereas 128 had an exaggerated dynamic surge.
Publisher: Wiley
Date: 24-12-2020
DOI: 10.1111/JCH.13767
Publisher: American Medical Association (AMA)
Date: 10-01-2017
Abstract: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). For loss of DALYs associated with systolic blood pressure of 140 mm Hg or higher, the loss increased from 95.9 million (95% uncertainty interval [UI], 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million) [corrected], and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million] 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million] 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million] 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this s le suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.
Publisher: American Medical Association (AMA)
Date: 12-09-2023
Publisher: Wiley
Date: 07-03-2022
DOI: 10.1111/DOM.14671
Abstract: To define the proportional and absolute benefits of the sodium‐glucose co‐transporter‐2 inhibitor canagliflozin in patients with type 2 diabetes (T2D) with and without peripheral arterial disease (PAD). We pooled in idual participant data from the CANVAS Program (n = 10 142) and CREDENCE trial (n = 4401). In this post hoc analysis, the main outcomes of interest were major adverse cardiovascular events (MACE: non‐fatal myocardial infarction, non‐fatal stroke or cardiovascular death), kidney outcomes, and extended major adverse limb events (MALE). Cox proportional hazards models were used to assess canagliflozin treatment effects in those with and without PAD. Absolute risk reductions per 1000 patients treated for 2.5 years were estimated using Poisson regression. Of 14 543 participants, 3159 (21.7%) had PAD at baseline. In patients with PAD, canagliflozin reduced MACE (hazard ratio, 0.76 95% confidence interval, 0.62‐0.92), with similar relative benefits for other cardiovascular and kidney outcomes in participants with or without PAD at baseline (all P interaction .268). There was no increase in the relative risk of extended MALE with canagliflozin, irrespective of baseline PAD history ( P interaction .864). The absolute benefits of canagliflozin were greater in those with PAD. Patients with T2D and PAD derived similar relative cardiorenal benefits from canagliflozin treatment but higher absolute benefits compared with those without PAD, with no increase in extended MALE.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2022
Publisher: Springer Science and Business Media LLC
Date: 20-07-2006
Abstract: The integrated relationship between inflammation, obesity and cardiovascular disease is currently a subject of much research interest. These specific relationships, however, have not been studied in-depth in South African population groups in order to determine the role of ethnicity. It is known that Africans, compared to Caucasians, suffer from a high prevalence of hypertension. It was therefore hypothesized that the levels of inflammatory markers (high-sensitivity C-reactive protein (hsCRP), fibrinogen and leptin) are higher in Africans compared to Caucasians and are notably associated with cardiovascular dysfunction in Africans. Apparently healthy African (N=102) and Caucasian (N=115) women, matched for age and body mass index (BMI), were recruited. Leptin, hsCRP, fibrinogen and lipid levels, waist circumference (WC), BMI, systolic and diastolic blood pressure, cardiac output (CO), total peripheral resistance (TPR) and Windkessel compliance were measured. Results showed that the levels of leptin, hsCRP and fibrinogen were significantly higher (P<0.05) in the African women. The inflammatory markers correlated strongly with cardiovascular parameters, age and obesity (BMI, WC) in both groups, but after adjusting for age and obesity, none of the correlations were significant anymore. Multiple regression analyses (with leptin, hsCRP or fibrinogen as dependent variable) showed that only leptin levels of African women were explained by cardiovascular parameters (BP, TPR and CO). In conclusion, even though African women had significantly higher leptin, hsCRP, fibrinogen and blood pressure levels than Caucasian women, no cardiovascular parameters explained the variation in the inflammatory markers (except for leptin levels of African women).
Publisher: South African Medical Association NPC
Date: 30-09-2022
DOI: 10.7196/SAMJ.2022.V112I8B.16648
Abstract: Background. South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. Objective. To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. Methods. Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. Results. Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex alcohol consumption interpersonal violence tobacco smoking and high systolic blood pressure while for females the leading risks were unsafe sex interpersonal violence high systolic blood pressure high body mass index and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (–41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). Conclusion. This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2019
Publisher: Georg Thieme Verlag KG
Date: 08-10-2014
Abstract: Severe underweight may be a risk factor for hypertension in developing countries, although the manner whereby this occurs is unknown. Leptin is known to exert both beneficial and detrimental vascular effects, and is predictive of poor cardiovascular outcome at high levels, but also at low levels. We explored the relationship between blood pressure and leptin in black men from South Africa with a body mass index (BMI) in the underweight to normal range. We included 113 African men (BMI≤25 kg/m(2)) and took anthropometric, biochemical and cardiovascular measures. The blood pressure-leptin relationship was then investigated along quintiles of leptin and within BMI stratified median split (20 kg/m(2)) groups. Blood pressure increased across leptin quintiles 1-3 (p for trend≤0.040), whereas no relationship was observed along quintiles 3 to 5 (p for trend≥0.14) (adjusted for age and waist circumference). Blood pressure was similar in the two BMI median split groups (p≥0.083). In the low BMI group only, blood pressure associated positively with leptin following unadjusted, partial, and full adjustment (systolic blood pressure and diastolic blood pressure: R(2)=0.20-0.27, β=0.32-0.34, p≤0.009). Decreasing leptin levels are not likely to contribute to hypertension prevalence in the underweight. Rather, in African men with a BMI≤20 kg/m(2), low leptin levels are positively and independently associated with elevated blood pressure, which is not seen at higher BMI (20-25 kg/m(2)). Our findings suggest a differential concentration dependent vascular effect of leptin in underweight and normal weight African men.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2015
DOI: 10.1038/HR.2015.123
Publisher: Wiley
Date: 13-01-2016
DOI: 10.1111/JCH.12768
Publisher: Wiley
Date: 19-11-2019
DOI: 10.1111/JCH.13735
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-09-2022
Abstract: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. MEDLINE, EMBASE, ClinicalTrials.gov , and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID‐19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all‐cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow‐up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all‐cause mortality (7.2% versus 7.5% relative risk [RR], 0.95 [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID‐19 severity or trial type. Network meta‐analysis identified no difference between angiotensin‐converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6% RR, 0.59 [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6% RR, 1.82 [95% CI, 1.05–3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. This meta‐analysis of randomized controlled trials evaluating angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID‐19 found no difference in all‐cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID‐19.
Publisher: Ubiquity Press, Ltd.
Date: 03-2018
DOI: 10.1016/J.GHEART.2017.06.001
Abstract: The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority action to reduce heart disease and stroke on the continent. The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025. Development of this roadmap started with the creation of a consortium of experts with leadership skills in hypertension. In 2014, experts in different fields, including physicians and nonphysicians, were invited to join. Via face-to-face meetings and teleconferences, the consortium made a situation analysis, set a goal, identified roadblocks and solutions to the management of hypertension and customized the World Heart Federation roadmap to Africa. Hypertension is a major crisis on the continent but very few randomized controlled trials have been conducted on its management. Also, only 25.8% of the countries have developed or adopted guidelines for management of hypertension. Other major roadblocks are either government and health-system related or health care professional or patient related. The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025. Hypertension affects millions of people in SSA and if left untreated, is a major cause of heart disease and stroke. Very few SSA countries have a clear hypertension policy. This PASCAR roadmap identifies practical and effective solutions that would improve detection, treatment and control of hypertension on the continent and could be implemented as is or adapted to specific national settings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2022
Publisher: Elsevier BV
Date: 08-2019
Publisher: Springer Science and Business Media LLC
Date: 14-10-2022
DOI: 10.1038/S41440-022-01071-3
Abstract: In Black populations excessive salt intake may exacerbate the genetic predisposition to hypertension and promote the early onset of cardiovascular disease. Ethnic differences in the interaction between sodium intake and the metabolome may play a part in hypertension and cardiovascular disease development. We determined (1) urinary amino acid and acylcarnitine profiles of young Black and White adults according to low, moderate, and high dietary salt intake, and (2) investigated the triad of salt intake, systolic blood pressure (SBP), and the associated metabolomics profile. This study included 447 White and 380 Black adults aged 20-30 years from the African-PREDICT study. Estimated salt intake was determined from 24-hour urinary sodium levels. Urinary amino acids and acylcarnitines were measured using liquid chromatography-tandem mass spectrometry. Black adults exhibited no significant differences in SBP, amino acids, or acylcarnitines across low ( 10g/day) salt intake. White adults with a high salt intake had elevated SBP compared to those with low or moderate intakes (p < 0.001). Furthermore, gamma-aminobutyric acid (GABA) (q = 0.020), citrulline (q = 0.020), glutamic acid (q = 0.046), serine (q = 0.054) and proline (q = 0.054) were lowest in those with higher salt intake. Only in White and not Black adults did we observe inverse associations of clinic SBP with GABA (Adj. R
Publisher: MDPI AG
Date: 08-02-2022
DOI: 10.3390/NU14030704
Abstract: Most studies disregard long-term dairy consumption behaviour and how it relates to mortality. We examined four different types of long-term milk consumption, namely whole milk, reduced fat milk, skim milk and soy milk, in relation to mortality among adults diagnosed with cardiovascular disease (CVD). A retrospective population-based study was conducted in Australia (the 45 and Up Study) linking baseline (2006–2009) and follow-up data (2012–2015) to hospitalisation and mortality data up to 30 September 2018. A total of 1,101 deaths occurred among 7236 participants with CVD over a mean follow-up of 8.4 years. Males (Hazard Ratio, HR = 0.69, 95% CI (0.54 0.89)) and females (HR = 0.59 (0.38 0.91)) with long-term reduced fat milk consumption had the lowest risk of mortality compared to counterparts with long-term whole milk consumption. Among participants with ischemic heart disease, males with a long-term reduced fat milk consumption had the lowest risk of mortality (HR = 0.63, 95% CI: 0.43 0.92). We conclude that among males and females with CVD, those who often consume reduced fat milk over the long-term present with a 31–41% lower risk of mortality than those who often consume whole milk, supporting dairy advice from the Heart Foundation of replacing whole milk with reduced fat milk to achieve better health.
Publisher: Elsevier BV
Date: 11-2016
Publisher: Wiley
Date: 19-10-2005
DOI: 10.1111/J.1464-5491.2005.01747.X
Abstract: To determine the prevalence of the metabolic syndrome (MS) among Aboriginal and Torres Strait Islander peoples. A further objective was to investigate the relationships between fasting insulin and blood pressure (BP) within these groups with increasing age. A cross-sectional population-based study included 369 Torres Strait Islanders (residing in Torres Strait and Far North Queensland), and 675 Aborigines from central Australia. Data necessary for classification of MS was collected, including fasting and 2-h glucose and insulin, urinary albumin and creatinine, anthropometric measurements, BP, serum lipids. The ATPIII criteria classified 43% of Torres Strait Islanders and 44% of Aborigines with MS, whereas 32 and 28%, respectively, had the MS according to WHO criteria. Agreement between the two criteria was only modest (kappa coefficient from 0.28 to 0.57). Factor analyses indicated no cluster including both insulin and BP in either population. Significant correlations (P < 0.05) [adjusted for gender, body mass index (BMI) and waist circumference] were observed between BP and fasting insulin: a positive correlation for Torres Strait Islanders aged 15-29 years, and an inverse correlation for Aborigines aged 40 years and older. Torres Strait Islanders and Aborigines had very high prevalences of the MS. Specific population characteristics (high prevalences of central obesity, dyslipidaemia, renal disease) may make the WHO definition preferable to the ATPIII definition in these population groups. The poor agreement between criteria suggests a more precise definition of the metabolic syndrome that is applicable across populations is required. This study showed an inverse relationship with age for the correlation of BP and fasting insulin.
Publisher: Wiley
Date: 12-08-2016
DOI: 10.1111/JCH.12894
Publisher: Wiley
Date: 25-11-2019
DOI: 10.1111/JCH.13741
Publisher: Elsevier BV
Date: 10-2020
Publisher: Pan American Health Organization
Date: 12-03-2020
Abstract: Objective. To characterize the design of excise taxes on sugar-sweetened beverages (SSBs) in Latin America and the Caribbean and assess opportunities to increase their impact on SSB consumption and health. Methods. A comprehensive search and review of the legislation in effect as of March 2019, collected through existing Pan American Health Organization and World Health Organization monitoring tools, secondary sources, and surveying ministries of finance. The analysis focused on the type of products taxed, and the structure and base of these excise taxes. Results. Out of the 33 countries analyzed, 21 apply excise taxes on SSBs. Seven countries also apply excise taxes on bottled water and at least four include sugar-sweetened milk drinks. Ten of these excise taxes are ad valorem with some tax bases set early in the value chain, seven are amount-specific, and four have either a combined or mixed structure. Three countries apply excise taxes based on sugar concentration. Conclusions. While the number of countries applying excise taxes on SSBs is promising, there is great heterogeneity in design in terms of structure, tax base, and products taxed. Existing excise taxes could be further leveraged to improve their impact on SSB consumption and health by including all categories of SSBs, excluding bottled water, and relying more on amount-specific taxes regularly adjusted for inflation and possibly based on sugar concentration. All countries would benefit from additional guidance. Future research should aim to address this gap.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2023
DOI: 10.1161/HYPERTENSIONAHA.123.21592
Abstract: Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP /90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.
Publisher: Wiley
Date: 26-10-2012
DOI: 10.1007/S11745-012-3732-8
Abstract: The prevalence of hypertension in sub-Saharan Africa is increasing rapidly, and treatment remains challenging. Although the use of L-carnitine in treatment has received much attention, studies reporting on physiological L-carnitine levels in hypertensives are limited. Our aim was to determine physiological levels of L-carnitine and acylcarnitines in African and Caucasian men, and to investigate associations between ambulatory blood pressure (BP) and carnitine levels. Participants included 101 African and 101 Caucasian teachers. Ambulatory BP measurements were conducted, and L-carnitine and acylcarnitine levels determined. African men showed significantly higher systolic BP (p < 0.001), diastolic BP (p < 0.001) and L-carnitine levels (p = 0.01). In both ethnic groups, partial regression analyses revealed a positive association between BP and L-carnitine, although in Caucasians it was with systolic (r = 0.20, p = 0.045), and in Africans with diastolic BP (r = 0.23, p = 0.023). After adjusting for confounders, an independent positive association between systolic (R(2) = 0.37, β = 0.12, p = 0.041) and diastolic BP (R(2) = 0.39, β = 0.14, p = 0.018) and L-carnitine and long-chain acylcarnitines (R(2) = 0.38, β = 0.17, p = 0.005 and R(2) = 0.39, β = 0.15, p = 0.011) were found, independent of ethnicity. Physiological L-carnitine levels were not only higher in Africans than in Caucasians but also above the expected reference range. Despite promising results on L-carnitine (and its short-chain derivatives) in hypertension treatment regimens, our findings paradoxically show that elevated BP is significantly associated with higher physiological L-carnitine and long-chain acylcarnitine levels.
Publisher: Frontiers Media SA
Date: 29-04-2020
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 07-2022
Publisher: The Endocrine Society
Date: 05-2010
DOI: 10.1210/JC.2009-2329
Abstract: Low serum IGF-I is an independent risk factor for diabetes and cardiovascular disease. These noncommunicable diseases are extremely common in urban black South Africans, but their IGF-I concentration is unknown. We aimed to compare serum IGF-I concentrations of African and Caucasian people, investigate their age-related IGF-I decline, and determine whether IGF-I could account, at least in part, for the high prevalence of noncommunicable diseases in black Africans. This cross-sectional study involved 211 African and 316 Caucasian men and women (aged 20-70 yr). Fasting glucose, insulin, lipids, albumin, creatinine, liver enzymes, cotinine, high-sensitivity C-reactive protein, reactive oxygen species, IGF-I, blood pressure (BP), and pulse wave velocity were determined. IGF-I was lower in Africans (P < 0.001) and in both ethnicities declined significantly by age quartiles (P < 0.001). In African men and women, IGF-I declined significantly from age quartile 1 to 2 (r = -0.65, P < 0.001), not seen in young Caucasian men and women (r = -0.08, P = 0.45 r = -0.10, P = 0.34). This was confirmed after adjustment for BP, insulin resistance, high-sensitivity C-reactive protein, cotinine, gamma-glutamyl transferase, and reactive oxygen species. Only young Africans showed significant negative correlations of IGF-I with BP, pulse wave velocity, and high-density lipoprotein cholesterol. Africans presented lower IGF-I levels than Caucasians due to an accelerated decline in serum IGF-I concentration prior to 40 yr of age. Strong associations of low serum IGF-I with blood pressure and arterial stiffness in young Africans suggest that the loss of cardiometabolic protection by IGF-I could predispose them to earlier disease onset.
Publisher: Springer Science and Business Media LLC
Date: 02-07-2020
DOI: 10.1038/S41591-020-0972-7
Abstract: An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Publisher: South African Medical Association NPC
Date: 30-09-2022
DOI: 10.7196/SAMJ.2022.V112I8B.16542
Abstract: Background. Ongoing quantification of trends in high blood pressure and the consequent disease impact are crucial for monitoring and decision-making. This is particularly relevant in South Africa (SA) where hypertension is well-established.Objective. To quantify the burden of disease related to high systolic blood pressure (SBP) in SA for 2000, 2006 and 2012, and describe age, sex and population group differences.Methods. Using a comparative risk assessment methodology, the disease burden attributable to raised SBP was estimated according to age, se, and population group for adults aged ≥25 years in SA in the years 2000, 2006 and 2012. We conducted a meta-regression on data from nine national surveys (N=124 350) to estimate the mean and standard deviation of SBP for the selected years (1998 - 2017). Population attributable fractions were calculated from the estimated SBP distribution and relative risk, corrected for regression dilution bias for selected health outcomes associated with a raised SBP, above a theoretical minimum of 110 - 115 mmHg. The attributable burden was calculated based on the estimated total number of deaths and disability-adjusted life years (DALYs). Results. Mean SBP (mmHg) between 2000 and 2012 showed a slight increase for adults aged ≥25 years (127.3 - 128.3 for men 124.5 - 125.2 for women), with a more noticeable increase in the prevalence of hypertension (31% - 39% in men 34% - 40% in women). In both men and women, age-standardised rates (ASRs) for deaths and DALYs associated with raised SBP increased between 2000 and 2006 and then decreased in 2012. In 2000 and 2012, for men, the death ASR (339/100 000 v. 334/100 000) and DALYs (5 542/100 000 v. 5 423/100 000) were similar, whereas for women the death ASR decreased (318/100 000 v. 277/100 000) as did age-standardised DALYs (5 405/100 000 v. 4 778/100 000). In 2012, high SBP caused an estimated 62 314 deaths (95% uncertainty interval 62 519 - 63 608), accounting for 12.4% of all deaths. Stroke (haemorrhagic and ischaemic), hypertensive heart disease and ischaemic heart disease accounted for % of the disease burden attributable to raised SBP over the period. Conclusion. From 2000 to 2012, a stable mean SBP was found despite an increase in hypertension prevalence, ascribed to an improvement in the treatment of hypertension. Nevertheless, the high mortality burden attributable to high SBP underscores the need for improved care for hypertension and cardiovascular diseases, particularly stroke, to prevent morbidity and mortality.
Publisher: Oxford University Press (OUP)
Date: 14-09-2020
DOI: 10.1093/EURHEARTJ/EHAA586
Abstract: Several blood pressure guidelines recommend low sodium intake (& .3 g/day, 100 mmol, 5.8 g/day of salt) for the entire population, on the premise that reductions in sodium intake, irrespective of the levels, will lower blood pressure, and, in turn, reduce cardiovascular disease occurrence. These guidelines have been developed without effective interventions to achieve sustained low sodium intake in free-living in iduals, without a feasible method to estimate sodium intake reliably in in iduals, and without high-quality evidence that low sodium intake reduces cardiovascular events (compared with moderate intake). In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake and suggests that a specific low sodium intake target (e.g. & .3 g/day) for in iduals may be unfeasible, of uncertain effect on other dietary factors and of unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world’s population consume a moderate range of dietary sodium (2.3–4.6g/day 1–2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day. While current evidence has limitations, and there are differences of opinion in interpretation of existing evidence, it is reasonable, based upon observational studies, to suggest a population-level mean target of & g/day in populations with mean sodium intake of & g/day, while awaiting the results of large randomized controlled trials of sodium reduction on incidence of cardiovascular events and mortality.
Publisher: BMJ
Date: 19-01-2022
Abstract: Over the last 30 years, South Africa has experienced four ‘colliding epidemics’ of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990–2007 and 2007–2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. Across the nine provinces, inequalities in mortality and life expectancy increased over 1990–2007, largely due to differences in HIV/AIDS, then decreased over 2007–2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
Publisher: Wiley
Date: 26-10-2019
DOI: 10.1111/JCH.13710
Publisher: Oxford University Press (OUP)
Date: 29-03-2018
Abstract: Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk. A comprehensive systematic review was performed following the PRISMA guidelines. A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk. The dose–response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5–20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02). These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.
Publisher: Elsevier BV
Date: 09-2018
Publisher: Ubiquity Press, Ltd.
Date: 25-01-2022
DOI: 10.5334/GH.1087
Publisher: Elsevier BV
Date: 10-2017
Publisher: MDPI AG
Date: 25-04-2022
DOI: 10.3390/JCDD9050130
Abstract: This study aims to compare soluble (pro)renin receptor [s(P)RR] levels between black and white adults and to explore the associations of left ventricular (LV) structure and function with s(P)RR in the total and ethnicity-stratified groups. The study s le included 1172 apparently healthy black (n = 587) and white (n = 585) participants of the African-PREDICT study aged 20–30 years. Echocardiography was performed to determine relative wall thickness (RWT), LV mass index, LV ejection fraction and stroke volume index (SVi). s(P)RR was analyzed from serum s les, while plasma renin activity-surrogate (PRA-S) and eq angiotensin II were determined using the RAS™ Fingerprint. s(P)RR was higher in the white participants compared to the black participants (p 0.001). In multivariable-adjusted linear regression analyses, we observed a positive association between RWT and s(P)RR (β = 0.141 p = 0.005) and negative associations of LV ejection fraction (β = −0.123 p = 0.016) and SVi (β = −0.144 p = 0.004) with s(P)RR only in white adults. Higher s(P)RR observed in white vs. black participants was associated with higher RWT and poorer LV function only in young white adults but not in their black counterparts. These results suggest that s(P)RR may contribute to LV remodeling and dysfunction in white populations due to its role in volume–pressure regulation and its proinflammatory as well as profibrotic effects.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2023
DOI: 10.1007/S11306-023-01987-Y
Abstract: Increased exposure to risk factors in the young and healthy contributes to arterial changes, which may be accompanied by an altered metabolism. To increase our understanding of early metabolic alterations and how they associate with markers of arterial stiffness, we profiled urinary metabolites in young adults with cardiovascular disease (CVD) risk factor(s) and in a control group without CVD risk factors. We included healthy black and white women and men ( N = 1202), aged 20–30 years with a detailed CVD risk factor profile, reflecting obesity, physical inactivity, smoking, excessive alcohol intake, masked hypertension, hyperglycemia, dyslipidemia and low socio-economic status, forming the CVD risk group ( N = 1036) and the control group ( N = 166). Markers of arterial stiffness, central systolic blood pressure (BP) and pulse wave velocity were measured. A targeted metabolomics approach was followed by measuring amino acids and acylcarnitines using a liquid chromatography-tandem mass spectrometry method. In the CVD risk group, central systolic BP (adjusted for age, sex, ethnicity) was negatively associated with histidine, arginine, asparagine, serine, glutamine, dimethylglycine, threonine, GABA, proline, methionine, pyroglutamic acid, aspartic acid, glutamic acid, branched chain amino acids (BCAAs) and butyrylcarnitine (all P ≤ 0.048). In the same group, pulse wave velocity (adjusted for age, sex, ethnicity, mean arterial pressure) was negatively associated with histidine, lysine, threonine, 2-aminoadipic acid, BCAAs and aromatic amino acids (AAAs) (all P ≤ 0.044). In the control group, central systolic BP was negatively associated with pyroglutamic acid, glutamic acid and dodecanoylcarnitine (all P ≤ 0.033). In a group with increased CVD risk, markers of arterial stiffness were negatively associated with metabolites related to AAA and BCAA as well as energy metabolism and oxidative stress. Our findings may suggest that metabolic adaptations may be at play in response to increased CVD risk to maintain cardiovascular integrity.
Publisher: Wiley
Date: 25-07-2017
DOI: 10.1111/JCH.12868
Publisher: Springer Science and Business Media LLC
Date: 05-08-2011
DOI: 10.1038/JHH.2010.82
Abstract: The renin-angiotensin-aldosterone system can be activated by sympathetic nervous input and is thought to have an important role in the prevalence of hypertension and cardiovascular risk in black Africans. We examined (1) the association between plasma renin responses to mental stress and a marker of sub-clinical atherosclerosis and (2) associations between resting renin and 24-h ambulatory blood pressure. Participants were 143 urbanized black African men and women (43.1 ± 7.7 years) drawn from a study of Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA). After an overnight fast, participants completed the Stroop mental stress task. Blood s les were drawn during baseline and 10 min after the task to assess the concentration of active renin in plasma. Blood pressure assessments included continuous Finometer measures during the stress testing and 24-h ambulatory monitoring. Carotid intima-media thickness (CIMT) was measured using high-resolution ultrasound. Approximately 50% of the s le responded to the task with an increase in renin concentration. Multiple linear regression analysis revealed an association between the renin stress response and CIMT (β = 0.024, 95% confidence interval, 0.004-0.043), after adjustment for conventional risk factors, blood pressure stress responses and basal levels of renin activity (R(2) for model = 0.37). In addition, resting renin was inversely associated with ambulatory blood pressure. In summary, heightened release of renin during a laboratory mental stressor was associated with a marker of sub-clinical atherosclerosis thus, it may be a potential mechanism in explaining the increased burden of cardiovascular disease in urbanized black Africans.
Publisher: Springer Science and Business Media LLC
Date: 09-02-2021
DOI: 10.1038/S41440-021-00627-Z
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 s les. 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.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.IJCARD.2018.11.116
Abstract: Due to the known contribution of excess sodium intake on elevations in blood pressure, salt reduction regulations are being introduced in countries all over the world. To study the contribution of sodium intake on cardiovascular disease development, we determined whether left ventricular mass associates with sodium excretion in young adults free from overt cardiovascular disease and those with masked hypertension. We included 681 participants (41% men and 50% black) in a cross-sectional analysis from the African-PREDICT study with complete 24-hour urine collections and successful ambulatory blood pressure monitoring (>70% valid readings). The participants were categorized as normotensive (n = 534) or masked hypertensive (n = 147). In addition, we determined left ventricular mass index (LVMI) along with traditional risk factors. Masked hypertensive in iduals had higher sodium excretion (149 vs. 128 mmol/L/day) and LVMI (78.1 vs. 69.6 g/m Our results indicated that higher sodium excretion (reflecting a higher salt intake) may contribute to increased left ventricular mass, potentially driven by the early development of masked or undetected hypertension.
Publisher: Georg Thieme Verlag KG
Date: 27-11-2018
Abstract: An increasing prevalence of obesity-related hypertension is observed in the youth and may have severe consequences for future cardiovascular disease development. Previous studies portrayed leptin as a potential factor involved in obesity-related hypertension development. In order to understand leptin’s contributions to early cardiovascular deterioration, we investigated leptin and its associations with measures of autonomic activity, endothelial activation, and blood pressure in young healthy black and white men and women. We included 820 participants (aged 20–30 years) and determined serum leptin and endothelial cellular adhesion molecules. We measured 24-h blood pressure, heart rate, and heart rate variability components. In multivariate-adjusted regression analyses, we found consistent associations between markers of autonomic activity (such as 24-h heart rate, day and night-time heart rate as well as heart rate variability total power) and leptin in both white (all p≤0.001) and black men (all p≤0.040). These findings were absent or less prominent in women, despite their almost 10-fold higher leptin levels than men. Only in white men, 24-h diastolic blood pressure was associated with leptin (Std β=0.37 p=0.006). This association was found to be partly mediated by autonomic activity (24-h heart rate variability total power). No independent associations were observed between leptin and markers of endothelial cell activation, irrespective of race or gender. Leptin’s independent association with autonomic neural activity in a young apparently healthy population suggests an early influence of leptin on autonomic function and future blood pressure elevation especially in men.
Publisher: Oxford University Press (OUP)
Date: 28-07-2016
Abstract: Inconsistent findings are reported on whether insulin-like growth factor-1 (IGF-1) is protective or harmful in predicting hypertension, carotid wall thickness and mortality. We determined the five-year prognostic value of IGF-1 for these outcomes in a large Black population prone to hypertension and cardiovascular disease. A longitudinal study as part of the PURE (Prospective Urban and Rural Epidemiology) study, North West Province, South Africa. We measured IGF-1 and IGF binding protein-3 (IGFBP-3) in 1038 HIV-uninfected participants (age range 32-94 years) and assessed blood pressure, carotid intima-media thickness and mortality. Over five years 116 deaths occurred. Baseline IGF-1 was similar in survivors and non-survivors (p = 0.50), but tended to be higher in survivors upon adjustment for IGFBP-3 and covariates (p = 0.061). Normotensives and hypertensives (p = 0.072), and those with carotid intima-media thickness < 0.9 mm and ≥ 0.9 mm also displayed similar baseline IGF-1 (p = 0.55). Multivariable-adjusted Cox-regression indicated high IGF-1 predicting lower risk for all-cause mortality (hazard ratio 0.45 0.23-0.88) and cardiovascular mortality (hazard ratio 0.26 0.08-0.83) when also adjusting for IGFBP-3. When including normo- and hypertensives at baseline, high IGF-1 was related to normotension at follow-up (hazard ratio 0.68 0.49-0.95). We found no association with carotid intima-media thickness (hazard ratio 0.59 0.31-1.14). In a Black South African population with low socio-economic status and harmful health behaviours, we found a protective independent association between IGF-1 and hypertension, cardiovascular and all-cause mortality, with no association with carotid wall thickness.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2023
DOI: 10.1038/S41371-021-00653-X
Abstract: South Africa was among the first countries to adopt mandatory regulation in 2016 to lower the salt content in processed foods, aiming to reduce population salt intake to <5 g/day. To assess the effectiveness of this regulation in 20-30 year-old adults, we determined the change in salt intake over a mean follow-up time of 4.56-years spanning the implementation of the regulation. This observational study included baseline (2013-2016 N = 668 24.9 ± 3 years 47.8% black 40.7% men) and follow-up data (2018-ongoing N = 311 25.4 ± 3.05 years 51.1% black 43.4% men) for participants of the African-PREDICT study. Salt intake was estimated from 24-h urinary sodium excretion. Median salt intake at baseline (N = 668) was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [7.26 g/day (5.30)] [unadjusted median: -0.82 g/day]. After adjusting for baseline salt intake to address regression to the mean, the mean salt reduction was -1.2 g/day. The greatest reductions were in men [mean difference: -1.47 g/day], black adults [mean difference: -2.04 g/day], and participants from low [mean difference: -1.89 g/day] or middle [mean difference: -1.84 g/day] socio-economic status groups, adjusting for baseline salt intake. Our preliminary findings suggest that South Africa's salt regulation has been effective in lowering salt intake in young adults by ~1.2 g salt/day. Our study supports the effectiveness of upstream interventions to lower population salt intake, particularly for vulnerable groups who may typically consume more processed foods. It needs to be determined if the legislation has the anticipated population health gains.
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-052986
Abstract: Understanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy. This formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management. A qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model. The study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal. A total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30–70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy. The respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient’s essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient’s details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2–3 times/week) preferably in the morning or evening. We found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a erse range of participants to ensure the mHealth strategy is acceptable to wider groups.
Publisher: Oxford University Press (OUP)
Date: 25-02-2022
Publisher: Oxford University Press (OUP)
Date: 05-2021
DOI: 10.1093/EURHEARTJ/SUAB033
Abstract: In the UK, heart and circulatory diseases account for 29% of all deaths (14% through coronary heart disease and 8% through stroke). In 2015, the prevalence of hypertension was 20% in the UK and 23% in the Republic of Ireland. In 2019, 14% of people registered with a UK general practice had hypertension and yet it was the attributable risk factor for around half of all deaths from coronary heart disease or stroke. We participated in May Measurement Month 2019 to increase awareness of blood pressure (BP) measurement, and to identify the proportion of undiagnosed hypertension and degree of uncontrolled hypertension in the community. The 2019 c aign set up screening sites within the community at places of worship, supermarkets, GP surgeries, workplaces, charity events, community pharmacies, gyms, and various other public places. We screened 10194 participants (mean age 51 ± 18 years, 60% women) and found that 1013 (9.9%) were on antihypertensive treatment, while 3408 (33.4%) had hypertension. Of the 3408 participants with hypertension, only 33.5% were aware of their condition despite 98.8% having previous BP measurements. In those on antihypertensive medication, only 38.2% had controlled BP (& and & mmHg). Our UK and Republic of Ireland data demonstrate concerning levels of undiagnosed hypertension and sub-optimal BP control in many in iduals with a diagnosis. This evidence supports a critical need for better systematic community and primary care screening initiatives.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
Publisher: Oxford University Press (OUP)
Date: 11-2009
DOI: 10.1038/AJH.2009.158
Abstract: Sub-Saharan Africans face an increasing burden of hypertension and related cardiac and cerebrovascular morbidity and mortality, making the identification of factors leading to early vascular abnormalities imperative. We investigated the possible influence of the antioxidant glutathione (GSH) on early subclinical atherosclerosis in 63 hypertensive (aged 45.2 years) and 34 normotensive (aged 38.9 years P < 0.001) nondiabetic African men. We measured ambulatory daytime systolic and diastolic blood pressure (SBP, DBP) as well as daytime mean arterial pressure (MAP), carotid intima-media thickness (CIMT), and calculated the cross-sectional wall area. We determined the reduced form of GSH in whole blood and blood glucose in serum. Blood glucose (110 vs. 92 mg/dl P < 0.001) and CIMT (0.75 vs. 0.61 mm P < 0.001) were higher in hypertensives compared to normotensives. No significant difference existed for GSH. Associations in normotensives suggested the hypotensive effect of GSH after single (SBP: r = -0.35, P < or = 0.05 DBP: r = -0.37, P < or = 0.05 MAP: r = -0.38, P < or = 0.05) and multiple (SBP: B = -0.015, P < 0.05 DBP: B = -0.011, P < 0.05 MAP: B = -0.012, P < 0.05) regression analyses. In hypertensives, CIMT (B = -0.00027, P < 0.01) and cross-sectional wall area (CSWA) (B = -0.0066, P < 0.05) correlated negatively with GSH. These findings were consistent after excluding 10 human immunodeficiency virus (HIV)-positive hypertensive subjects. In hypertensive African men, CIMT is negatively associated with GSH, suggesting a possible contributory role of attenuated GSH levels in the development of subclinical atherosclerosis.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2022
DOI: 10.1186/S12903-022-02239-6
Abstract: Dental caries remains the most prevalent non-communicable disease globally affecting 60–90% of children. The World Health Organisation’s (WHO) health-promoting school program offers a framework for dental intervention in low- and middle-income countries (LMICs). This study explored teacher contributions to children’s oral health in relation to the WHO health-promoting school framework in rural Uganda. Semi structured interviews were conducted with a purposive s le of 18 teachers. All interviews were transcribed verbatim and analysed thematically. Many teachers reported preparing children to practise proper oral hygiene care through skills training and demonstrations around proper teeth brushing. Teachers’ roles included raising health awareness by providing information on oral health topics using different educational methods. Many teachers mentioned performing oral health examinations on children at the school, first aid, referral for dental treatments and engaging parents, students and health workers in oral health promotion. Teachers play an essential role in oral health promotion in countries like Uganda. Teachers are implementing key principles of the WHO’s health-promoting school framework on the ground and need to be considered as a key public health resource. If improvements in oral health are to be attained in Sub-Saharan Africa and other LMICs, government interventions need to harness teachers’ contributions in delivering oral health promotion.
Publisher: Oxford University Press (OUP)
Date: 08-2020
DOI: 10.1093/EURHEARTJ/SUAA047
Abstract: Raised blood pressure (BP) was the biggest contributor to the global burden of disease in 2017, with lack of awareness and adequate control of BP identified as the main drivers of this disease burden. In 2017, an opportunistic BP screening and awareness c aign called May Measurement Month (MMM) in the UK and Republic of Ireland (RoI) highlighted that levels of undiagnosed hypertension and uncontrolled hypertension in the community screened were approximately 23% and 40%, respectively. MMM18 was undertaken to further the c aign’s efforts to increase awareness and create an evidence base of population risk associated with high BP. MMM18 BP screenings were conducted in the community at places of worship, supermarkets, GP surgeries, workplaces, community pharmacies, gyms, and various other public places. A total of 5000 volunteers, aged 47.3 (±17.2) years, 60% female were screened. Of all 5000 in iduals screened, 1716 (34.3%) were hypertensive, of which only 51.3% were aware of their condition, 42.8% on antihypertensive treatment, and only 51.5% of those on medication controlled to target BP of & /90 mmHg. Furthermore, obese, overweight, and underweight participants all had significantly higher BP values compared to in iduals with a healthy body mass index (BMI). The 2018 MMM c aign in the UK and the RoI confirmed approximately one in three adults were hypertensive, with more than half having uncontrolled BP. In addition, these findings show that people with low BMI are at risk of having high BP. Finally, with only one in two people aware of their high BP, awareness remains a significant public health concern.
Publisher: Oxford University Press (OUP)
Date: 05-2021
Publisher: Elsevier BV
Date: 10-2020
Publisher: Informa UK Limited
Date: 03-12-2015
Publisher: Elsevier BV
Date: 02-2019
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S13098-019-0502-2
Abstract: South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk ( 5%) to very high-risk scores ( 30%). Among the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44–60) of the patients were stratified to very low risk ( 5%) compared to 8% (95% CI 4–13) that were at a very high risk ( 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50 p 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds. Approximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected in iduals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study s les are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 10-05-2019
DOI: 10.1038/S41371-019-0210-2
Abstract: Repeated 24-hour urine collection is considered to be the gold standard for assessing salt intake. This is often impractical in large-population studies, especially in low–middle-income countries. Equations to estimate 24-hour urinary salt excretion from a spot urine s le have been developed, but have not been widely validated in African populations. This study aimed to systematically assess the validity of four existing equations to predict 24-hour urinary sodium excretion (24UNa) from spot urine s les in a nationally representative s le of South Africans. Spot and 24-hour urine s les were collected in a subs le ( n = 438) of participants from the World Health Organisation Study on global AGEing and adult health (SAGE) Wave 2 in South Africa in 2015. Measured 24UNa values were compared with predicted 24UNa values from the Kawasaki, Tanaka, INTERSALT and Mage equations using Bland–Altman plots. In this subs le (mean age 52.8 ± 16.4 years body mass index 30.2 ± 8.2 kg/m 2 76% female 73% black African 42% hypertensive), all four equations produced a significantly different population estimate compared with the measured median value of 6.7 g salt/day (IQR 4.4–10.5). Although INTERSALT underestimated salt intake (−3.77 g/d −1.64 to −7.09), the other equations overestimated by 1.28 g/d (−3.52 1.97), 6.24 g/d (2.22 9.45), and 17.18 g/d (8.42 31.96) for Tanaka, Kawasaki, and Mage, respectively. Bland–Altman curves indicated unacceptably wide levels of agreement. Use of these equations to estimate population level salt intake from spot urine s les in South Africans is not recommended.
Publisher: MDPI AG
Date: 18-10-2020
DOI: 10.3390/NU12103185
Abstract: The endogenous Na+/K+-ATPase inhibitor, marinobufagenin (MBG), strongly associates with salt intake and a greater left ventricular mass index (LVMi) in humans and was shown to promote cardiac fibrosis and hypertrophy in animals. The adverse effects of MBG on cardiac remodeling may be exacerbated with obesity, due to an increased sensitivity of Na+/K+-ATPase to MBG. This study determined whether MBG is related to the change in LVMi over time in adults with a body mass index (BMI) ≥30 kg/m2 (obese) and kg/m2 (non-obese). The study followed 275 healthy participants (aged 20–30 years) from the African-Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) study over 4.5 years. At baseline, we measured 24 h urine MBG excretion. MBG levels were positively associated with salt intake. LVMi was determined by two-dimensional echocardiography at baseline and after .5 years. With multivariate adjusted analyses in obese adults (N = 56), we found a positive association of follow-up LVMi (Adjusted (Adj.) R2 = 0.35 Std. β = 0.311 p = 0.007) and percentage change in LVMi (Adj. R2 = 0.40 Std. β = 0.336 p = 0.003) with baseline MBG excretion. No association of LVMi (Adj. R2 = 0.37 p = 0.85) or percentage change in LVMi (Adj. R2 = 0.19 p = 0.68) with MBG excretion was evident in normal weight adults (N = 123). These findings suggest that obese adults may be more sensitive to the adverse cardiac effects of MBG and provide new insight into the potential role of dietary salt, by way of MBG, in the pathogenesis of cardiac remodeling in obese in iduals.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2022
DOI: 10.1161/STROKEAHA.121.035852
Abstract: Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian in iduals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-043625
Abstract: Whether ACE inhibitors (ACEi) or angiotensin II receptor blocker (ARB) therapy should be continued, initiated or ceased in patients with COVID-19 is uncertain. Given the widespread use of ACEi/ARBs worldwide, guidance on the use of these drugs is urgently needed. This prospective meta-analysis aims to pool data from randomised controlled trials (RCTs) to assess the safety and efficacy of ACEi/ARB therapy in adults infected with SARS-CoV-2. RCTs will be eligible if they compare patients with COVID-19 randomised to ACEi/ARB continuation or commencement versuss no ACEi/ARB therapy study duration ≥14 days recruitment completed between March 2020 and May 2021. The primary outcome will be all-cause mortality at ≤30 days. Secondary outcomes will include mechanical ventilation, admission to intensive care or cardiovascular events at short-term follow-up (≤30 days) and all-cause mortality at longer-term follow-up ( month). Prespecified subgroup analyses will assess the effect of sex age comorbidities smoking status ethnicity country of origin on all-cause mortality. A search of ClinicalTrials.gov has been performed, which will be followed by a formal search of trial registers, preprint servers, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify RCTs that meet inclusion criteria. To date, a search of ClinicalTrials.gov identified 21 potentially eligible trials for this meta-analysis. We will request trial investigators/sponsors to contribute standardised grouped tabular outcome data. Ethics approval and informed consent will be the responsibility of the in idual RCTs. Dissemination of results will occur by peer-reviewed publication. The results of our analysis can inform public health policy and clinical decision making regarding ACEi/ARB use in patients with COVID-19 on a global scale.
Publisher: Springer Science and Business Media LLC
Date: 21-03-2022
DOI: 10.1038/S41371-022-00670-4
Abstract: A recent study found that only 23.8% of blood pressure (BP) devices available for purchase from Australian pharmacies were validated for accuracy. The extent to which pharmacists are aware of this, and other issues related to the accuracy of BP devices, is not known and gathering this information was the aim of this study. An online survey of Australian pharmacists was distributed via the Pharmaceutical Society of Australia between 1 October and 25 November 2020. Questions were focused on the views of pharmacists related to the accuracy of BP devices. Two hundred and ten pharmacists completed the survey. The accuracy of BP devices sold by pharmacists was considered 'quite' or 'extremely important' to most respondents (94%). However, most respondents (90%) were unaware that less than one-quarter of BP devices sold by Australian pharmacies were validated, and this was 'quite' or 'extremely surprising' to many (69%). Many respondents (64%) associated a particular brand of BP device with greater accuracy. There was low awareness on proper ways to identify accurate BP devices, such as checking reputable online databases (43%). BP devices were stocked in respondents' pharmacies based on perceived quality (50%), accuracy (40%), or as determined by the pharmacy chain (36%). In conclusion, providing accurate BP devices to consumers is important to pharmacists, but they were generally unaware that most devices available from pharmacies were not validated for accuracy. Pharmacist education, alongside advocacy for policies including regulations and strategic action, is required to ensure only validated BP devices are sold in Australia.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.HLC.2014.12.005
Abstract: In South Africa respiratory diseases are highly prevalent, with cardiovascular disease being a manifestation. However, international reference values for lung function are commonly used, which may not be appropriate to correctly identify reduced lung function. An inverse relationship exists between lung function and blood pressure (BP) but is not investigated extensively in black South Africans. We included 2010 Africans from the PURE (Prospective Urban Rural Epidemiology) study (aged > 35 years) in the North West Province. Spirometry was performed and predicted values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were calculated from South African, European and United States prediction equations. With the exception of the European predicted values, all other predicted mean FEV1 and FVC were above 80%. South African reference values displayed the highest percentages of the predicted values for FEV1 and FVC (87.9 and 99.7%, respectively.) BP increased from quintiles five to one for both FEV1 and FVC, (p for trend <0.001). After adjustment the differences remained (p<0.05). South African reference values yielded higher percentages of predicted FEV1 and FVC values than European and US equations suggesting that South African prediction equations may be more useful when investigating lung function in black South Africans. Elevated BP is related to reduced lung function, highlighting the importance in managing both respiratory- and cardiovascular disease.
Publisher: Springer Science and Business Media LLC
Date: 11-08-2005
Abstract: The comparison of the associations between chronically elevated leptin levels and cardiovascular function in obese Africans and Caucasians has not yet been determined. Therefore, the aim of this study was to compare leptin's associations with cardiovascular function in obese African and obese Caucasian women to determine whether leptin's associations differ between these two groups. This study consisted of two case-case control studies. The first study included a s le of 102 apparently healthy African women and the second, 115 apparently healthy Caucasian women. All lean and obese subjects were selected from each study. The Finometer apparatus was used to obtain a more elaborate cardiovascular profile. Serum leptin levels, insulin levels and the lipid profile were determined. Stroke volume (SV) and cardiac output (CO) were significantly (P< or =0.01) elevated in both obese African and Caucasian groups compared to their lean controls. Total peripheral resistance (TPR) was significantly decreased and arterial compliance (C(W)) significantly increased in both obese African and Caucasian groups. In the obese Caucasian group, diastolic blood pressure (DBP) was significantly (P< or =0.01) lower, SV and C(W) significantly higher (P< or =0.01) and TPR significantly lower compared to the age, body mass index (BMI), and leptin-matched obese African group. After adjusting for age and BMI, leptin correlated negatively with DBP (P< or =0.05 r=-0.33) and TPR (P< or =0.05 r=-0.36) in the obese Caucasian group, but not in the obese African group. Even though leptin levels were similar in obese African and Caucasian women, leptin is favourably associated with vascular function in obese Caucasians, but not in obese Africans.
Publisher: Pan American Health Organization
Date: 26-02-2021
Abstract: Cerca de ¼ dos adultos têm hipertensão arterial, que é o fator de risco isolado mais importante para morte (incluídas as mortes por cardiopatia e acidente vascular cerebral). Existem políticas eficazes que poderiam facilitar escolhas pessoais saudáveis para evitar a elevação da pressão arterial e, se plenamente implementadas, podem prevenir a ocorrência da hipertensão arterial. É fácil rastrear e tratar a hipertensão, MAS somente cerca de 50% dos adultos hipertensos estão cientes de sua condição, e apenas cerca de 1 em cada 7 é tratado adequadamente. A prevenção e controle da hipertensão é o principal mecanismo de prevenção e controle das doenças não transmissíveis e um modelo para outros riscos de doenças não transmissíveis. Tratamentos eficazes com mudanças de estilo de vida e medicamentos poderiam prevenir e controlar a hipertensão arterial na maioria das pessoas se aplicados sistematicamente à população as intervenções simples são viáveis em todos os ambientes e podem melhorar a atenção primária. É necessária a ação continuada e urgente a fim de obter mudanças efetivas nas políticas públicas e no sistema de saúde para prevenir e controlar a hipertensão arterial.
Publisher: Oxford University Press (OUP)
Date: 05-2019
Abstract: Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global c aign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 c aign was expanded, aiming to include more participants and countries. Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic s ling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 in iduals (mean age 45.3 years 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) in iduals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 in iduals with untreated hypertension and 111 214 in iduals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The c aign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these in iduals at risk.
Publisher: Wiley
Date: 22-01-2020
DOI: 10.1111/JCH.13813
Publisher: Springer Science and Business Media LLC
Date: 28-02-2013
DOI: 10.1038/JHH.2013.14
Abstract: Hypertension, a major risk factor for cardiovascular disease worldwide, is increasing significantly in urbanised South Africans. Impaired glomerular filtration is a potential contributor to hypertension. Although HIV infection is widespread, little is known regarding its contribution to diminished estimated glomerular filtration rate (eGFR) and, in turn, hypertension in Africans. We compared eGFRs and cardiovascular profiles of newly identified HIV infected African men (N=53) not yet undergoing anti-retroviral therapy, and uninfected African men of similar age and anthropometry. The aim of the study was to determine whether eGFR is diminished in treatment naive HIV infected in iduals and whether eGFR is associated with a potential modulator of hypertension, namely serum L-arginine. Cardiovascular risk factor profiles of HIV infected and uninfected men were similar. In men with healthy eGFRs >90 ml min(-1) per 1.73 m(2), eGFR was significantly lower with HIV infection (114 (90 147)) compared with that in uninfected men: (120 (91 168)), P=0.043. Despite the absence of clinically-diagnosed renal dysfunction, eGFR associated significantly with serum L-arginine only in HIV infected men (R(2)=0.277, β=-0.299, P=0.034), whereas L-arginine did not stay in the model for uninfected men. This difference suggests that the fate of L-arginine as a substrate for nitric oxide generation may be altered in HIV infected in iduals. Subsequently this is likely to escalate endothelial dysfunction, contributing to later hypertension and cardiovascular disease. Our findings show that while glomerular filtration rate is not associated with L-arginine in uninfected men, it is diminished and significantly negatively associated with serum L-arginine in HIV infected men.
Publisher: Elsevier BV
Date: 12-2019
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.NUMECD.2015.10.014
Abstract: Heightened cardiovascular reactivity and delayed recovery to stress are associated with an increased risk of cardiovascular disease. Africans, who are more prone to develop hypertension, show greater cardiovascular reactivity to stress. However, causal factors underlying in idual and ethnic differences in stress reactivity and recovery remain largely unexplored. Leptin, which is known for its sympatho-activating effects, is higher in Africans compared to Caucasians for any given body mass index. We compared how cardiovascular reactivity and recovery relate to leptin in African (n = 200) and Caucasian (n = 209) teachers. We measured leptin in serum and cardiovascular baseline and reactivity continuously with the Finometer device during the cold pressor test for 1 min, and recovery at intervals of 1, 3 and 5 min. Africans had higher body mass index, leptin and blood pressure (all P < 0.001). After full adjustment in multiple regression analyses, associations were seen mainly at the 5 min recovery interval. In Africans, cardiac output reactivity (β = -0.335 P = 0.0018) and arterial compliance- (β = -0.241 P = 0.048) associated negatively and total peripheral resistance- (β = 0.227 P = 0.047) positively with leptin. In Caucasians, diastolic blood pressure correlated positively with leptin (β = 0.200 P = 0.015). In Africans, higher circulating leptin levels associated with prolonged cardiovascular recovery after exposure to stress which could explain their increased vulnerability to hypertension development.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2020
DOI: 10.1161/HYPERTENSIONAHA.120.14719
Abstract: Self-home blood pressure (BP) monitoring is recommended to guide clinical decisions on hypertension and is used worldwide for cardiovascular risk management. People usually make their own decisions when purchasing BP devices, which can be made online. If patients purchase nonvalidated devices (those not proven accurate according to internationally accepted standards), hypertension management may be based on inaccurate readings resulting in under- or over-diagnosis or treatment. This study aimed to evaluate the number, type, percentage validated, and cost of home BP devices available online. A search of online businesses selling devices for home BP monitoring was conducted. Multinational companies make worldwide deliveries, so searches were restricted to BP devices available for one nation (Australia) as an ex le of device availability through the global online marketplace. Validation status of BP devices was determined according to established protocols. Fifty nine online businesses, selling 972 unique BP devices were identified. These included 278 upper-arm cuff devices (18.3% validated), 162 wrist-cuff devices (8.0% validated), and 532 wrist-band wearables (0% validated). Most BP devices (92.4%) were stocked by international e-commerce businesses (eg, eBay, Amazon), but only 5.5% were validated. Validated cuff BP devices were more expensive than nonvalidated devices: median (interquartile range) of 101.1 (75.0–151.5) versus 67.4 (30.4–112.8) Australian Dollars. Nonvalidated BP devices dominate the online marketplace and are sold at lower cost than validated ones, which is a major barrier to accurate home BP monitoring and cardiovascular risk management. Before purchasing a BP device, people should check it has been validated at www.stridebp.org .
Publisher: Elsevier BV
Date: 07-2021
Publisher: Springer Science and Business Media LLC
Date: 07-05-2010
DOI: 10.1038/HR.2010.65
Abstract: Sub-Saharan Africans face an increasing burden of hypertension. Although controversial, recent experimental evidence strongly suggests that serum calcium contributes to elevated blood pressure through increased vascular resistance. We investigated the associations of 24-h blood pressure and cardiovascular reactivity with serum calcium in African men stratified by age. The study consisted of 50 younger (median age: 38 years) and 49 older (median age: 49 years) participants. We measured 24-h ambulatory blood pressure with a mean successful inflation rate of 72.6%. Total peripheral resistance and stroke volume reactivity were obtained using a Finometer device during application of the Stroop color and word conflict test. Total serum calcium was adjusted for serum albumin. Results showed that serum calcium levels were similar between the younger and older groups. However, in the younger group, 24-h systolic blood pressure, 24-h diastolic blood pressure and total peripheral resistance reactivity correlated positively, whereas stroke volume reactivity correlated negatively with serum calcium in single and multiple regression analyses (systolic blood pressure: B=34.99, P=0.017 diastolic blood pressure: B=34.93, P<0.001 total peripheral resistance reactivity: B=65.44, P=0.048 stroke volume reactivity: B=-45.40, P=0.017). No associations were evident in the older African men. In conclusion, 24-h ambulatory systolic and diastolic blood pressures are positively associated with serum calcium in African men younger than 43 years. The blood pressure-serum calcium relationship seems to be mediated through increased vascular resistance during stress.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2015
DOI: 10.1007/S00394-015-1069-9
Abstract: To determine optimal body mass index (BMI) cut-points for the identification of cardiometabolic risk in black South African adults. We performed a cross-sectional study of a weighted s le of healthy black South Africans aged 25-65 years (721 men, 1386 women) from the North West and Free State Provinces. Demographic, lifestyle and anthropometric measures were taken, and blood pressure, fasting serum triglycerides, high-density lipoprotein (HDL) cholesterol and blood glucose were measured. We defined elevated cardiometabolic risk as having three or more risk factors according to international metabolic syndrome criteria. Receiver operating characteristic curves were applied to identify an optimal BMI cut-point for men and women. BMI had good diagnostic performance to identify clustering of three or more risk factors, as well as in idual risk factors: low HDL-cholesterol, elevated fasting glucose and triglycerides, with areas under the curve >.6, but not for high blood pressure. Optimal BMI cut-points averaged 22 kg/m In black South African men, a BMI cut-point of 22 kg/m
Publisher: Hindawi Limited
Date: 10-2016
Abstract: The objective of this study was to make use of a quantitative and qualitative approach comparing the systemic renin-angiotensin system (RAS) of hypertensive black and white African men by using RAS equilibrium analysis. This sub-study involved 23 black ( n = 15) and white ( n = 8) hypertensive men aged 39.5–41 years, living in the North West Province of South Africa. The RAS-Fingerprinting was determined with LC-MS/MS quantification of angiotensin peptides. Blood pressure and other variables were determined with known methods. The main finding of this study was the significant lower Ang I ( .0 and 45.1 pg/ml p = 0.005) and Ang II (15.6 and 123.9 pg/ml p ⩽ 0.001) encountered in the hypertensive black African men compared to their white counterparts. Levels of Ang 1-5 (downstream metabolite of Ang 1-7) (1.8 and 3.0 pg/ml), were detected in black and white hypertensive men, respectively. The observed differences between circulating RAS components, which are reflected via equilibrium angiotensin levels, point to a distinctive molecular regulation of the RAAS in the two study cohorts. The increased peripheral resistance observed in hypertensive black in iduals might take over a dominant role in control of blood pressure in this study population. A novel highly sensitive LC-MS/MS method resolved the issue of peptide recovery variations during s le preparation by using internal standards for each in idual angiotensin metabolite.
Publisher: eLife Sciences Publications, Ltd
Date: 09-03-2021
DOI: 10.7554/ELIFE.60060
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2022
Publisher: Oxford University Press (OUP)
Date: 22-05-2018
Publisher: MDPI AG
Date: 08-07-2020
DOI: 10.3390/NU12072026
Abstract: Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-in idual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine s les results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine s les over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated s les for spot and 24 h s les were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-in idual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-in idual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot s les for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine s les are not appropriate to detect participants with salt intakes below the recommended 5 g/day.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-07-2022
Publisher: Oxford University Press (OUP)
Date: 13-12-2013
DOI: 10.1093/AJH/HPS007
Abstract: Heart failure in the African population is reaching alarming levels. Increased afterload as a result of increased vasoconstriction during stress may lead to impaired ventricular function and stroke volume (SV) as well as vascular hypertrophy. In this study, we challenged the cardiovascular system in order to evaluate the possible contribution of indicators of α-adrenergic vasoconstriction (i.e., vascular resistance and SV reactivity) on left ventricular mass and carotid intima-media thickness (CIMT) in African and Caucasian men. We evaluated 101 African and 101 Caucasian male schoolteachers. Ambulatory blood pressure measurements were taken. Total peripheral resistance, Windkessel compliance and SV, and resting and reactivity values were obtained using a Finometer device while the Stroop color word conflict test was being applied. The electrocardiogram was recorded to obtain the Cornell product as indication of left ventricular mass. The CIMT was measured and the cross-sectional wall area (CSWA) calculated. African men showed higher total vascular resistance resting values as well as higher positive reactivity values compared with Caucasian men. The SV decreased significantly during stress in African men while resting blood pressure and the Cornell product value increased. SV showed a consistent association with left ventricular mass (β = -0.21 P = 0.04) and CSWA (β = -0.24 P = 0.01) in single and multiple regression analyses. No such associations were evident in the Caucasian men. African men showed a suppressed SV, possibly as a result of an increased ventricular afterload leading to end-organ damage.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJGH-2021-006454
Abstract: Chronic kidney disease (CKD) is a global public health problem, seemingly affecting in iduals from low-income and-middle-income countries (LMICs) disproportionately, especially in sub-Saharan Africa. Despite the growing evidence pointing to an increasing prevalence of CKD across Africa, there has not been an Africa-wide concerted effort to provide reliable estimates that could adequately inform health services planning and policy development to address the consequences of CKD. Therefore, we established the CKD in Africa (CKD-Africa) Collaboration. To date, the network has curated data from 39 studies conducted in 12 African countries, totalling 35 747 participants, of which most are from sub-Saharan Africa. We are, however, continuously seeking further collaborations with other groups who have suitable data to grow the network. Although many successful research consortia exist, few papers have been published (with none from Africa) detailing the challenges faced and lessons learnt in setting up and managing a research consortium. Drawing on our experience, we describe the steps taken and the key factors required to establish a functional collaborative consortium among researchers in Africa. In addition, we present the challenges we encountered in building our network, how we managed those challenges and the benefit of such a collaboration for Africa. Although the CKD-Africa Collaboration is focused primarily on CKD research, many of the lessons learnt can be applied more widely in public health research in LMICs.
Publisher: Springer Science and Business Media LLC
Date: 03-06-2020
DOI: 10.1007/S00394-020-02292-3
Abstract: Low-grade inflammation and a diet high in salt are both established risk factors for cardiovascular disease. High potassium (K + ) intake was found to counter increase in blood pressure due to high salt intake and may potentially also have protective anti-inflammatory effects. To better understand these interactions under normal physiological conditions, we investigated the relationships between 22 inflammatory mediators with 24-h urinary K + in young healthy adults stratified by low, medium and high salt intake (salt tertiles). We stratified by ethnicity due to potential salt sensitivity in black populations. In 991 healthy black ( N = 457) and white ( N = 534) adults, aged 20–30 years, with complete data for 24-h urinary sodium and K + , we analysed blood s les for 22 inflammatory mediators. We found no differences in inflammatory mediators between low-, mid- and high-sodium tertiles in either the black or white groups. In multivariable-adjusted regression analyses in white adults, we found only in the lowest salt tertile that K + associated negatively with pro-inflammatory mediators, namely interferon gamma, interleukin (IL) -7, IL-12, IL-17A, IL-23 and tumour necrosis factor alpha (all p ≤ 0.046). In the black population, we found no independent associations between K + and any inflammatory mediator. In healthy white adults, 24-h urinary K + associated independently and negatively with specific pro-inflammatory mediators, but only in those with a daily salt intake less than 6.31 g, suggesting K + to play a protective, anti-inflammatory role in a low-sodium environment. No similar associations were found in young healthy black adults.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2022
DOI: 10.1161/HYPERTENSIONAHA.121.17765
Abstract: Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBP MAP/DBPcal ), or bSBP/diastolic blood pressure (cSBP SBP/DBPcal ), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all in iduals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBP MAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBP SBP/DBPcal , respectively. We pragmatically propose as upper normal limit for 24-hour cSBP MAP/DBPcal 135 mm Hg and for 24-hour cSBP SBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBP SBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBP MAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.
Publisher: Oxford University Press (OUP)
Date: 04-2019
Publisher: Georg Thieme Verlag KG
Date: 08-09-2015
Abstract: Insulin-like growth factor 1 (IGF-1), an insulin sensitivity and vasculoprotective factor, associates negatively with the metabolic syndrome. However, IGF-1 is reduced by factors such as inflammation, oxidative stress and liver dysfunction. We investigated the relationship between bioavailable IGF-1 and the number of metabolic syndrome components and determined whether this relationship is independent of inflammation, oxidative stress and gamma glutamyl transferase (γ-GT a marker of liver dysfunction). This study included 907 black and white participants stratified by sex (aged 43.0±11.8 years). Among them 63 participants had fasting glucose levels of ≥+7.0+mmol/l and/or used diabetes medication. Via standard methods we determined waist circumference, fasting glucose, triglycerides, high-density lipoprotein cholesterol and blood pressure. We also determined high-sensitivity C-reactive protein (CRP), reactive oxygen species (ROS), γ-GT, IGF-1 and insulin-like growth factor binding protein 3 (IGFBP-3). IGF-1/IGFBP-3 was used as an estimate of bioavailable IGF-1. Total IGF-1 was similar between men and women (p=0.10), however, bioavailable IGF-1 was lower in women (p<0.001). In multivariate-adjusted analyses, IGF-1/IGFBP-3 was inversely associated with the number of metabolic syndrome components in both sexes (men: β=- 0.11 p=0.013 and women: β=- 0.17 p=0.003). Upon inclusion of ROS, γ-GT and CRP, significance was lost. In patients without diabetes, the results for men changed marginally, but were consistent for women. We found an inverse association between bioavailable IGF-1 and the number of metabolic syndrome components. But the relationship was dependent on oxidative stress, liver dysfunction and inflammation, suggesting underlying processes by which the metabolic syndrome attenuates IGF-1.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/10641960802409838
Abstract: The literature shows an increase in endothelin-1 with increased levels of erythrocytes. There are also indications that inflammation and elevated endothelin-1 levels interact with erythropoiesis. In this study, the association of erythrocytes and endothelin-1 in women of different ethnicities was investigated. Blood pressure, vascular resistance, and C-reactive protein (P = 0.09) were significantly higher in the African women (n = 102) compared to the Caucasian women (n = 115), while arterial compliance was significantly lower in the African women with no significant differences for endothelin-1. In single, partial, and multiple regression analyses, there was a significant positive correlation between the red blood cell count and log endothelin-1 in the Caucasians while in the Africans there was a weak negative correlation. This is an indication that endothelin-1 might interfere with erythrocyte production in Africans with higher levels of inflammation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: Oxford University Press (OUP)
Date: 08-2020
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.MVR.2019.103937
Abstract: Globally, a detrimental shift in cardiovascular disease risk factors and a higher mortality level are reported in some black populations. The retinal microvasculature provides early insight into the pathogenesis of systemic vascular diseases, but it is unclear whether retinal vessel calibers and acute retinal vessel functional responses differ between young healthy black and white adults. We included 112 black and 143 white healthy normotensive adults (20-30 years). Retinal vessel calibers (central retinal artery and vein equivalent (CRAE and CRVE)) were calculated from retinal images and vessel caliber responses to flicker light induced provocation (FLIP) were determined. Additionally, ambulatory blood pressure (BP), anthropometry and blood s les were collected. The groups displayed similar 24 h BP profiles and anthropometry (all p > .24). Black participants demonstrated a smaller CRAE (158 ± 11 vs. 164 ± 11 MU, p < .001) compared to the white group, whereas CRVE was similar (p = .57). In response to FLIP, artery maximal dilation was greater in the black vs. white group (5.6 ± 2.1 vs. 3.3 ± 1.8% p < .001). Already at a young age, healthy black adults showed narrower retinal arteries relative to the white population. Follow-up studies are underway to show if this will be related to increased risk for hypertension development. The reason for the larger vessel dilation responses to FLIP in the black population is unclear and warrants further investigation.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.ALCOHOL.2014.11.002
Abstract: Excessive alcohol use and non-alcoholic fatty liver disease (NAFLD) are putative cardiovascular disease risk factors. In order to ease the identification of these conditions on primary health care level, we aimed to determine and compare the demographic and cardiometabolic characteristics of excessive alcohol users and those with suspected NAFLD in black South Africans. In the Prospective Urban Rural Epidemiology study (North West Province, South Africa, N = 2021, collected in 2005) we selected 338 participants, namely: 1) alcohol users (N = 143) reporting 'yes' to alcohol intake, with high gamma-glutamyl transferase (GGT) ≥80 U/L and a percentage carbohydrate deficient transferrin (%CDT) ≥2% 2) non-alcohol users (N = 127) self-reporting 'no' to alcohol intake with GGT ≤30 U/L and %CDT ≤2% and 3) NAFLD group (N = 68) who were non-drinkers with GGT levels ≥60 U/L and %CDT ≤ 2%. The demographics indicated that the alcohol users were mostly men (73%) with a body mass index (BMI) of 19.8 (15.2-27.3) kg/m(2), 90% of which were smokers. Systolic blood pressure (SBP) of alcohol users significantly correlated with high-density lipoprotein cholesterol (HDL-C) (β = 0.24 p = 0.003) and waist circumference (WC) (β = 0.22 p = 0.006). Non-alcohol users were mostly women (84%) with a BMI of 26.0 (18.0-39.2) kg/m(2) and blood pressure in this group related positively with triglycerides. The NAFLD group were also mostly women (72%) with a comparatively larger WC (p < 0.001) and an adverse metabolic profile (total cholesterol: 5.55 ± 1.69 mmol/L glycosylated hemoglobin: 6.03 (4.70-9.40) %). Diastolic blood pressure in the NAFLD group associated positively with WC (β = 0.27 p = 0.018). We therefore found disparate gender and cardiometabolic profiles of black South Africans with suspected NAFLD and excessive alcohol use. The described profiles may aid health care practitioners in low resource settings when using these crude screening measures of gender, obesity indices (and self-reported alcohol use) to identify in iduals at risk.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.BIOPSYCHO.2005.11.010
Abstract: Specific coping mechanisms of Africans during urbanization were compared to and correlated with cardiovascular responses and perception of health data. Subjects included men (N=286) and women (N=360). The COPE questionnaire classified subjects as active (AC) or passive (PC) copers and the General Health Questionnaire measured subjective perception of health. The Finapres recorded blood pressure continuously before and during application of a handgrip test. Analyses adjusting for age, body mass index and resting cardiovascular data revealed that AC rural subjects showed predominantly cardiac responses and PC rural subjects predominantly vascular responses. All urbanized African men and women showed higher resting blood pressure, vascular responsiveness and hypertension prevalences than their rural counterparts. All rural AC subjects, especially women, and all urban PC subjects, especially men, reported a poorer perception of health. In conclusion, subjects with a PC style showed a predominantly vascular response in rural and urban areas whereas subjects with an AC style seem to shift from a predominant cardiac output response to a predominant vascular resistance response when moving from a rural to an urban area.
Publisher: Elsevier BV
Date: 04-2021
DOI: 10.1016/J.NUMECD.2020.12.021
Abstract: Heart rate variability (HRV) is a main determinant of autonomic function and related to the development of hypertension and cardiovascular (CV) disease. Hypertension develops in black populations at an earlier age, which could be due to differences in the autonomic nervous system activity and sodium otassium handling in black and white populations. We investigated whether HRV is associated with 24 h urinary sodium and potassium excretion and blood pressure (BP) in a young bi-ethnic cohort. We examined 423 black and 483 white healthy adults (aged 24.5 ± 3.1 years) for 24 h HRV, including standard deviation of normal RR intervals (SDNN) reflecting autonomic variations over time, and root mean square of successive differences (RMSSD) reflecting parasympathetic activity. We measured 24 h urinary sodium and potassium concentration and BP. The black group had lower SDNN and potassium excretion as well as higher RMSSD, sodium and Na/k ratio compared to the white group (all p < 0.05). Only in black in iduals, urinary potassium excretion was independently and negatively associated with SDNN (β[95% CI] -0.26[-0.50 -0.02]ms) and RMSSD (-0.14[-0.27 -0.01]ms, p < 0.05). One unit increase in sodium otassium (Na/K) ratio was associated with higher SDNN (β[95% CI] 3.04[0.89 5.19]ms) and RMSSD (1.60[0.41 2.78]ms) in the black cohort only (both p < 0.001). In both groups elevated 24 h diastolic BP was associated with lower RMSSD (p < 0.05). Lower potassium excretion and higher Na/K ratio related independently to higher HRV in young and healthy black adults. A better ethnic-specific understanding of sodium and potassium handling is required as part of preventive cardiology, especially in black in iduals. ClinicalTrials.gov Identifier: NCT03292094 URL: t2/show/NCT03292094.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 31-10-2019
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.HLC.2013.07.019
Abstract: The use of antiretroviral treatment is known to be accompanied by several negative health outcomes and may negatively affect a country such as South Africa, which is the most burdened by the human immunodeficiency virus (HIV) in the world. We aimed to determine whether receiving antiretroviral treatment changes the cardiometabolic profile of HIV-infected South Africans. In this sub-study, embedded in the Prospective Urban and Rural Epidemiology (PURE) study, we compared the cardiometabolic profile in a cohort of 66 treated and 71 never treated HIV-infected participants from the North-West province, South Africa. By using standard techniques, these participants' cardiometabolic, biochemical and lifestyle variables were assessed in 2005 and 2010, respectively. The treated group showed a higher percentage change in pulse pressure (13.3% p = 0.004), systolic blood pressure (4.5% p = 0.029) and CD4 cell count (9.2% p = 0.009) levels over five years. During follow-up (2010), lipid variables were worse in the treated group. Further, antiretroviral treatment was associated with the percentage change in pulse pressure (R(2) = 0.24 β = 0.19 p = 0.020). We concluded that Africans receiving antiretroviral treatment had a greater increase in pulse pressure and systolic blood pressure, as well as an unfavourable lipid profile when compared to never treated participants. Whether, in the long term, antiretroviral treatment will lead to increased arterial stiffness and/or accelerated atherosclerosis among this HIV-infected African population remains to be seen.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2023
DOI: 10.1161/HYPERTENSIONAHA.122.20589
Abstract: Sex differences in blood pressure control are recognized. We systematically investigated sex differences in specific components of ambulatory blood pressure (ABP), including variability, day-night changes, morning surge, and hypertension types. We analyzed ABPs of 52 911 participants (45.6% male, 54.4% female, 37.0% treated for hypertension) visiting 860 Italian community pharmacies. Sex differences in ABP levels and patterns were evaluated in the whole group and 4 risk groups (antihypertensive-treated patients, patients with diabetes, dyslipidemia, or cardiovascular disease). Average 24-hour, day-time, and night-time blood pressure values were consistently higher in males than females ( P .001). Variability in ABP was higher in females, except during the night. Nondippers and an abnormal morning surge were more common among males (odds ratio and 95% CI, 1.282 [1.230–1.335] and 1.244 [1.159–1.335] P .001). The prevalence of 24-hour and masked hypertension was higher in males (odds ratio and 95% CI, 2.093 [2.019–2.170] and 1.347 [1.283–1.415] P .001) and that of white-coat hypertension in females (0.719 [0.684–0.755] P .001). Ambulatory heart rate mean values were higher ( P .001) in females. Day-time HR variability was higher and night-time heart rate variability lower in females ( P .001). Sex differences in ABP levels and patterns detected in the whole population were replicated in all risk groups, except for the prevalence of abnormal morning surge (between sexes difference in antihypertensive-treated participants only). Females show better ABP control than males, but with an increased blood pressure variability and a greater prevalence of white-coat hypertension. These findings support tailored management of hypertension. URL: www.clinicaltrials.gov Unique identifier: NCT03781401
Publisher: South African Medical Association NPC
Date: 30-09-2022
DOI: 10.7196/SAMJ.2022.V112I8B.16490
Abstract: Background. Elevated sodium consumption is associated with increased blood pressure, a major risk factor for cardiovascular and chronic kidney disease.Objectives. To quantify the deaths and disability-adjusted life years (DALYs) attributed to high sodium intake in persons aged ≥25 years in South Africa (SA) for 2000, 2006 and 2012.Methods. Comparative risk assessment (CRA) methodology was used and population attributable fractions (PAFs) of high sodium intake, mediated through high blood pressure (BP), for cardiovascular and chronic kidney disease were estimated. This was done by taking the difference between the PAF for elevated systolic BP (SBP) based on the estimated SBP level in the population and the PAF based on the estimated SBP that would result if sodium intake levels were reduced to the theoretical minimum risk exposure level (1 g/day) according to population group and hypertension categories. A meta-regression based on data from nine national surveys conducted between 1998 and 2017 was used to estimate the prevalence of hypertension by age, sex and population group. Relative risks identified from international literature were used and the difference in PAFs was applied to local burden estimates from the second South African National Burden of Disease Study. Age-standardised rates were calculated using World Health Organization (WHO) standard population weights. The attributable burden was also estimated for 2012 using an alternative target of 2 g/day proposed in the National Strategic Plan for the Prevention and Control of Non-communicable Diseases (NSP).Results. High sodium intake as mediated through high SBP was estimated to cause 8 071 (95% uncertainty interval (UI) 6 542 - 15 474) deaths in 2012, a drop from 9 574 (95% UI 8 158 - 16 526) in 2006 and 8 431 (95% UI 6 972 - 14 511) in 2000. In 2012, ischaemic heart disease caused the highest number of deaths in persons (n=1 832), followed by haemorrhagic stroke (n=1 771), ischaemic stroke (n=1 484) and then hypertensive heart disease (n=1 230). Ischaemic heart disease was the highest contributor to deaths for males (27%), whereas for females it was haemorrhagic stroke (23%). In 2012, 1.5% (95% UI 1.3 - 2.9) of total deaths and 0.7% (95% UI 0.6 - 1.2) of total DALYs were attributed to high sodium intake. If the NSP target of g/day sodium intake had been achieved in 2012, ~2 943 deaths and 48 870 DALYs would have been averted.Conclusion. Despite a slight decreasing trend since 2006, high sodium intake mediated through raised BP accounted for a sizeable burden of disease in 2012. Realising SA’s target to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation.
Publisher: Georg Thieme Verlag KG
Date: 09-2007
Abstract: Rapid urbanisation has led African women to have an obesity prevalence double than that of Caucasian women, and this also holds true for the stroke prevalence in Africans. The study aimed to compare various metabolic syndrome (MS) criteria of the International Diabetes Federation (IDF) of body mass index and age-matched African (n=102) and Caucasian women (n=115). More Caucasian (30.4%) than African women (24.8%) had MS. Only 48% of African women had waist circumferences (WC) higher than the IDF cutoff, compared to 62.6% of Caucasians. Caucasian women were significantly taller and heavier and had higher triglycerides, plasminogen activator inhibitor-1 activity, and cortisol. African women had significantly higher blood pressure, leptin, fibrinogen and C-reactive protein, and higher odds ratios for having the MS for HDL-cholesterol, blood pressure, and fasting glucose than Caucasians. It is concluded that the IDF WC criterion needs a downward adjustment for African women due to a smaller body size. Lean African women seem to be at higher risk for MS than Caucasians. South Africa needs to stem the increasing rates of type 2 diabetes by decreasing obesity and by education (unschooled African women showed a 4.8 times higher likelihood of having MS than schooled women).
Publisher: Informa UK Limited
Date: 26-05-2021
Publisher: Springer Science and Business Media LLC
Date: 17-05-2007
Publisher: Springer Science and Business Media LLC
Date: 06-12-2019
DOI: 10.1007/S00394-018-1875-Y
Abstract: Despite selenium's beneficial effects in counteracting oxidative stress, inflammation, and vascular endothelial dysfunction, controversial results exist regarding the long-term associations between selenium and atherosclerosis, arterial stiffness, and hypertension. We investigated in normal and selenium-deficient groups (and the total group), whether serum selenium relates to measures of large artery structure and function over 10 years. This longitudinal study included black adults from rural and urban areas in South Africa. Serum selenium and blood pressure were measured at baseline (N = 987). At follow-up, carotid intima media thickness (IMT), cross-sectional wall area (CSWA), carotid-femoral pulse wave velocity (c-fPWV), and blood pressure were measured (N = 718). Selenium deficiency was classified as serum levels < 8 µg/100 ml. In multivariable-adjusted regression analyses performed in the normal selenium group, c-fPWV after 10 years was negatively associated with baseline selenium (β = - 0.09 p = 0.016). In the normal selenium group, baseline (but not 10 years) blood pressure also associated negatively with baseline selenium (β = - 0.09 p = 0.007). Both IMT (β = 0.12 p = 0.001) and CSWA (β = 0.10 p = 0.003) after 10 years associated positively with baseline selenium in the total, normal, and selenium-deficient groups. We found a long-term vascular protective association of selenium on arterial stiffness and blood pressure in Africans with normal selenium levels, supporting the notion that selenium fulfills a vascular protective role. In contrast, we found a potential detrimental association between selenium and carotid wall thickness, particularly evident in in iduals within the highest quartile of serum selenium.
Publisher: Springer Science and Business Media LLC
Date: 12-2002
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-05-2021
DOI: 10.1161/CIRCULATIONAHA.120.048740
Abstract: People with type 2 diabetes and chronic kidney disease experience a high burden of hypertension, but the magnitude and consistency of blood pressure (BP) lowering with canagliflozin in this population are uncertain. Whether the effects of canagliflozin on kidney and cardiovascular outcomes vary by baseline BP or BP-lowering therapy is also unknown. The CREDENCE trial (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) randomized people with type 2 diabetes and chronic kidney disease to canagliflozin or placebo. In a post hoc analysis, we investigated the effect of canagliflozin on systolic BP across subgroups defined by baseline systolic BP, number of BP-lowering drug classes, and history of apparent treatment-resistant hypertension (BP ≥130/80 mm Hg while receiving ≥3 classes of BP-lowering drugs, including a diuretic). We also assessed whether effects on clinical outcomes differed across these subgroups. The trial included 4401 participants, of whom 3361 (76.4%) had baseline systolic BP ≥130 mm Hg, and 1371 (31.2%) had resistant hypertension. By week 3, canagliflozin reduced systolic BP by 3.50 mm Hg (95% CI, –4.27 to –2.72), an effect maintained over the duration of the trial, with similar reductions across BP and BP-lowering therapy subgroups (all P interaction ≥0.05). Canagliflozin also reduced the need for initiation of additional BP-lowering agents during the trial (hazard ratio, 0.68 [95% CI, 0.61–0.75]). The effect of canagliflozin on kidney failure, doubling of serum creatinine, or death caused by kidney or cardiovascular disease (hazard ratio, 0.70 [95% CI, 0.59–0.82]) was consistent across BP and BP-lowering therapy subgroups (all P interaction ≥0.35), as were effects on other key kidney, cardiovascular, and safety outcomes. In people with type 2 diabetes and chronic kidney disease, canagliflozin lowers systolic BP across all BP-defined subgroups and reduces the need for additional BP-lowering agents. These findings support use of canagliflozin for end-organ protection and as an adjunct BP-lowering therapy in people with chronic kidney disease. URL: www.clinicaltrials.gov Unique identifier: NCT02065791.
Publisher: Cambridge University Press (CUP)
Date: 05-10-2017
Publisher: Informa UK Limited
Date: 26-05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-09-2023
Publisher: Springer Science and Business Media LLC
Date: 02-08-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Springer Science and Business Media LLC
Date: 28-04-2011
DOI: 10.1038/HR.2011.45
Abstract: Recent evidence suggests that low-grade urinary albumin excretion is a marker of early general attenuation of vascular function, but studies are limited to Caucasian population groups. We compared low-grade urinary albumin excretion (<3.5 mg mmol(-1) or 30 μg mg(-1)) between non-diabetic African (aged, 41.7 years n=70) and Caucasian (aged, 44.6 years n=91) men and ethnic-specific associations thereof with arterial stiffness and ambulatory blood pressure. The albumin-to-creatinine ratio (ACR) was determined from an 8 h overnight urine collection. We recorded ambulatory blood pressure over 24 h during a typical workday and the carotid-dorsalis pedis pulse wave velocity measured the next morning after a controlled overnight stay. ACR was higher in Africans compared with Caucasians (P < 0.001), also after adjusting for 24 h systolic blood pressure, diastolic blood pressure and hypertension prevalence (P < 0.001) or when grouped by similar 24 h mean arterial pressures (P < 0.01 for all categories). Daytime (P=0.002) and night time (P < 0.001) systolic and daytime (P < 0.001) and night time (P < 0.001) diastolic blood pressures were higher in Africans compared with Caucasians, but no differences existed for daytime and night time pulse pressure and pulse wave velocity. In African men only, after adjustment for covariates, night time systolic blood pressure (β=0.347 P=0.003), diastolic blood pressure (β=0.298 P=0.010) and mean arterial pressure (β=0.331 P=0.004) correlated positively with ACR. In addition, daytime (β=0.265 P=0.032) and night time (β=0.258 P=0.038) pulse pressure as well as pulse wave velocity (β=0.271 P=0.032) correlated positively with ACR. In conclusion, arterial stiffness and ambulatory blood pressure are already associated with low-grade albuminuria in non-diabetic African men with normal kidney function.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.MVR.2021.104180
Abstract: Plasminogen activator inhibitor-1 (PAI-1), traditionally associated with fibrinolysis, is increasingly implicated in impaired vascular function. However, studies on its association with microvascular function are limited to the cutaneous and coronary microvascular beds in older and diseased in iduals. To better understand its potential involvement in the early stages of disease development, we investigated the associations of retinal vasodilatory responses to flicker light with PAI-1 activity (PAI-1 We included healthy Black and White women and men (n = 518 aged 20-30 years), and measured plasma PAI-1 In multivariate regression analyses, maximal retinal venular dilation associated independently and inversely with PAI-1 Our data suggest that in young in iduals, PAI-1 may already be associated with subclinical microvascular dysfunction.
Publisher: Informa UK Limited
Date: 02-09-2014
DOI: 10.3109/10715762.2014.951840
Abstract: Various studies indicate a relationship between increased oxidative stress and hypertension, resulting in increased DNA damage and consequent excretion of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG). The aim of this study was to compare urinary 8-oxodG levels in African and Caucasian men and to investigate the association between ambulatory blood pressure (BP) and pulse pressure (PP) with 8-oxodG in these groups. We included 98 African and 92 Caucasian men in the study and determined their ambulatory BP and PP. Biochemical analyses included, urinary 8-oxodG, reactive oxygen species (ROS) (measured as serum peroxides), ferric reducing antioxidant power (FRAP), total glutathione (GSH), glutathione peroxidase (GPx) and glutathione reductase (GR) activity. The African men had significantly higher systolic (SBP) and diastolic blood pressure (DBP) (both p < 0.001). Assessment of the oxidative stress markers indicated significantly lower 8-oxodG levels (p < 0.001) in the African group. The African men also had significantly higher ROS (p = 0.002) with concomitant lower FRAP (p < 0.001), while their GSH levels (p = 0.013) and GR activity (p < 0.001) were significantly higher. Single and partial regression analyses indicated a negative association between urinary 8-oxodG levels with SBP, DBP and PP only in African men. These associations were confirmed in multiple regression analyses (SBP: R(2) = 0.41 β = -0.25 p = 0.002, DBP: R(2) = 0.30 β = -0.21 p = 0.022, PP: R(2) = 0.30 β = -0.19 p = 0.03). Our results revealed significantly lower urinary 8-oxodG in African men, accompanied by a negative association with BP and PP. We propose that this may indicate a dose-response relationship in which increased oxidative stress may play a central role in the up-regulation of antioxidant defence and DNA repair mechanisms.
Publisher: Ubiquity Press, Ltd.
Date: 2021
DOI: 10.5334/GH.1066
Publisher: Oxford University Press (OUP)
Date: 04-2019
Publisher: Informa UK Limited
Date: 28-04-2015
DOI: 10.3109/10641963.2015.1013123
Abstract: Haemostatic- and oxidative stress markers are associated with increased cardiovascular risk. In the black population, evidence exists that both an imbalance in the haemostatic system and oxidative stress link with the development of hypertension. However, it is unclear whether these two risk components function independently or are related, specifically in the black population, who is known to have a high prevalence of stroke. We aimed to investigate associations between the haemostatic system and oxidative stress in black and white South Africans. We performed a cross-sectional study including 181 black (mean age, 44 51.4% women) and 209 white (mean age, 45 51.7% women) teachers. Several markers of the haemostatic- (von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1, d-dimer and clot lysis time) and oxidant-antioxidant (serum peroxides, total glutathione, glutathione peroxidase- and glutathione reductase activities) systems were measured. Along with a worsened cardiovascular profile, the black group had higher haemostatic-, inflammation- and oxidative stress markers as well as decreased glutathione peroxidase activity. In multiple regression analyses, fibrinogen was positively associated with serum peroxides (p < 0.001) in both ethnic groups. In the black population, we found negative associations of von Willebrand factor and clot lysis time with glutathione peroxidase activity (p ≤ 0.008), while a positive association existed between clot lysis time and serum peroxides (p = 0.011) in the white population. We conclude that in the black population, decreased GPx activity accompanies an altered haemostatic profile, while in the white population associations may suggest that serum peroxides impair fibrin clot lysis.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.THROMRES.2014.03.037
Abstract: Hypertension is highly prevalent in black South Africans in which morbidity and mortality from stroke are on the increase. Elevated blood pressure and haemostatic markers can induce changes in blood rheology and endothelial function which could result in a procoagulant state that increases the risk for cerebrovascular disease. Information about the coagulation and fibrinolytic systems of people from African descent are limited. We therefore, investigated the haemostatic profile and its relationships with blood pressure in black South Africans. We measured ambulatory blood pressure and haemostatic markers of 201 black and 208 white school teachers. The haemostatic markers included measurements representing coagulation and fibrinolysis (von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1, fibrin D-dimer and clot lysis time). Black participants displayed significantly higher blood pressure, von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1 and D-dimer levels and longer clot lysis times (p≤0.001). Single, partial and multiple regression analyses showed that systolic (p≤0.011) and diastolic blood pressure (p=0.010) correlated positively with D-dimer in black participants, while systolic (p≤0.001) and daytime diastolic blood pressure (p=0.011) correlated negatively with clot lysis time in white participants. The black population had a more prothrombotic profile, with higher levels of coagulation markers and inhibited fibrinolysis, than the white study participants. The positive association between blood pressure and elevated D-dimer in the blacks may contribute to the high prevalence of hypertension and related increased cardiovascular and cerebrovascular risk in this group.
Publisher: MDPI AG
Date: 06-09-2019
DOI: 10.3390/FOODS8090394
Abstract: Nutritional transition in Africa is linked with increased blood pressure (BP). We examined 10-year fatty acid status and longitudinal associations between in idual long-chain polyunsaturated fatty acids (PUFA), BP and status of hypertension (≥140/90 mmHg and/or medication use) in black South Africans. We included 300 adults ( years) participating in the Prospective Urban Rural Epidemiology study, and analysed data from three consecutive examinations (2005, 2010 and 2015 study years). Fatty acids in plasma phospholipids were analysed by gas chromatography-mass spectrometry. We applied sequential linear mixed models for continuous outcomes and generalized mixed models for the hypertension outcome, in the complete s le and separately in urban and rural subjects. Mean baseline systolic/diastolic BP was 137/89 mmHg. Ten-year hypertension status increased among rural (48.6% to 68.6%, p = 0.001) and tended to decrease among urban subjects (67.5% to 61.9%, p = 0.253). Regardless of urbanisation, n-6 PUFA increased and eicosapentaenoic acid (EPA, C20:5 n-3) decreased over the 10-years. Subjects in the highest tertile of arachidonic acid (C20:4 n-6) had 3.81 mmHg lower systolic (95% confidence interval (CI): −7.07, −0.54) and 3.82 mmHg lower diastolic BP (DBP) (95% CI: −5.70, −1.95) compared to the reference tertile, irrespective of lifestyle and clinical confounders. Similarly, osbond acid (C22:5 n-6) was inversely associated with DBP. Over the 10-years, subjects in the highest EPA tertile presented with +2.92 and +1.94 mmHg higher SBP and DBP, respectively, and with 1.46 higher odds of being hypertensive. In black South African adults, in idual plasma n-6 PUFA were inversely associated with BP, whereas EPA was adversely associated with hypertension, supporting implementation of dietary fat quality in national cardiovascular primary prevention strategies.
Publisher: Oxford University Press (OUP)
Date: 08-2020
DOI: 10.1093/EURHEARTJ/SUAA043
Abstract: Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and acting as a temporary solution to the lack of screening programmes worldwide. As part of MMM, screening in South Africa in 2017 revealed that 24.5% of adults (mean age = 31 years) have hypertension and only half of those with hypertension had controlled BP. These data highlight the need for continued screening and awareness c aigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2018. Blood pressure measurements, the definition of hypertension and statistical analyses followed the MMM protocol. The sites screened were general populations and university c uses in preference to hospitals and clinics, aiming to raise awareness and allow access to screening to those less likely to be aware of their BP. In total, 2965 in iduals (age 40.5 ± 18.2 years) were screened. After multiple imputation for missing BP readings, 34.6% had hypertension, only 56.7% of those with hypertension were aware, 21.2% of those not receiving treatment for hypertension were hypertensive, and a large proportion (42.5%) of in iduals receiving antihypertensive medication had uncontrolled BP. These results suggest that opportunistic screening c aigns can identify significant numbers with undiagnosed and uncontrolled hypertension. The high proportions of in iduals with undiagnosed and treated uncontrolled hypertension highlight the need for hypertension awareness c aigns and more rigorous management of hypertension.
Publisher: Informa UK Limited
Date: 23-10-2020
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.ALCOHOL.2017.08.011
Abstract: Blood HDL cholesterol and LDL cholesterol levels are known to be higher and lower, respectively, in drinkers than in nondrinkers, and the beneficial effects of alcohol on cholesterol metabolism are thought to mainly explain the lower risk for ischemic heart disease in light-to-moderate drinkers than in nondrinkers. However, it remains unknown whether sensitivities of HDL and LDL cholesterol levels to alcohol are different or not. The subjects of this study were 21,572 middle-aged Japanese men, and they were ided into three tertile groups for blood HDL cholesterol levels. The relationships between habitual alcohol intake and LDL cholesterol levels were investigated in each tertile for HDL cholesterol. In all of the tertile groups for HDL cholesterol, mean LDL cholesterol levels were significantly lower in the drinking subgroups than in the nondrinking subgroup and tended to be lower with an increase of alcohol intake. In all of the tertile groups for HDL cholesterol, odds ratios for high LDL cholesterol of each drinking subgroup vs. the nondrinking subgroup were significantly lower than the reference level of 1.00, and also tended to be lower with an increase of alcohol intake. The odds ratios of each drinking subgroup tended to be lower in the 1st tertile group for HDL cholesterol than in the 3rd tertile group. Drinkers in the 1st tertile for HDL cholesterol are thought to have relatively low sensitivity of HDL cholesterol to alcohol, but clearly showed lower LDL cholesterol levels than those found in nondrinkers. Therefore, the sensitivity of LDL cholesterol level to alcohol is different from the sensitivity of HDL cholesterol level to alcohol.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-04-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1161/HYPERTENSIONAHA.122.20448
Abstract: Hypertension is the leading risk factor for cardiovascular disease and premature death among women globally. However, there is a fundamental lack of knowledge regarding the sex-specific pathophysiology of the condition. In addition, risk factors for hypertension and cardiovascular disease unique to women or female sex are insufficiently acknowledged in clinical guidelines. This review summarizes the existing evidence on women and female-specific risk factors and clinical management of hypertension, to identify critical knowledge gaps relevant to research, clinical practice, and women’s heart health awareness. Female-specific risk factors relate not only to reproduction, such as the association of gynecological conditions, adverse pregnancy outcomes or menopause with hypertension, but also to the specific roles of women in society and science, such as gender differences in received medical care and the underrepresentation of women in both the science workforce and as participants in research, which contribute to the limited evidence-based, gender- or sex-specific recommendations. A key point is that the development of hypertension starts in young, premenopausal women, often in association with disorders of reproductive organs, and therefore needs to be managed early in life to prevent future cardiovascular disease. Considering the lower blood pressure levels at which cardiovascular disease occurs, thresholds for diagnosis and treatment of hypertension may need to be lower for women.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2016
Publisher: Oxford University Press (OUP)
Date: 23-07-2012
DOI: 10.1093/IJE/DYS106
Abstract: Longitudinal cohort studies in sub-Saharan Africa are urgently needed to understand cardiovascular disease development. We, therefore, explored health behaviours and conventional risk factors of African in iduals with optimal blood pressure (BP) (≤ 120/80 mm Hg), and their 5-year prediction for the development of hypertension. The Prospective Urban Rural Epidemiology study in the North West Province, South Africa, started in 2005 and included African volunteers (n = 1994 aged > 30 years) from a s le of 6000 randomly selected households in rural and urban areas. At baseline, 48% of the participants were hypertensive (≥ 140/90 mmHg). Those with optimal BP (n = 478) were followed at a success rate of 70% for 5 years (213 normotensive, 68 hypertensive, 57 deceased). Africans that became hypertensive smoked more than the normotensive in iduals (68.2% vs 49.8%), and they also had a greater waist circumference [ratio of geometric means of 0.94 cm (95% CI: 0.86-0.99)] and greater amount of γ-glutamyltransferase [0.74 U/l (95% CI: 0.62-0.88)] at baseline. The 5-year change in BP was independently explained by baseline γ-glutamyltransferase [R(2) = 0.23, β = 0.13 U/l (95% CI: 0.01-0.19)]. Alcohol intake also predicted central systolic BP and carotid cross-sectional wall area (CSWA) at follow-up. Waist circumference was another predictor of BP changes [β = 0.18 cm (95% CI: 0.05-0.24)] and CSWA. HIV infection was inversely associated with increased BP. During the 5 years, 24% of Africans with optimal BP developed hypertension. The surge in hypertension in Africa is largely explained by modifiable risk factors. Public health strategies should focus aggressively on lifestyle to prevent a catastrophic burden on the national health system.
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.NUT.2009.10.004
Abstract: The objective of this study was to compare the inflammatory status of children with differences in nutritional status. This was a cross-sectional study of 184 African children aged 13-18 y from a low socioeconomic background that compared stunted with non-stunted and lean with over-fat (percentage of body fat above normal cutoff points) children. Fasting serum tumor necrosis factor-alpha, interleukin-6, C-reactive protein, and insulin were measured using high-sensitivity methods. Body composition was assessed using anthropometry and air-displacement plethysmography. T tests for parametric data and the Mann-Whitney test for non-parametric data were used to compare groups. Regression analyses and principal components analyses were done to assess relations between body composition and biochemical variables. Of all participants 18% were stunted. Serum tumor necrosis factor-alpha of stunted girls was higher than in non-stunted girls. More of the stunted boys were over-fat compared with their non-stunted counterparts. Regression analyses showed that insulin resistance, diastolic blood pressure, and C-reactive protein contributed significantly to interleukin-6 in boys. Serum C-reactive protein, waist circumference, and body mass index clustered together in factor analysis in boys. Serum interleukin-6, waist-hip ratio, and tumor necrosis factor-alpha clustered together in factor analysis in girls. An association between adiposity and stunting and between adiposity low-grade inflammation was found in this study. Interventions for stunted children focus mainly on correction of undernutrition by providing feeding schemes. Attention should, however, also be paid to changes in body composition over time to prevent excessive abdominal fat accumulation and risk for cardiovascular diseases later in life.
Publisher: Informa UK Limited
Date: 2003
DOI: 10.1080/08037050310001075
Abstract: To investigate whether associations and differences exist regarding the arterial compliance, dietary intake and anthropometric parameters of children of four different ethnic groups in South Africa. In this study, 1244 children from four ethnic groups, aged 10-15 years, were randomly selected from five regions of the North West Province. Blood pressure was measured with a Finapres apparatus and analysed to obtain systemic arterial compliance. Measurements were done to obtain body mass index (BMI), waist-to-hip ratio and percentage body fat. Dietary intake was determined with a 24-h dietary recall questionnaire. The black and mixed-origin subjects indicated the lowest values (p < or = 0.05) for BMI, percentage body fat, and dietary intake, whereas the white and Indian subjects showed significantly higher values than the other ethnic groups. The white and Indian children had significantly higher arterial compliance than the black and mixed-origin children at all ages from 10 to 15 years. Compliance showed significant correlations with all anthropometric parameters. Since black and mixed-origin children have the highest prevalence of undernutrition and stunted growth, it is suggested that parental undernutrition and inadequate nutrition in early life, associated with lower arterial compliance, may lead to the onset of adult hypertension.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Oxford University Press (OUP)
Date: 10-09-2021
DOI: 10.1093/AJH/HPAB139
Abstract: To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. The database included 10,930 subjects (54.8% women median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th–95th percentile interval, 1.3–12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in in idual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension.
Publisher: Ubiquity Press, Ltd.
Date: 2022
DOI: 10.5334/GH.1172
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.HLC.2014.09.019
Abstract: Fibulin-1 and soluble urokinase-type plasminogen activator receptor (suPAR) emerged as mediators in the development of sclerotic disease. SuPAR along with C-reactive protein (CRP) and albumin delineate inflammatory processes associated with extracellular matrix turnover in atherosclerosis. We explored the independent relationship of fibulin-1 with these inflammatory markers in a bi-ethnic South African population. This study included 290 Africans (men: n=130 and women: n=160) and 343 sex- and age-matched Caucasians (men: n=160 and women: n=183). Serum fibulin-1, suPAR, CRP and albumin levels were measured along with conventional cardiovascular and metabolic variables. In both single and age-adjusted regression analyses, fibulin-1 correlated with both suPAR and albumin in African men and with suPAR in Caucasian men. These findings were absent in women. In multivariate regression analysis, these associations were confirmed in African men (R(2)=0.22 β=0.329 p<0.001) and Caucasian men (R(2)=0.14 β=0.234 p=0.008). Fibulin-1 independently associated positively with suPAR in all men, but inversely with albumin in African men only. These results are indicating the presence of potential subclinical inflammation (suPAR) within the extracellular matrix of endothelial tissue, contributing to the potential onset of cardiac fibrosis or vascular sclerosis among these South African men with lower albumin levels.
Publisher: Informa UK Limited
Date: 20-09-2013
DOI: 10.3109/10641963.2012.721839
Abstract: Hypertension (HT) and the metabolic syndrome are major problems in Africa. The role of sex hormones in the cardiovascular profile of black Africans in South Africa has not been studied. Our objective was to study the association between the sex hormones and ambulatory blood pressure and the heart rate (HR) in black and white South Africans. The 24-hour ambulatory blood pressure measurements were performed and the blood s les were taken between 07:00 and 09:00 hours. A total of 80 black and 98 white South African teachers between 25 and 65 years of age from similar socioeconomic backgrounds from the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study were included. As a result, a more vulnerable cardiovascular profile was observed in Africans compared with Caucasians. In the African group, low testosterone (T) explained 19%-36% of the variance in systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR, whereas in the Caucasian group non-sex-hormone-binding globulin (non-SHBG)-bound T explained 27% of the variance in HR. In the African males, inverse associations between blood pressure and T (SBP: P = .08 DBP: P = .02) and non-SHBG-bound T (SBP: P < .001 DBP: P < .01) and HR (P < 0.01) were observed. Ambulatory HR predicted a prediabetic state in Africans. In conclusion, low T levels may predispose or result in impaired cardiovascular function in African men. The possibility exists that a prediabetic state, vagal-impaired HR, and hyperkinetic blood pressure responses may predispose or result in low T levels in African men.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.IJCARD.2015.03.041
Abstract: Elevated inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) are well-known risk factors for cardiovascular mortality. The less familiar marker, soluble urokinase plasminogen activator receptor (suPAR), is known to predict cancer, infections and all-cause mortality. We determined whether suPAR, CRP and IL-6 are predictive of both all-cause and cardiovascular mortality in a black population, highly burdened by cardiovascular disease and HIV infection. We included 1425 black South Africans, of which 208 died within five years after baseline data collection. EDTA plasma biomarker levels were determined, while all-cause and cardiovascular mortality were used as endpoints. At baseline suPAR, CRP and IL-6 were higher in non-survivors than in survivors (P<0.001). SuPAR (HR 1.27, 95% CI 1.09-1.48), IL-6 (HR 1.49, 95% CI 1.24-1.78) and CRP (HR 1.39, 95% CI 1.17-1.65) predicted all-cause mortality, while only suPAR (HR 1.40, 95% CI 1.04-1.87) and IL-6 (HR 1.61, 95% CI 1.10-2.35) predicted cardiovascular mortality. The prognostic value of suPAR was independent of IL-6 and CRP (P≤0.015). SuPAR predicted both all-cause and cardiovascular mortality, independent of traditional risk factors, HIV and other inflammatory markers, underlining the prognostic value of suPAR in a black population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2020
Publisher: Consilium Medicum
Date: 15-04-2021
DOI: 10.26442/00403660.2021.04.200818
Abstract: Analysis of routine clinical practice of hypertensive patient management represents one of the important tools in the search for further ways to minimize hypertension-associated cardiovascular and renal adverse outcomes. To compare the strategies for hypertension management and features of clinical use of I1-imidazoline receptor (I1-IR) agonists in the Russian Federation and other countries where the STRAIGHT (Selective imidazoline receptor agonists Treatment Recommendation and Action In Global management of HyperTension) study was conducted. It was a cross-sectional online study involving physicians of various specializations. The study was conducted from January 18 to July 1, 2019, in seven countries with a high rate of I1-IR agonist prescription, including Russia. A total of 125 (4.5%) responders filled out the survey in the Russian Federation, which was somewhat lower than in other countries (6.8%). The participants were mostly general practitioners (54.0%) and cardiologists (42.0%), while in other countries greater ersity was seen. Most Russian physicians (83.0%) seemed to rely on national clinical guidelines in their routine practice, while in other countries the US guidelines were more popular (66.0%). The majority of responders stated that they took into account the traditional risk factors of hypertension when initiating the therapy every second responder noted if sleep apnea was present. Awareness of I1-IR agonists, their prescription rate and their preference were higher in Russia. The main reported benefits of I1-IR agonists were their efficacy, including in resistant hypertension, and their metabolic effects (in Russia). Most participants preferred I1-IR agonists as third-line therapy (65.0% in Russia vs 60.0% in other countries) and in combination with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARB) (55.0% in Russia vs 54.0% in other countries). Compared to responders from other countries, Russian physicians prescribe I1-IR agonists as first-line (15.0% vs 5.0%) and second-line (48.0% vs 21.0%) therapy more often. Russian physicians were the most aware of I1-IR agonists and tended to prescribe drugs of this class for hypertension management more often, and I1-IR agonist combination with ACEi was preferable compared to physician responders from other countries. Antihypertensive efficacy and metabolic effects were reported as the major benefits of I1-IR agonist therapy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-04-2021
DOI: 10.1161/CIRCRESAHA.120.318729
Abstract: In recent decades low- and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carers, and increases costs to the health system, facing challenges such as low physician-to-patient ratios and lack of access to medicines. Established risk factors include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity. Emerging risk factors include pollution (air, water, noise, and light), urbanization, and a loss of green space. Risk factors that require further in-depth research are low birth weight and social and commercial determinants of health. Global actions include the HEARTS technical package and the push for universal health care. Promising research efforts highlight that successful interventions are feasible in LMICs. These include creation of health-promoting environments by introducing salt-reduction policies and sugar and alcohol tax implementing cost-effective screening and simplified treatment protocols to mitigate treatment inertia pooled procurement of low-cost single-pill combination therapy to improve adherence increasing access to telehealth and mHealth (mobile health) and training health care staff, including community health workers, to strengthen team-based care. As the blood pressure trajectory continues creeping upward in LMICs, contextual research on effective, safe, and cost-effective interventions is urgent. New emergent risk factors require novel solutions. Lowering blood pressure in LMICs requires urgent global political and scientific priority and action.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.HLC.2016.01.019
Abstract: Bilateral systolic blood pressure (SBP) differences > 10mmHg is a common finding in clinical practice. Such BP differences in older in iduals are associated with peripheral vascular disease, linked to microvascular dysfunction. Investigating retinal vessel calibres could provide insight into systemic microvascular function and may predict cardiovascular outcomes. Therefore we investigated the link between inter-arm systolic blood pressure differences (IASBPD) and the retinal microvasculature to determine the usefulness of IASBPD as an early marker of microvascular changes. In this cross-sectional study, we used data from 403 apparently healthy participants (20-30 years) (42% men 49% black) taking part in the African-PREDICT study. Participants underwent retinal vessel imaging, anthropometric measurements and blood s ling. Brachial BP was measured sequentially in both arms to determine the mean IASBPD. Participants were stratified into two groups with an IASBPD < 10mmHg (n=329) and ≥ 10mmHg (n=47), the only difference in characteristics being a higher right arm SBP in the latter group (p=0.005). We found no association between IASBPD and retinal vessel calibres in any group. Less than 2% of the variance in IASBPD was explained by potential risk factors, with only SBP associating independently with IASBPD (β=115 p=0.039). In a young population an increased IASBPD is not related to retinal vessel diameters suggesting that it does not reflect early microvascular alterations.
Publisher: Springer Science and Business Media LLC
Date: 12-08-2021
DOI: 10.1038/S41440-021-00720-3
Abstract: High blood pressure (BP) is a global health challenge. Isometric resistance training (IRT) has demonstrated antihypertensive effects, but safety data are not available, thereby limiting its recommendation for clinical use. We conducted a systematic review of randomized controlled trials comparing IRT to controls in adults with elevated BP (systolic ≥130 mmHg/diastolic ≥85 mmHg). This review provides an update to office BP estimations and is the first to investigate 24-h ambulatory BP, central BP, and safety. Data were analyzed using a random-effects meta-analysis. We assessed the risk of bias with the Cochrane risk of bias tool and the quality of evidence with GRADE. Twenty-four trials were included (n = 1143 age = 56 ± 9 years, 56% female). IRT resulted in clinically meaningful reductions in office systolic (-6.97 mmHg, 95% CI -8.77 to -5.18, p < 0.0001) and office diastolic BP (-3.86 mmHg, 95% CI -5.31 to -2.41, p < 0.0001). Novel findings included reductions in central systolic (-7.48 mmHg, 95% CI -14.89 to -0.07, p = 0.035), central diastolic (-3.75 mmHg, 95% CI -6.38 to -1.12, p = 0.005), and 24-h diastolic (-2.39 mmHg, 95% CI -4.28 to -0.40, p = 0.02) but not 24-h systolic BP (-2.77 mmHg, 95% CI -6.80 to 1.25, p = 0.18). These results are very low/low certainty with high heterogeneity. There was no significant increase in the risk of IRT, risk ratio (1.12, 95% CI 0.47 to 2.68, p = 0.8), or the risk difference (1.02, 95% CI 1.00 to 1.03, p = 0.13). This means that there is one adverse event per 38,444 bouts of IRT. IRT appears safe and may cause clinically relevant reductions in BP (office, central BP, and 24-h diastolic). High-quality trials are required to improve confidence in these findings. PROSPERO (CRD42020201888) OSF ( 0.17605/OSF.IO/H58BZ ).
Publisher: Springer Science and Business Media LLC
Date: 24-04-2008
DOI: 10.1038/JHH.2008.35
Abstract: Hypertension is highly prevalent in South Africa, resulting in high stroke mortality rates. Since obesity is very common among South African women, it is likely that obesity contributes to the hypertension prevalence. The aims were to determine whether black African women have higher blood pressures (BPs) than Caucasian women, and whether obesity is related to their cardiovascular risk. African (N=102) and Caucasian (N=115) women, matched for age and body mass index, were included. Correlations between obesity (total body fat, abdominal obesity and peripheral fat) and cardiovascular risk markers (haemodynamic parameters, lipids, inflammatory markers, prothrombotic factors, adipokines, HOMA-IR (homoeostasis model assessment insulin resistance)) were compared between the ethnic groups (adjusted for age, smoking, alcohol and physical activity). Comparisons between low- and high-BP groups were also made for each ethnic group. Results showed that African women had higher BP (P<0.01) with increased peripheral vascular resistance. Surprisingly, African women showed significantly weaker correlations between obesity measures and cardiovascular risk markers when compared to Caucasian women (specifically systolic BP, arterial resistance, cardiac output, fibrinogen, plasminogen activator inhibitor-1, leptin and resistin). Interestingly, the latter risk markers were also not significantly different between low- and high-BP African groups. African women, however, presented significant correlations of obesity with triglycerides, C-reactive protein and HOMA that were comparable to the Caucasian women. Although urban African women have higher BP than Caucasians, their obesity levels are weakly related to traditional cardiovascular risk factors compared to Caucasian women. The results, however, suggest a link with the development of insulin resistance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 22-08-2017
DOI: 10.1007/S00726-017-2483-5
Abstract: The relationship of both asymmetric (ADMA) and symmetric (SDMA) dimethylarginine with carotid wall thickness is inconclusive especially among black populations. We aimed to compare carotid intima media thickness (cIMT) and dimethylarginine levels in 75 black and 91 white men at baseline and after a 3-year follow-up, and to investigate associations of percentage change in cIMT with percentage change in dimethylarginine levels (ADMA and SDMA). Plasma levels of ADMA and SDMA were determined with a liquid chromatography mass spectrometry method and B-mode ultrasonography was used to determine the cIMT at baseline and follow-up. In black men, mean cIMT (p = 0.79) and ADMA levels (p = 0.67) remained the same, but SDMA levels were lower (p < 0.001) when comparing baseline and follow-up. In white men, cIMT increased (p < 0.001), but both mean ADMA and SDMA levels decreased (p < 0.001) over time. In black men, percentage change in cIMT was positively associated with percentage change in ADMA (R
Publisher: Springer Science and Business Media LLC
Date: 08-03-2012
DOI: 10.1007/S10753-011-9308-6
Abstract: Soluble urokinase plasminogen activator receptor (suPAR) is associated with inflammation and may predict lipodystrophy and dysmetabolism in human immunodeficiency virus (HIV)-infected in iduals on antiretroviral therapy. We aimed to assess firstly, whether suPAR levels are elevated in treated and untreated HIV-1-infected Africans compared to uninfected controls at baseline and at a 3-year follow-up, and secondly whether suPAR levels are correlated with cardiovascular and/or metabolic changes. SuPAR, cardiovascular, and metabolic variables were assessed and the percentage change was determined. HIV-1-infected black South Africans had significantly higher suPAR levels than uninfected controls at baseline and at follow-up 3 years later. However, only the treated HIV-1-infected participants showed an increase in suPAR levels at follow-up. The treated group also showed signs of lipodystrophy and their baseline suPAR levels correlated positively with an increased waist circumference. This study indicates that suPAR levels increase and that baseline suPAR is associated with an increase in abdominal fat distribution in HIV-infected black Africans on antiretroviral therapy.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.NUT.2012.08.009
Abstract: A waist:height ratio (WHtR) higher than 0.5 has been proposed as a cutoff point for abdominal obesity in both sexes and at all ages. It is unknown if this cutoff point is appropriate for previously undernourished adolescents. We assessed the cutoff value of the WHtR associated with an increased metabolic risk in 178 black South African 14- to 18-y-old adolescents (69 boys, 109 girls). We measured weight, height, waist circumference, fasting plasma glucose and insulin levels, serum high-sensitivity C-reactive protein, and blood pressure and calculated the WHtR and homeostasis model assessment of insulin resistance (HOMA-IR). Using receiver operating characteristics curve analyses, we assessed the WHtR with the highest sensitivity and specificity to discriminate adolescents with increased fasting plasma glucose, HOMA-IR, serum high-sensitivity C-reactive protein, and blood pressure from those with "normal" values. The WHtR cutoff points derived from the receiver operating characteristics curves ranged from 0.40 to 0.41, with best diagnostic value at 0.41. A WHtR of 0.40 had 80% sensitivity and 38.5% specificity to classify adolescents with fasting blood glucose level higher than 5.6 mmol/L (area under the curve [AUC] 0.57). A WHtR of 0.41 had 64% sensitivity and 58.5% specificity for a HOMA-IR higher than 3.4 (AUC 0.66), 55% sensitivity and 55.6% specificity for a high-sensitivity C-reactive protein level higher than 1 mg/L (AUC 0.57), and 64% sensitivity and 50.2% specificity for a blood pressure higher than the age-, sex-, and height-specific 90th percentiles (AUC 0.56). Adolescents with a WHtR higher than 0.41 had an odds ratio of 2.46 (95% confidence interval 0.96-6.30) for having a HOMA-IR higher than 3.4. The WHtR cutoff to indicate metabolic risk for black South African adolescents is 0.41, which is lower than the proposed international cutoff of 0.5. The WHtR can be used for screening adolescents with components of the metabolic syndrome in intervention programs.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.REGPEP.2010.06.008
Abstract: Adipokines contribute directly to the coexistence of insulin resistance and endothelial dysfunction. Most studies focus on a single adipokine. We therefore investigated the independent relationships of leptin, adiponectin, tumor necrosis factor-alpha, resistin and visfatin, as well as the gut hormone ghrelin with blood pressure and insulin resistance. Secondly we evaluated the interrelationships of adipokines and ghrelin in concert with various cardiometabolic markers. Caucasian women (N=115) with varying levels of obesity (aged 31.3 + or - 9.18 years) were included. Significant correlations of leptin, adiponectin, ghrelin and visfatin with mean arterial pressure (p<0.05) disappeared after adjustment for age, body mass index and waist circumference. But significant correlations with insulin resistance (HOMA) (for leptin, adiponectin and ghrelin) remained significant after adjustments. Factor analyses yielded five factors, but two main clusters, namely a metabolic syndrome cluster (including leptin, adiponectin and ghrelin) and a vascular atherosclerotic cluster (including tumor necrosis factor-alpha, visfatin and resistin). Factor analyses identified patterns which indicate specific roles of the various adipokines. Leptin, adiponectin and ghrelin were more closely related to insulin resistance and central obesity as core components of the metabolic syndrome. Visfatin, tumor necrosis factor-alpha and resistin seem to direct their effects onto the vascular system possibly by means of mechanisms such as inflammation, vasoconstriction and coagulation.
Publisher: Hogrefe Publishing Group
Date: 11-2015
DOI: 10.1024/0301-1526/A000466
Abstract: Abstract. Background: Low levels of testosterone in men and changes in retinal microvascular calibre are both associated with hypertension and cardiovascular disease risk. Sex hormones are also associated with blood flow in microvascular beds which might be a key intermediate mechanism in the development of hypertension. Whether a direct association between endogenous testosterone and retinal microvascular calibre exists is currently unknown. We aimed to determine whether testosterone is independently associated with ocular perfusion via a possible association with retinal vascular calibre or whether it plays only a secondary role via its effect on blood pressure in a bi-ethnic male cohort. Probands and methods: A total of 72 black and 81 white men (28-68 years of age) from the follow-up phase of the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study were included in this sub-study. Ambulatory pulse pressure and intraocular perfusion pressures were obtained, while metabolic variables and testosterone were measured from fasting venous blood s les. Retinal vascular calibre was quantified from digital photographs using standardised protocols. Results: The black men revealed a poorer cardiometabolic profile and higher pulsatile pressure ( 50 mm Hg), intraocular pressure and diastolic ocular perfusion pressure than the white men (p ≤ 0.05). Only in the white men was free testosterone positively associated with retinal calibre, i.e. arterio-venular ratio and central retinal arterial calibre and inversely with central retinal venular calibre. These associations were not found in the black men, independent of whether pulse pressure and ocular perfusion pressure were part of the model. Conclusions: These results suggest an independent, protective effect of testosterone on the retinal vasculature where an apparent vasodilatory response in the retinal resistance microvessels was observed in white men.
Publisher: Oxford University Press (OUP)
Date: 10-09-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-01-2023
Publisher: Cold Spring Harbor Laboratory
Date: 03-07-2023
DOI: 10.1101/2023.07.03.23292156
Abstract: Most cardiovascular mortality is due to hypertension and onset may be in youth. We investigated the prevalence of and risk factors for elevated blood pressure (BP) (hypertension (≥140/90mmHg) and high-normal BP (130-139/85-89mmHg)) among youth in Zimbabwe. A population-based survey of randomly s led 18-24 year olds from 24 communities in three provinces was conducted, with standardised questionnaires to collect socio-demographic, behavioural and clinical data. Height, weight and BP were recorded. The association of potential risk factors with elevated BP was examined using multivariable logistic regression. Of 17,682 participants recruited (98% of those eligible), 17,637 had complete data. The median age was 20 (IQR: 19-22) years and 60.7% were female. After excluding pregnant women (N=754), the prevalence of hypertension and high-normal BP was 7.4% (95% CI:7.0-7.8) and 12.2% (95% CI:12.7-13.7), respectively. Prevalence of hypertension was higher in men (8.7% (95% CI:8.2-9.6) vs 6.6% (95% CI:6.0-6.9) in men and women, respectively) but with age increased to equivalent levels among women (at 18y 7.3% (95% CI:6.2-8.6) and 4.3% (95% CI:3.5-5.2) at 23-24 years 10.9% (95% CI:9.3-12.5) and 9.50% (95% CI:8.4-10.7) in men and women, respectively). After adjusting for confounders, male sex ((aOR) 1.53 (95% CI:1.36-1.74)), increasing age (19-20 years aOR:1.20 (1.00-1.44) 21-22 years aOR:1.45 (95% CI 1.20-1.75) 23-24 years aOR 1.90 (95% CI:1.57-2.30), vs 18 years) and obesity (aOR 1.94 (95% CI:1.53-2.47)) were associated with hypertension. Being underweight (aOR 0.79 (0.63-0.98)) and living with HIV (aOR 0.71 (95% CI:0.55-0.92)) were associated with lower odds of hypertension. Prevalence of elevated BP is high among youth in SSA and rises rapidly with age. Further research is needed to understand drivers of BP elevation and the extent of target organ damage in youth in SSA, to guide implementation of prevention and management strategies. Wellcome Trust.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
Publisher: Springer Science and Business Media LLC
Date: 28-09-2015
DOI: 10.1007/S00408-015-9804-9
Abstract: Reduced lung function is associated with a risk for the development of cardiovascular disease. This association may be due to chronic inflammation which is often present in those with reduced lung function. We investigated the possible role of systemic inflammation as the mediator between lung function and arterial stiffness in 1534 black South Africans. Spirometric data including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained. C-reactive protein (CRP), interleukin-6 (IL-6), blood pressure (BP) and carotid-radial pulse wave velocity (PWV) were determined. In multivariable-adjusted models, an independent inverse association was found between IL-6 and FEV1 (β = -0.20, p < 0.001) and FVC (β = -0.18, p < 0.001). Similar results were found for CRP. PWV was inversely associated with FEV1 (β = -0.06, p = 0.037). No association was found between inflammatory markers, BP or PWV. Reduced lung function was associated with increased inflammation and arterial stiffness. The lack of association between arterial stiffness and inflammatory markers suggests that inflammation may not be the mediating link between lung and vascular function in this population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-07-2023
Abstract: Sodium glucose cotransporter‐2 inhibitors reduce systolic blood pressure (SBP), but whether they affect SBP variability is unknown. There also remains uncertainty regarding the prognostic value of SBP variability for different clinical outcomes. Using in idual participant data from the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program and CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial, we assessed the effect of canagliflozin on SBP variability in people with type 2 diabetes across 4 study visits over 1.5 years as measured by standard deviation, coefficient of variation, and variability independent of the mean. We used multivariable Cox regression models to estimate associations of SBP variability with cardiovascular, kidney, and mortality outcomes. In 11 551 trial participants, canagliflozin modestly lowered the standard deviation of SBP variability (−0.25 mm Hg [95% CI, –0.44 to −0.06]), but there was no effect on coefficient of variation (0.02% [95% CI, –0.12 to 0.16]) or variability independent of the mean (0.08 U [95% CI, –0.11 to 0.26]) when adjusting for correlation with mean SBP. Each 1 standard deviation increase in standard deviation of SBP variability was independently associated with higher risk of hospitalization for heart failure (hazard ratio [HR], 1.19 [95% CI, 1.02–1.38]) and all‐cause mortality (HR, 1.12 [95% CI, 1.01–1.25]), with consistent results observed for coefficient of variation and variability independent of the mean. Increases in SBP variability were not associated with kidney outcomes. In people with type 2 diabetes at high cardiovascular risk or with chronic kidney disease, higher visit‐to‐visit SBP variability is independently associated with risks of hospitalization for heart failure and all‐cause mortality. Canagliflozin has little to no effect on SBP variability, independent of its established SBP‐lowering effect. URL: www.clinicaltrials.gov Unique identifiers: NCT01032629, NCT01989754, NCT02065791.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-06-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-06-2023
Publisher: American Chemical Society (ACS)
Date: 09-09-2023
Publisher: AMPCo
Date: 24-10-2020
DOI: 10.5694/MJA2.50836
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-06-2023
DOI: 10.1097/HJH.0000000000003488
Abstract: Raised blood pressure (BP) remains the biggest risk factor contributing to the global burden of disease and mortality, despite the COVID-19 pandemic. May Measurement Month (MMM), an annual global screening c aign aims to highlight the importance of BP measurement by evaluating global awareness, treatment and control rates among adults with hypertension. In 2021, we assessed the global burden of these rates during the COVID-19 pandemic. Screening sites were set up in 54 countries between May and November 2021 and screenees were recruited by convenience s ling. Three sitting BPs were measured, and a questionnaire completed including demographic, lifestyle and clinical data. Hypertension was defined as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to impute the average BP when readings were missing. Of the 642 057 screenees, 225 882 (35.2%) were classified as hypertensive, of whom 56.8% were aware, and 50.3% were on antihypertensive medication. Of those on treatment, 53.9% had controlled BP ( /90 mmHg). Awareness, treatment and control rates were lower than those reported in MMM c aigns before the COVID-19 pandemic. Minimal changes were apparent among those testing positive for, or being vaccinated against COVID-19. Of those on antihypertensive medication, 94.7% reported no change in their treatment because of the COVID-19 pandemic. The high yield of untreated or inadequately treated hypertension in MMM 2021 confirms the need for systematic BP screening where it does not currently exist.
Publisher: Oxford University Press (OUP)
Date: 23-08-2023
DOI: 10.1093/EURHEARTJ/EHAD535
Abstract: Effervescent formulations of paracetamol containing sodium bicarbonate have been reported to associate with increased blood pressure and a higher risk of cardiovascular diseases and all-cause mortality. Given the major implications of these findings, the reported associations were re-examined. Using linked electronic health records data, a cohort of 475 442 UK in iduals with at least one prescription of paracetamol, aged between 60 and 90 years, was identified. Outcomes in patients taking sodium-based paracetamol were compared with those taking non–sodium-based formulations of the same. Using a deep learning approach, associations with systolic blood pressure (SBP), major cardiovascular events (myocardial infarction, heart failure, and stroke), and all-cause mortality within 1 year after baseline were investigated. A total of 460 980 and 14 462 patients were identified for the non–sodium-based and sodium-based paracetamol exposure groups, respectively (mean age: 74 years 64% women). Analysis revealed no difference in SBP [mean difference −0.04 mmHg (95% confidence interval −0.51, 0.43)] and no association with major cardiovascular events [relative risk (RR) 1.03 (0.91, 1.16)]. Sodium-based paracetamol showed a positive association with all-cause mortality [RR 1.46 (1.40, 1.52)]. However, after further accounting of other sources of residual confounding, the observed association attenuated towards the null [RR 1.08 (1.01, 1.16)]. Exploratory analyses revealed dysphagia and related conditions as major sources of uncontrolled confounding by indication for this association. This study does not support previous suggestions of increased SBP and an elevated risk of cardiovascular events from short-term use of sodium bicarbonate paracetamol in routine clinical practice.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.IJCARD.2017.08.070
Abstract: Pulse pressure lification (PPA), i.e. the lification from central arteries to the periphery, is inversely related to arterial stiffness, organ damage and mortality. It is known that arterial stiffness is higher in black than white populations, but it is unclear if this is due to early vascular aging. We therefore investigated whether PPA declines earlier in young normotensive black South Africans, when compared to their white counterparts. We included 875 black and white men and women from the African-PREDICT study (55% black, 41% men), aged 20-30years, with no prior diagnosis of chronic disease, screened for normotensive clinic blood pressure (BP). We determined supine central PP (cPP), and supine brachial systolic- and diastolic BP, from which brachial PP (bPP) was calculated. PPA was defined as the ratio of the litude of the PP between these distal and proximal locations (bPP/cPP). We found the mean PPA to be lower in black compared to white participants (1.43 vs. 1.46 P=0.013). In black adults PPA declined earlier with increasing age (P-trend<0.001), with a weak trend in whites (P=0.069) after adjustment for sex, socio-economic status, height, heart rate and mean arterial pressure. In multivariable-adjusted regression, we found an independent inverse association between PPA and age only in the black group (β=-0.18, P=0.002). PPA declines earlier with age in normotensive black adults younger than 30years, exemplifying early vascular aging which may predispose black in iduals to future cardiovascular outcomes.
Publisher: Springer Science and Business Media LLC
Date: 03-10-2017
DOI: 10.1038/IJO.2017.240
Publisher: Springer Science and Business Media LLC
Date: 25-06-2021
DOI: 10.1038/S41371-021-00569-6
Abstract: Exogenous estrogens and progestins may affect the components of the renin-angiotensin-aldosterone system (RAAS). Changes in ventricular blood volume are associated with increased secretion of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP), which may also be affected by hormonal contraceptives. In this study, we aimed to compare components of the RAAS and NT-proBNP between groups using different hormonal contraceptives, including the combination pill, the injection or implant, and controls (no contraception) in black and white women of fertile age (20 - 30 years). Secondly, we determined whether blood pressure and NT-proBNP are associated with the RAAS components. We included 397 black and white women not using contraceptives, 120 using the combination pill, and 103 receiving an injection/implant. RAAS Triple-A analysis was carried out with LC-MS/MS quantification, and blood pressure measurements (ABPM) taken over 24 h. We found that serum aldosterone was higher (475.7 vs. 249.2 pmol/L p < 0.001) in the combination pill group than in the no contraception group of white women. The aldosterone-angiotensin II ratio (AA2) was higher (5.4 vs. 2.5 p < 0.001) in the combination pill group than in the no contraception group. In the black women using the combination pill, we found a borderline-positive and borderline-negative association between 24-h systolic blood pressure and NT-proBNP with equilibrium (eq) Ang II, respectively. In white women using the combination pill, only CRP contributed positively and independently to NT-proBNP. To conclude, activation of RAAS by different hormonal contraceptives may increase future risk for the development of hypertension in young black and white women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Publisher: MDPI AG
Date: 15-03-2021
DOI: 10.3390/NU13030944
Abstract: It is unknown whether a healthy diet or unhealthy diet combined with specific supplements may jointly contribute to incidence of obesity and cardiovascular disease (CVD). We included 69,990 participants from the 45 and Up Study who completed both baseline (2006–2009) and follow-up (2012–2015) surveys. We found that compared to participants with a long-term healthy diet and no supplement consumption, those with a long-term healthy diet combined with multivitamins and minerals (MVM) or fish oil consumption were associated with a lower incidence of CVD (p 0.001) whilst those with an unhealthy diet and no MVM or fish oil consumption were associated with a higher risk of obesity (p 0.05). Compared to participants with a long-term healthy diet and no calcium consumption, the combination of a long-term healthy diet and calcium consumption was linked to a lower risk of CVD (IRR = 0.87, 95% CI: 0.78 0.96). In conclusion, a long-term healthy diet combined with MVM or fish oil was associated with a lower incidence of CVD. Participants who maintained a healthy diet and used calcium supplements were associated with a lower incidence of obesity. However, these associations were not found among those with an unhealthy diet, despite taking similar supplements.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1016/J.DIABRES.2006.10.010
Abstract: The present study aimed to reveal racial differences in the metabolic pattern of C-peptide and non-esterified fatty acids (NEFA), and in their associations with cardiovascular measures in healthy urban African (102) and Caucasian women (115) from South Africa. An oral glucose tolerance test was performed with measurements before and at 30, 60, 90 and 120min. Various cardiovascular parameters and blood lipids were assessed. Statistical analyses were done in a sub-s le of pre-menopausal women. Fasting C-peptide and hepatic insulin extraction were significantly higher in lean African women compared to their Caucasian counterparts, with no racial differences between women with abdominal obesity. Postchallenge C-peptide response and hepatic insulin extraction were significantly higher in Caucasians with abdominal obesity. There were no racial differences in insulin sensitivity and resistance. Despite different associations of C-peptide and NEFA with cardiovascular measures between the ethnicities both showed significant positive correlations with triglycerides. Increased fasting C-peptide levels and unfavorable associations of C-peptide and NEFA with triglycerides and cardiovascular measures implicate a higher cardiovascular risk in lean African women only. This may be of importance for the development of hypertension in this population group.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2023
Publisher: Wiley
Date: 05-10-2020
DOI: 10.1111/JCH.14065
Publisher: Elsevier BV
Date: 06-2021
Publisher: Informa UK Limited
Date: 09-12-2012
DOI: 10.3109/10641963.2011.628727
Abstract: Serum γ-glutamyltransferase (GGT) is increasingly regarded as a marker of vascular function. However, the usefulness of this marker is in dispute. Gender and ethnic differences, as well as the serum level range where correlations with vascular function will emerge, may complicate the usefulness of GGT. The aim is to compare correlations with markers of vascular function between African and Caucasian groups. This cross-sectional target population study involved four groups of African and Caucasian men and women of 100 participants each. Fasting lipids, GGT, C-reactive protein (CRP), reactive oxygen species, and glycosylated hemoglobin (HbA1c) were determined as well as blood pressure, carotid intima-media thickness (CIMT), and left ventricular hypertrophy. γ-Glutamyltransferase levels were significantly higher in Africans compared with Caucasians and also higher in men than in women. γ-Glutamyltransferase correlated with triglycerides in all four groups and after adjusting the correlations sustained in the male groups but disappeared in women. Correlations existed between GGT and blood pressure, except for the African women. After adjustments, CIMT correlated with GGT in Caucasian men (r = 0.29 P < .01). Glycosylated hemoglobin was associated with GGT in Caucasian women (r = 0.26 P = .01) as well as CRP (r = 0.36 P < .01). When the groups were ided into low and high GGT groups by median split, most of the correlations disappeared in the high GGT groups. Gender and ethnic-specific associations occurred regarding GGT and variables associated with cardiovascular function. With high levels of GGT the correlations diminished. The usefulness of GGT as a marker of vascular dysfunction seems limited.
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.IJPSYCHO.2005.07.015
Abstract: The purpose of this study was to compare active and passive coping strategies of Africans with perception of own health and cardiovascular data. The subjects included 236 apparently healthy Africans (men=109 women=127). The COPE questionnaire was adapted, translated and validated for Africans. Scores on reliable sub-scales were used to classify men and women into more active coping (AC) and more passive coping (PC) subgroups. The General Health Questionnaire measured subjective perception of health. Blood pressure was recorded before and during application of the handgrip test, using the Finapres, a continuous non-invasive blood pressure monitor. Plasma renin activity (PRA) values, measured with radio immuno assay, were compared to blood pressure variables. Analyses of co-variance, adjusted for resting values and age, indicated that PC men responded with a larger increase in total peripheral resistance (TPR) (p=0.006), larger decrease in stroke volume (p=0.07), smaller increase in cardiac output (p=0.09) and larger increases in PRA resting (p=0.04) and reactivity (p< or =0.05) values. PC subjects reported a more negative perception of health than AC subjects. Young PC women presented greater hypertension prevalence rates (p< or =0.01) than AC women. In conclusion, all AC and PC subjects reacted with increased vascular reactivity on the handgrip test. PC men presented enhanced vascular reactivity, PRA and perception of poorer health values.
Publisher: Springer Science and Business Media LLC
Date: 11-02-2010
DOI: 10.1038/JHH.2010.1
Abstract: The African population is considered a high-risk group for the development of hypertension, and identifying risk factors are therefore essential in preventive actions against cardiovascular disease (CVD). Elevated levels of uric acid (UA) are often associated with CVD. Our first aim was to establish possible ethnic differences in UA levels between African and Caucasian men. Our second aim was to determine any associations between UA levels and cardio-metabolic variables, and also how these correlates differ between the two groups. African (N=87) and Caucasian (N=121) men participated in this cross-sectional study. Our results have shown that African men had significantly lower (353±87.7 vs 401±98.2 P<0.01) UA levels compared with Caucasian men. Waist circumference and triglycerides correlated strongly with UA in both ethnic groups. This was confirmed with a forward stepwise multiple regression analysis. After adjustment for confounders, the correlation between UA and triglycerides remained significant only in the Caucasians (r=0.29 P=0.02), whereas only the African men showed an independent correlation between UA and total peripheral resistance (TPR) (r=0.23 P=0.04). TPR increased significantly across UA tertiles only in the African men (P=0.01 vs P=0.96). In conclusion, despite their lower UA levels, Africans showed an independent relationship between UA and vascular resistance, indicating a possible explanation for their high prevalence of hypertension.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Publisher: Massachusetts Medical Society
Date: 05-10-2023
Publisher: Springer Science and Business Media LLC
Date: 11-04-2023
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.THROMRES.2014.04.021
Abstract: Although both coagulation and fibrinolysis are associated with cardiovascular disease (CVD) the underlying nature and pathways of many of these associations are still unclear. Our aim was to determine which of the current or 5-year prior levels of total fibrinogen, fibrinogen γ', plasminogen activator inhibitor-1 (PAI-1act) and global fibrinolytic potential were the stronger determinant of arterial structure and function. This prospective study consisted of 2010 Africans over the age of 35 years with 5-year follow-up data available for 1288 participants. Cardiovascular measurements included arterial stiffness, blood pressure and carotid intima media thickness. Fibrinogen γ' showed stronger associations with blood pressure than total fibrinogen also in the presence of other CVD risk factors. PAI-1act was positively associated with blood pressure both cross-sectionally and prospectively, with the longitudinal association being the stronger determinant, also after adjustment for known CVD risk factors. Clot lysis time (CLT) was positively associated, both prospectively and cross-sectionally, with intima media thickness and negatively with markers of arterial stiffness but not after adjustment for known CVD risk factors. Fibrinogen γ' was more strongly associated with CVD function than total fibrinogen. PAI-1act was significantly associated with blood pressure with changes in PAI-1 levels preceding changes in blood pressure. Different mechanisms may be at play determining arterial wall stiffness/thickening and blood pressure as observed from the opposing associations with PAI-1act and CLT. CLT was not independently related to cardiovascular measures as its associations were weakened in the presence of other known CVD risk factors.
Publisher: American Scientific Publishers
Date: 2016
Abstract: Fe₃O₄ films were prepared by electrodeposition under varying preparation conditions (current density, temperature, and time). The electrodeposited Fe₃O₄ were characterized in terms of morphology and composition using scanning electron microscopy (SEM) and X-ray diffraction (XRD). The electrodeposited films were also tested as anode in coin cell systems. Fluoroethylene carbonate (FEC) electrolyte was found to improve the battery performance due to formation of a better solid electrolyte interface (SEI). Conducting polymer of polypyrrole (PPY) was coated on the surface of Fe₃O₄ films for the first time with the aim to improve the electric conductivity and to buffer volume expansion of Fe₃O₄ films.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
Publisher: Springer Science and Business Media LLC
Date: 29-03-2023
DOI: 10.1038/S41586-023-05772-8
Abstract: Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1–6 . Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was .1 kg m –2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have lified.
Publisher: Hindawi Limited
Date: 2018
DOI: 10.1017/GHEG.2018.7
Abstract: Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. Pooled analyses of 14 studies comprising 21 023 in iduals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG ( .3 mmol/L) was analysed using regression models. Among 10 615 in iduals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
Publisher: Oxford University Press (OUP)
Date: 08-2007
DOI: 10.1530/EJE-07-0044
Abstract: Objective : Concentrations of adiponectin, an adipocytokine with insulin-sensitizing actions, may vary according to ethnic group. This study aimed to determine whether fasting adiponectin levels of Caucasian and African women differ. A second objective was to determine which components of the metabolic syndrome are more closely related to adiponectinemia in both groups. Design : A cross-sectional study including 102 urban African and 115 Caucasian women with a wide range of obesity aged 20–55 years. Methods : Anthropometric measurements were taken, namely weight, height, body mass index, waist circumference, and hip circumference. Cardiovascular measurements included blood pressure and arterial compliance. Fasting blood s les were taken to determine glucose, insulin, C-peptide, leptin, adiponectin, and lipid levels. Results : Mean adiponectin levels of the whole groups did not differ, but normal weight African women ( N = 38) showed marginally lower adiponectin levels than their Caucasian counterparts ( N = 41 P = 0.047). No differences in adiponectin were shown for overweight and obese women. Separate multiple regression analyses for ethnic groups showed that only homeostasis model assessment-insulin resistance (HOMA-IR) significantly contributed to the variance in adiponectin levels of African women, whereas leptin, triacylglycerol levels and HOMA-IR contributed significantly to adiponectin variance in Caucasian women. An additional multiple regression analysis in a combined ethnic group ( N = 217) showed ethnicity to be a significant contributor to variances in adiponectin levels. Conclusions : Even though adiponectin levels of these ethnic groups are similar, different associations of adiponectin with leptin and triacylglycerol levels might indicate that there are ethnic differences regarding the mechanistic functions of adiponectin within the scope of the metabolic syndrome.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-06-2022
Publisher: Cambridge University Press (CUP)
Date: 30-06-2020
DOI: 10.1017/S0007114520002391
Abstract: CVD is the most common chronic condition and the highest cause of mortality in the USA. The aim of the present work was to investigate diet and sedentary behaviour in relation to mortality in US CVD survivors. The National Health and Nutrition Examination Surveys conducted between 1999 and 2014 linked to the US mortality registry updated to 2015 were investigated. Multivariate adjusted Cox regression was used to derive mortality hazards in relation to sedentary behaviour and nutrient intake. A multiplicative and additive interaction analysis was conducted to evaluate how sedentariness and diet influence mortality in US CVD survivors. A s le of 2473 participants followed for a median period of 5·6 years resulted in 761 deaths, and 199 deaths were due to CVD. A monotone increasing relationship between time spent in sedentary activities and mortality risk was observed for all-cause and CVD mortality (hazard ratio (HR) = 1·20, 95 % CI 1·09, 1·31 and HR = 1·19, 95 % CI 1·00, 1·67, respectively). Inverse mortality risks in the range of 22–34 % were observed when comparing the highest with the lowest tertile of dietary fibre, vitamin A, carotene, riboflavin and vitamin C. Sedentariness below 360 min/d and dietary fibre and vitamin intake above the median interact on an additive scale influencing positively all-cause and CVD mortality risk. Reduced sedentariness in combination with a varied diet rich in dietary fibre and vitamins appears to be a useful strategy to reduce all-cause and CVD mortality in US CVD survivors.
Publisher: Springer Science and Business Media LLC
Date: 11-2013
DOI: 10.1007/S00726-013-1611-0
Abstract: Globally the prevalence of non-communicable diseases, such as hypertension and type 2 diabetes, are escalating. Metabolomic studies indicated that circulating branched chain amino acids (BCAAs) are associated with insulin resistance, coronary artery disease and increased risk for cardiovascular events. We aimed to extend the current understanding of the cardiovascular risk associated with BCAAs. We explored whether BCAAs are related to markers of cardiovascular disease in a bi-ethnic population and whether this relationship was influenced by chronic hyperglycaemia. We included 200 African and 209 Caucasian participants, and determined their ambulatory blood pressure and carotid intima-media thickness (cIMT). We analysed blood s les for glycated haemoglobin (HbA1c) and BCAAs. Participants were stratified into two groups according to their HbA1c value using the median cut-off value of 5.6%. Ambulatory BP, cIMT and BCAAs were significantly higher (all p < 0.001) in the high HbA1c group. Single regression analyses indicated significant positive associations of ambulatory blood pressure and cIMT with BCAAs (all p < 0.05) in both the groups. These associations between ambulatory systolic blood pressure (SBP) (r = 0.16, p = 0.035) and cIMT (r = 0.22, p = 0.004) with BCAAs remained in the high HbA1c group after adjusting for age, gender, ethnicity and body mass index (BMI) and were confirmed in multiple regression analyses (ambulatory SBP: R (2) = 0.17, β = 0.21, p = 0.005 and cIMT: R (2) = 0.30, β = 0.19, p = 0.003). Our results demonstrate that BCAAs are independently related to ambulatory BP and cIMT in in iduals with high HbA1c levels and suggest that potential cardiovascular deterioration accompany the rise in BCAAs in conditions of hyperglycaemia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Publisher: Cambridge University Press (CUP)
Date: 10-11-2018
DOI: 10.1017/S1368980017002683
Abstract: The present study set out to determine whether morning spot urine s les can be used to monitor Na (and K) intake levels in South Africa, instead of the ‘gold standard’ 24 h urine s le. Participants collected one 24 h and one spot urine s le for Na and K analysis, after which estimations using three different formulas (Kawasaki, Tanaka and INTERSALT) were calculated. Between 2013 and 2015, urine s les were collected from different population groups in South Africa. A total of 681 spot and 24 h urine s les were collected from white ( n 259), black ( n 315) and Indian ( n 107) subgroups, mostly women. The Kawasaki and the Tanaka formulas showed significantly higher ( P ≤0·001) estimated Na values than the measured 24 h excretion in the whole population (5677·79 and 4235·05 v . 3279·19 mg/d). The INTERSALT formula did not differ from the measured 24 h excretion for the whole population. The Kawasaki formula seemed to overestimate Na excretion in all subgroups tested and also showed the highest degree of bias (−2242 mg/d, 95 % CI−10 659, 6175) compared with the INTERSALT formula, which had the lowest bias (161 mg/d, 95 % CI−4038, 4360). Estimations of Na excretion by the three formulas should be used with caution when reporting on Na intake levels. More research is needed to validate and develop a specific formula for the South African context with its different population groups. The WHO’s recommendation of using 24 h urine collection until more studies are carried out is still supported.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
Publisher: Elsevier BV
Date: 05-2017
Publisher: American Medical Association (AMA)
Date: 02-05-2023
Abstract: This study examines the availability, cost, and consumer ratings of blood pressure–measuring devices relative to validation status across 10 countries.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2021
DOI: 10.1161/HYPERTENSIONAHA.120.16879
Abstract: This study presents a detailed profile of the renin-angiotensin-aldosterone system (RAAS), electrolytes, volume loading, blood pressure (BP), and total peripheral resistance in healthy young Black and White adults. We also explored longitudinal associations between BP and RAAS. We included normotensive Black (N=543) and White (N=573) adults (20–30 years) and followed N=324 over ≈4.5 years. We measured clinic (central, brachial) and 24-hour BP, total peripheral resistance and left ventricular dimensions. We determined serum NT-proBNP (N-terminal prohormone B-type natriuretic peptide), RAAS, and 24-hour urinary and serum Na + and K + . RAAS components, left ventricular internal diameter (diastole), end diastolic volume and NT-proBNP were lower ( P .001) in Black than White adults, despite similar clinic SBP. However, central systolic BP and total peripheral resistance were higher in Black adults ( P .001). Plasma renin activity and angiotensin II were comparable between Black and White groups ( P .05) only in quartile 1 of Na + /K + values. In both groups, RAAS was lower in the higher quartiles of 24-hour Na + and NT-proBNP (all P -trend≤0.014). Over 4.5 years, all BPs increased in the Black ( P .001) but not White group. The increase in central systolic BP over time was associated with elevated serum aldosterone only in Black adults (β=0.18, P =0.038). We found that RAAS concentrations in healthy Black adults were half of those of White participants, which may not be explained by volume expansion. Yet, baseline aldosterone predicted BP elevation over time in Black adults. RAAS was similar in Black and White adults only at low Na + /K + scenarios, suggesting an essential role of potassium. URL: www.clinicaltrials.gov Unique identifier: NCT03292094.
Publisher: Elsevier BV
Date: 02-2020
Publisher: BMJ
Date: 11-2016
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 15-11-2010
DOI: 10.1007/S11745-009-3369-4
Abstract: Dyslipidemia has been documented worldwide among human immunodeficiency virus-infected (HIV) in iduals and these changes are reminiscent of the metabolic syndrome (MetS). In South Africa, with the highest number of HIV infections worldwide, HIV-1 subtype C is prevalent, while HIV-1 subtype B (genetically different from C) prevails in Europe and the United States. We aimed to evaluate if HIV infection (subtype C) is associated with dyslipidemia, inflammation and the occurrence of the MetS in Africans. Three hundred newly diagnosed HIV-infected participants were compared to 300 age, gender, body mass index and locality matched uninfected controls. MetS was defined according to the Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. The HIV-infected group showed lower high density lipoprotein cholesterol (1.23 vs. 1.70 mmol/L) and low density lipoprotein cholesterol (2.60 vs. 2.80 mmol/L) and higher triglycerides (1.29 vs. 1.15 mmol/L), C-reactive protein (3.31 vs. 2.13 mg/L) and interleukin 6 (4.70 vs. 3.72 pg/L) levels compared to the uninfected group. No difference in the prevalence of the MetS was seen between the two groups (ATP III, 15.2 vs. 11.5% IDF, 21.1 vs. 22.6%). This study shows that HIV-1 subtype C is associated with dyslipidemia, but not with a higher incidence of MetS in never antiretroviral-treated HIV-infected Africans.
Publisher: Clinics Cardive Publishing
Date: 02-09-2016
Publisher: Pan American Health Organization
Date: 08-01-2021
DOI: 10.26633/RPSP.2021.2
Abstract: Objetivo. Este estudio se propuso describir el impacto del registro deficiente de la causa de muerte en las tendencias de mortalidad por suicidios y homicidios mediante la imputación de información faltante. Métodos. Estudio observacional y descriptivo de la tendencia temporal de la mortalidad por causas externas registradas en Argentina en el período 1997-2018. Para la imputación de la intencionalidad, se ajustaron modelos logísticos a partir de variables predictoras provenientes del Informe Estadístico de Defunción. Se utilizaron estadísticas vitales y proyecciones de población como fuentes secundarias. Resultados. Medida con los datos originales, la mortalidad por causas externas descendió en homicidios y accidentes. Dichos descensos se hicieron más marcados con la información corregida, ya que la imputación impactó con mayor fuerza al principio del período. La mortalidad por suicidios registró un aumento de 8,0%, que luego de la corrección ascendió a 12,9%. Conclusiones. La corrección no modifica de manera sustantiva la tendencia de la mortalidad por causas externas, aunque tiene mayor impacto en la mortalidad por homicidios y suicidios, elevándola.
Publisher: Pan American Health Organization
Date: 22-02-2021
DOI: 10.26633/RPSP.2021.7
Abstract: Objectives. To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. Methods. A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. Results. Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. Conclusions. The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2015
DOI: 10.1038/JHH.2014.71
Abstract: Vascular calcification and cardiovascular diseases have been associated with altered bone metabolism. We explored the relationships of arterial pressures and carotid intima-media thickness (CIMT) with parathyroid hormone, 25-hydroxycholecalciferol and their ratio (PTH:25(OH)D3) as well as a marker of bone resorption (CTX) in lean and overweight/obese African women. A population of 434 African women older than 46 years was ided into lean and overweight/obese groups. We assessed brachial blood pressure, central pulse pressure (cPP) and CIMT, and determined PTH, 25(OH)D3 and CTX concentrations. Overweight/obese women had elevated PTH and PTH:25(OH)D3 compared with lean women (both P<0.001), whereas lean women had higher CTX (P<0.001). Single, partial and multiple regression analyses indicated that, in lean women CIMT was independently associated with PTH:25(OH)D3 (R(2)=0.22 β=0.26 P=0.003), whereas in obese women cPP was associated with both PTH:25(OH)D3 (R2=0.20 β=0.17 P=0.017) and CTX (R2=0.20 β=0.17 P=0.025). In conclusion, we found that in African women with increased adiposity, cPP (as a surrogate measure of arterial stiffness), was positively associated with alterations in bone metabolism and calciotropic hormones, whereas CIMT of lean women was positively associated with PTH:25(OH)D3. Our results suggest that alterations in bone and calcium metabolism may contribute to arterial calcification in older African women.
Publisher: Informa UK Limited
Date: 28-09-2020
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.HLC.2016.11.010
Abstract: Hypertensive heart disease is a rising concern, especially among black South African women. As high sensitivity cardiac troponin T (cTnT) is a marker of cardiomyocyte damage, we determined the potential link of (i) systemic endothelial dysfunction (reflected by urinary albumin-to-creatinine ratio), (ii) large artery stiffness, (iii) cardiac volume load (estimated by the N-terminal prohormone B-type natriuretic peptide (Nt-proBNP)), and (iv) ECG left ventricular hypertrophy in post-menopausal black women. In 121 (50 normotensive and 71 hypertensive) black women (mean age: 60.6 years), basic cardiovascular assessments including blood pressure and ECG were performed, along with plasma and urinary biomarkers including cTnT. The cTnT levels (p=0.049) along with Nt-proBNP (p=0.003), pulse pressure (p<0.0001) and the Cornell product (p=0.030) were higher in hypertensive than normotensive women. Only in hypertensive women, was cTnT independently associated with urinary albumin-to-creatinine ratio (β=0.25 p=0.019), pulse pressure (β=0.31 p=0.019), Nt-proBNP (β=0.47 p<0.0001) and Cornell product (β=0.31 p=0.018). An independent association between albumin-to-creatinine ratio and cTnT was also evident in normotensive women (β=0.34 p=0.037). We found cTnT to be a useful marker in an elderly black population relating to several measures of cardiovascular deterioration - from subclinical endothelial dysfunction to left ventricular hypertrophy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-03-2021
DOI: 10.1161/HYPERTENSIONAHA.120.16625
Abstract: High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.
Publisher: Elsevier BV
Date: 11-2017
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.HLC.2018.07.003
Abstract: It is well established that an exaggerated morning blood pressure surge (MBPS) is associated with an increased risk for cardiovascular disease development in hypertensive in iduals. However, in non-dipping in iduals, a lower surge was reportedly associated with increased cardiovascular risk. Sympathetic nervous system activity is involved in 24-hour blood pressure fluctuations, including night-time dipping and the MBPS. To better understand this interaction, we investigated associations of MBPS with heart-rate variability and baroreceptor sensitivity in young healthy dippers and non-dippers. We included black and white men and women (n=827), aged 20-30 years and determined the MBPS using two formulas: the sleep-trough and dynamic morning surge. For autonomic function we determined baroreceptor sensitivity and heart-rate variability. The majority of non-dippers in this population were black (70.4%), presenting lower sleep-trough and dynamic morning surge (all p<0.001). Heart-rate variability was comparable between dippers and non-dippers, whereas baroreceptor sensitivity was higher in non-dippers (p=0.021). Despite a suppressed MBPS profile in non-dippers, we found both sleep-trough (β=-0.25 p=0.039) and dynamic morning surge (β=-0.14 p=0.047) to be inversely and independently associated with 24-hour heart-rate variability (total power). These results were absent in dippers. In conclusion, we found a higher night-time blood pressure coupled with lower MBPS in young healthy non-dippers. Furthermore, this lower MBPS was independently and negatively associated with autonomic neural activity, suggesting increased autonomic function involvement in MBPS suppression of non-dippers. The predictive value of suppressed nocturnal dipping pattern should be investigated while taking autonomic neural activity into account.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.HLC.2022.01.010
Abstract: Single-pill combination (SPC) therapy is recommended as first-line therapy for most patients in global hypertension guidelines due to benefits of improved adherence and blood pressure (BP) control. We aimed to understand factors affecting SPC use in the management of raised BP in Australia. A mixed-method study comprising of qualitative (policy review and interviews) and quantitative (Pharmaceutical Benefits Scheme [PBS] data) approaches. Australian and international hypertension guideline recommendations regarding SPC use the Australian registration and subsidy approval processes of SPCs use of SPCs on the PBS cost-analysis of PBS-listed SPCs compared to free-drug combinations perceptions of healthcare providers towards SPCs. The 2016 Australian Heart Foundation's "Guideline for the diagnosis and management of hypertension in adults" does not recommend combination therapy (including SPCs) as first-line treatment. Additional challenges in the uptake of SPCs include: (1) the additional PBS requirements and barriers imposed for the listing of SPCs. (2) Script volumes for SPCs have not matched the rise in the number of SPCs listed for subsidy, have plateaued since 2016 and remained significantly lower than single constituent scripts. (3) SPCs are not subsidised by the PBS for initial treatment. Most SPCs provided substantial cost savings for in idual patients compared to free-drug combinations. Health care providers were positive about the cost-saving and convenience of SPCs, however perceived negatives included inflexibility of SPCs during dose titration, medicine shortages, and potential adverse effects when initiating treatment with multiple drugs. The safety, efficacy and cost-saving potential of SPCs have been established in the literature but several roadblocks in the existing health system in Australia impede uptake. Interventions addressing these barriers may facilitate improved uptake, which may in turn improve blood pressure control in Australia.
Publisher: Ubiquity Press, Ltd.
Date: 23-02-2022
DOI: 10.5334/GH.1103
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-06-2023
Publisher: Wiley
Date: 22-05-2014
DOI: 10.1111/ECI.12278
Abstract: Soluble urokinase plasminogen activator receptor (suPAR), a novel indicator of low-grade inflammation, is associated with cardiovascular disease and mortality in the general population, while an unhealthy lifestyle influences inflammatory status. We aimed to explore the relationship of suPAR with lifestyle and cardiometabolic risk factors in a black South African population. This cross-sectional study includes 1068 men and women (56·4 ± 10·1 years) from the North West province who took part in the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study in 2010. Captured data included a detailed lifestyle profile (tobacco use, alcohol consumption, physical activity, psychological and dietary intake status), biochemical analyses (suPAR, C-reactive protein (CRP), glucose and lipids), as well as cardiovascular and anthropometric measurements. In exploratory analyses, we observed positive relationships between suPAR and lifestyle factors, such as tobacco use (P-trend < 0·001), both alcohol consumption (P-trend = 0·001) and γ-glutamyl transferase (GGT) (P-trend < 0·001) and unemployment (P-trend = 0·002). suPAR and CRP correlated significantly (r = 0·23 P < 0·001). These relationships were confirmed in multiple regression analyses as suPAR independently associated with tobacco use (β = 0·13 P < 0·001), GGT (β = 0·24 P < 0·001) and unemployment (β = 0·07 P = 0·039). suPAR did not associate with the cardiometabolic factors glucose, lipids, blood pressure or measures of adiposity. suPAR was independently associated with unhealthy lifestyle behaviours, but not with cardiometabolic risk factors suggesting that suPAR, as known predictor of cardiovascular disease and mortality, is augmented by modifiable cardiovascular risk factors. These findings emphasise the need for a healthy lifestyle to decrease the burden of cardiovascular disease in Africans.
Publisher: Elsevier BV
Date: 12-2020
Publisher: American Medical Association (AMA)
Date: 15-02-2022
Publisher: Oxford University Press (OUP)
Date: 06-2006
DOI: 10.1016/J.AMJHYPER.2005.12.014
Abstract: Impaired baroreflex sensitivity (BRS) is associated with cardiovascular diseases and the metabolic syndrome. Because lipid abnormalities have been associated with impaired BRS, this study aimed to determine whether diets known to improve the lipid profile, namely a diet high in polyunsaturated fatty acids (walnuts) or monounsaturated fatty acids (cashew nuts), would improve BRS in subjects with metabolic syndrome (MS). A controlled feeding trial with a randomized, controlled, parallel study design was undertaken, which involved 62 subjects with MS. Subjects were stratified according to gender and age and were randomized into three groups receiving a control diet, or a diet high (20% energy) in walnuts or unsalted cashew nuts for 8 weeks while maintaining body weight. The BRS, C-reactive protein (CRP), and MS components were measured before and after the intervention. After the intervention, BRS in the walnut-fed study group decreased (P = .038) and that in the cashew-fed study group increased (P = .036), but the BRS in the control group did not change (P = .56). The percent change of the walnut versus cashew group differed (P = .019). Body mass index, waist circumference, blood pressure, high-density lipoprotein cholesterol, and triacylglycerol did not change. The fasting glucose concentrations of the cashew group increased (P = .03). The significant improvements in BRS obtained by a diet rich in cashew nuts underline the beneficial cardiovascular effects of nuts. However, the opposite result was obtained with a diet rich in walnuts. These significant changes observed might indicate that BRS is particularly sensitive and influenced by changes in diet without changes in obesity.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.DIABRES.2018.05.048
Abstract: Black populations from sub-Saharan Africa have a high prevalence of cardiovascular disease, which places significant strain on public health systems. Aortic stiffness is a prominent risk factor for cardiovascular disease development. We reported earlier that excessive alcohol use predicts aortic stiffness. However, we require a better understanding of other biomarkers involved in stiffness development, beyond alcohol use. Therefore, we determined which biomarkers (metabolic, inflammatory, endothelial activation and oxidative stress) relate to aortic stiffness in young and older black South Africans, self-reporting no alcohol-use. We included cross-sectional data from young (aged 24.7 ± 3.24 years) black adults participating in the African Prospective study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study (N = 216), and five-year follow-up data from older (aged 61.6 ± 9.77 years) black adults (N = 322) participating in the South African leg of the Prospective Urban and Rural Epidemiology study, conducted in the North West Province (PURE-SA-NWP). We excluded all participants self-reporting alcohol use. We determined biomarkers from blood s les, and measured carotid-femoral pulse wave velocity (PWV). Of all biomarkers investigated in multivariable-adjusted regression analyses, only plasma glucose (R Dysglycaemia independently predicted aortic stiffness after five years in older black adults. Life-course management of body weight and sugar intake are important in preventing early vascular ageing and subsequent cardiovascular disease development in Africa.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.HLC.2011.10.009
Abstract: This study compared NT-proBNP levels and the association with cardiovascular markers between Africans and Caucasians from South Africa. This cross-sectional study involved 201 Africans and 255 Caucasians from the North West province, South Africa. Serum NT-proBNP concentrations, blood pressure, pulse wave velocity and arterial compliance were measured. NT-proBNP levels were significantly higher (P<0.001) in Africans than Caucasians, also after adjusting for gender, body mass index (BMI) and pulse wave velocity (P=0.008). This significant difference became borderline significant after adjusting for systolic blood pressure (SBP) (P=0.060), and non-significant after adjusting for arterial compliance (P=0.35). In single regression, a significant positive correlation of NT-proBNP with SBP (r=0.26 P<0.001) and pulse pressure (PP) (r=0.28 P<0.001) were shown for Africans only. After multiple adjustments, the associations of NT-proBNP with SBP and PP remained significant in Africans (SBP: β=0.187, P<0.01 PP: β=0.234, P<0.001), with no significant associations in Caucasians. NT-proBNP levels were higher in Africans than Caucasians, independently of BMI and gender. This difference was partly driven by higher SBP and lower arterial compliance in Africans. NT-proBNP was persistently associated with SBP and PP in Africans, but not in Caucasians. These associations may suggest early vascular changes contributing to cardiac alterations in Africans.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2017
DOI: 10.1038/JHH.2017.18
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
Publisher: MDPI AG
Date: 28-04-2021
Abstract: Sub-Saharan African (SSA) migrants face nutrition and lifestyle changes upon arrival in a host country. The shift in diet and lifestyle reflects post-migration acculturation and could predispose migrants to nutrition- and lifestyle- related chronic diseases. A mixed-methods systematic review of published studies and the grey literature on post-migration nutrition and lifestyle transition among SSA migrants will be undertaken. Studies published in English and conducted from 2000 to 2020 using quantitative and/or qualitative methods will be included. Ten bibliographic databases will be searched: Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, PubMed, ProQuest, PsycINFO, Informit and Web of Science. Data extraction will be informed by the Cochrane PROGRESS-Plus framework and the Joanna Briggs Institute manual. The quality of the included studies will be appraised for risk of bias using validated tools. An integrated approach to quantitative and qualitative data synthesis through data transformation will be undertaken, and a narrative synthesis of the findings will be provided. This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and provides insight into the scope and parameters of the systematic review to be conducted. The aim of the review is to evaluate the association between post-migration nutrition and lifestyle transition and the risk of developing chronic diseases among SSA migrants in Australia. This review will provide insight into possible areas for interventions to improve the health of migrants. Systematic Review Registration: The protocol was registered with the PROSPERO international prospective register of systematic reviews CRD42020206560.
Publisher: Informa UK Limited
Date: 20-06-2014
DOI: 10.3109/10641963.2013.789044
Abstract: The purpose of this study was to evaluate whether active renin concentration is associated with markers of end-organ damage in urbanized Africans. This study forms part of the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study. For this study, 81 men and 74 women were ided into low- and high-renin groups. Ambulatory blood pressure measurements were conducted. A resting 12-lead ECG was determined in order to determine the gender-specific Cornell voltage. Cardiovascular variables were continuously recorded with the Finometer. Carotid-dorsalis pedis pulse wave velocity was obtained with the Complior acquisition system. The carotid intima-media thickness (CIMT) was obtained with the SonoSite MicroMaxx. Blood s les were collected serum and plasma were stored at -80 °C for analysis. Anthropometric measurements were taken using standard methods. A general health questionnaire was also completed. The urinary creatinine was determined with a calorimetric method and albumin with a turbidimetric method. The serum sodium and potassium were determined by making use of the Konelab TM 20i Sequential Multiple Analyzer Computer (SMAC). The concentration of active renin in the plasma was analyzed by making use of a high-sensitivity radio-immunometric assay. A negative association (r=-0.29, p<0.01) exists between renal function (ACR) and plasma renin in the low-renin group (<6.18 pg/mL), which was not observed in Africans with high-renin levels. It seems evident that low renin in black South Africans may result in sub-clinical renal damage and impaired vascular function in a group of urbanized black South Africans.
Publisher: Oxford University Press (OUP)
Date: 19-04-2017
DOI: 10.1093/AJH/HPX061
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2020
Publisher: The Endocrine Society
Date: 03-2009
DOI: 10.1210/JC.2007-2427
Abstract: Objective: The Finnish Diabetes Risk Score (FINDRISC) questionnaire is a practical screening tool to estimate the diabetes risk and the probability of asymptomatic type 2 diabetes. In this study we evaluated the usefulness of the FINDRISC to predict insulin resistance in a population at increased diabetes risk. Design: Data of 771 and 526 participants in a cross-sectional survey (1996) and a cohort study (1997–2000), respectively, were used for the analysis. Data on the FINDRISC and oral glucose tolerance test parameters were available from each participant. The predictive value of the FINDRISC was cross-sectionally evaluated using the area under the curve-receiver operating characteristics method and by correlation analyses. A validation of the cross-sectional results was performed on the prospective data from the cohort study. Results: The FINDRISC was significantly correlated with markers of insulin resistance. The receiver operating characteristics-area under the curve for the prediction of a homeostasis model assessment insulin resistance index of more than five was 0.78 in the cross-sectional survey and 0.74 at baseline of the cohort study. Moreover, the FINDRISC at baseline was significantly associated with disease evolution (P & 0.01), which was defined as the change of glucose tolerance during the 3 yr follow-up. Conclusions: The results indicate that the FINDRISC can be applied to detect insulin resistance in a population at high risk for type 2 diabetes and predict future impairment of glucose tolerance.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.ATHEROSCLEROSIS.2015.03.015
Abstract: The role the human immunodeficiency virus (HIV) and antiretroviral treatment on endothelial activation, and the subsequent relationship with cardiovascular disease, is not well understood. We investigated endothelial activation, inflammatory and cardiometabolic profiles, and measures of vascular structure and function of 66 antiretroviral treated (ART), 78 never-treated (no-ART) HIV infected and 165 HIV free Africans. Blood s les were obtained for biochemical analysis and blood pressure, pulse wave velocity (PWV) and carotid intima-media thickness (IMT) measurements were performed. The HIV infection duration was at least five years and the treatment 2.86±0.13 years. The intracellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) levels were elevated in the HIV infected groups compared to the controls. The odds of higher adhesion molecule levels were increased when HIV infected (especially in the no-ART group) OR no-ART vs. no-HIV: ICAM 3.92 (2.2-7.0) VCAM 16.2 (7.5-35). ICAM and VCAM associated with HIV status and interleukin-6 (IL-6) in the total group (all p<0.01). In both HIV infected groups VCAM associated inversely with CD4 counts (no-ART: β=-0.28, p=0.01 ART: β=-0.22, p=0.07) and TC (no-ART: β=-0.36, p<0.01 ART: β=-0.27, p=0.03). The ART group had an unfavourable lipid profile compared to the no-ART group. The inflammatory markers (C-reactive protein (CRP) and IL-6), PWV and IMT did not differ between the three groups. HIV infected Africans showed endothelial activation when compared to HIV free controls. The endothelial activation was not accompanied by increased inflammation (as measured with CRP and IL-6), arterial stiffness or sub-clinical atherosclerosis.
Publisher: Oxford University Press (OUP)
Date: 04-06-2017
DOI: 10.1093/IJE/DYX078
Publisher: Springer Science and Business Media LLC
Date: 05-2003
Publisher: Springer Science and Business Media LLC
Date: 04-2020
Publisher: Elsevier BV
Date: 10-2017
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/J.NUT.2004.09.010
Abstract: First, we wanted to dispel the myth that avocados are fattening and therefore should be avoided in energy-restricted diets. Second, we examined the effects of avocados, a rich source of monounsaturated fatty acids, as part of an energy-restricted diet on weight loss, serum lipids, fibrinogen, and vascular function in overweight and obese subjects. Sixty-one free-living volunteers (13 men and 48 women), with body mass index of 32 +/- 3.9 kg/m(2) (mean +/- standard deviation) participated in this randomized, controlled, parallel study. Subjects were paired and randomly assigned to one of two groups. The experimental group consumed 200 g/d of avocado (30.6 g of fat), which substituted for 30 g of other mixed dietary fats such as margarine or oil, and the control group excluded avocado from their energy-restricted diet for 6 wk. Seven-day isoenergetic menus were planned according to mean energy requirements of both sexes to provide total energy intakes consisting of 30% fat, 55% carbohydrates, and 15% protein. Anthropometric measurements, physical activity, blood pressure, and arterial compliance were measured with standard methods at the beginning and end of the intervention. Fasting blood s les were drawn at the beginning and end of the intervention. Fifty-five subjects completed the study. The compliance rate to avocado intake in the experimental group was 94.6%. The percentage of plasma oleic acid increased significantly with the consumption of avocado in the experimental group, whereas a decrease was seen in the percentage of myristic acid from baseline to the end of the intervention in both groups but was significant only in the experimental group. Anthropometric measurements (body mass, body mass index, and percentage of body fat) decreased significantly in both groups during the study (P < 0.001), and the change was similar in both groups. Serum lipid concentrations (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triacylglycerols), fibrinogen, blood pressure, and arterial compliance did not change significantly within or between groups. The consumption of 200 g/d of avocado within an energy-restricted diet does not compromise weight loss when substituted for 30 g of mixed dietary fat. Serum lipid concentrations, plasma fibrinogen, arterial compliance, and systolic and diastolic blood pressures were not affected by weight loss or avocado intake.
Publisher: Springer Science and Business Media LLC
Date: 05-03-2015
DOI: 10.1038/HR.2015.28
Abstract: The relationship between obesity and the development of cardiovascular disease is well established. However, the underlying mechanisms contributing to vascular disease and increased cardiovascular risk in the obese remain largely unexplored. Since leptin exerts direct vascular effects, we investigated leptin and the relationship thereof with circulating markers of vascular damage, namely plasminogen activator inhibitor-1 antigen (PAI-1(ag)), von Willebrand factor antigen (vWF(ag)) and urinary albumin-to-creatinine ratio (ACR). The study included a bi-ethnic population of 409 African and Caucasian teachers who were stratified into lean (<0.5) and obese (⩾0.5) groups according to waist-to-height ratio. We obtained ambulatory blood pressure measurements and determined serum leptin levels, PAI-1(ag), vWF(ag) and ACR, as markers of vascular damage. The obese group had higher leptin (P<0.001) and PAI-1(ag) (P<0.001) levels and a tendency existed for higher vWF(ag) (P=0.068). ACR did not differ between the two groups (P=0.21). In single regression analyses positive associations existed between leptin and all markers of vascular damage (all P<0.001) only in the obese group. After adjusting for covariates and confounders in multiple regression analyses, only the association between leptin and PAI-1(ag) remained (R(2)=0.440 β=0.293 P=0.0021). After adjusting for gender, ethnicity and age, additional analyses indicated that leptin also associated with fibrinogen and clot lysis time in both lean and obese groups, which in turn is associated with 24- h blood pressure and pulse pressure. This result provides evidence that elevated circulating leptin may directly contribute to vascular damage, possibly through mechanism related to thrombotic vascular disease.
Publisher: Springer Science and Business Media LLC
Date: 05-2019
Publisher: Elsevier BV
Date: 05-2023
Publisher: Wiley
Date: 12-2009
DOI: 10.1038/OBY.2009.157
Abstract: Sub-Saharan Africa is afflicted by high hypertension prevalence that is expected to rise even further along with increasing obesity rates. The present study aimed to investigate the role of visfatin in obesity and to explore associations of visfatin with markers of endothelial function and hemodynamics in African women compared to a well-matched white s le. The present study involved urban African (n = 102) and white (n = 115) women from South Africa, in idually matched for age and BMI. We measured blood pressure, cardiac output, and arterial compliance noninvasively, and analyzed visfatin as well as circulating markers of vascular function and inflammation in serum. Serum visfatin concentration did not differ between African and white women. Visfatin was unrelated to obesity in African women but positive associations for total and abdominal obesity were found in white women. Age- and obesity-adjusted univariate and multivariate analyses revealed significant positive associations of visfatin with endothelin-1 and fibrinogen in African women. Identical analyses in white women indicated a positive association of visfatin with C-reactive protein and von Willebrand factor. Our findings suggest a possible role of visfatin in the cardiovascular system that seems to be independent of obesity in the African women.
Publisher: Springer Science and Business Media LLC
Date: 05-03-2015
DOI: 10.1038/HR.2015.22
Abstract: Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker that links inflammation with cardiovascular risk. However, studies linking suPAR and hypertension are scant. First, we determined whether baseline suPAR is elevated in normotensive black South Africans who developed hypertension over 5 years, compared with those who remained normotensive and second, whether hypertension is associated with suPAR. This substudy is embedded in the South African leg of the Prospective Urban and Rural Epidemiology study, performed in the North West Province. We investigated 429 normotensive in iduals, of which 191 developed hypertension and 238 remained normotensive over 5 years. We determined suPAR from plasma (ethylenediaminetetraacetic acid) s les with the suPARnostic ELISA Kit and blood pressure with an OMRON HEM-757 device. Despite similar mean baseline suPAR levels (P=0.43), suPAR increased more in the group that developed hypertension compared with those who remained normotensive (14.2% vs. 6.94% P=0.007). Five-year percentage change in systolic blood pressure correlated positively (r=0.23 P=0.002) and associated independently with baseline suPAR (β=0.14 P=0.043), only in participants who developed hypertension. Participants were 1.41 times more likely (P=0.015) to develop hypertension with 1 s.d. increase in percentage change in suPAR levels over 5 years. Change in systolic blood pressure was associated with baseline suPAR in hypertensive participants and change in suPAR with hypertensive status. This study highlights the need for more research on the role of suPAR in hypertension and cardiovascular disease development in black South Africans.
Publisher: Oxford University Press (OUP)
Date: 06-01-2019
Abstract: 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 in idual-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. 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 s ling 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 in iduals. The prospective African-PREDICT study in young black and white adults will contribute to a clear understanding of early cardiovascular disease development.
Publisher: Elsevier BV
Date: 07-2017
Publisher: Springer Science and Business Media LLC
Date: 30-08-2012
DOI: 10.1038/HR.2012.130
Abstract: Hypertension and obesity are serious health burdens in sub-Saharan Africa. Urbanized Africans seem to be more susceptible to the development of these diseases than Caucasians. Current research suggests that leptin may be an important contributor to the development of hypertension and atherosclerosis. The aim of this study was to investigate leptin levels and their associations with cardiovascular function in urbanized Africans and Caucasians. Serum leptin, ambulatory blood pressure and carotid intima-media thickness were measured, and the cross-sectional wall area (CSWA) was calculated. The results showed that Africans had higher leptin levels (P<0.001), ambulatory blood pressure (P<0.001), carotid intima-media thickness (P<0.01) and CSWA (P<0.01) than Caucasians. As we found no interaction between ethnicity and gender for the association between leptin and the cardiovascular variables, we focused mainly on the total group of Africans and Caucasians. In single, partial and multiple regression analyses, positive associations of ambulatory systolic blood pressure (β=0.256 P<0.001), diastolic blood pressure (β=0.143 P=0.012), pulse pressure (β=0.327 P<0.001) and CSWA (β=0.107 P=0.038) with leptin were observed. Even after adjusting for body mass index (BMI), the association between CSWA (β=0.107 P=0.038) and leptin remained. Our findings therefore suggest that leptin may contribute to the development of atherosclerosis, independent of BMI.
Publisher: Massachusetts Medical Society
Date: 20-12-2018
Publisher: Informa UK Limited
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2012
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.CPCARDIOL.2017.03.001
Abstract: Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99mmHg) with low (cardiovascular mortality <1% at 10 years) to moderate (cardiovascular mortality ≥1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged <80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only lifestyle measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 "isolated" hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2) The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥55 years and women ≥60 years with uncomplicated grade 1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 22-03-2021
DOI: 10.1038/S41366-021-00803-8
Abstract: Circulating growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine that increases in older in iduals with established cardiovascular disease (CVD) and obesity. To address potential targets in primary prevention, we aimed to determine whether body weight, waist circumference, waist/height ratio, body mass index (BMI), body surface area (BSA) and leptin associate with GDF-15 in young underweight, lean and overweight/obese (ow/ob) adults. We included 1189 adults aged 20-30 years. We grouped participants as underweight (BMI ≤ 18 kg/m Our findings may suggest that in young adults with either underweight or excess adiposity, increased GDF-15 levels may contribute to the development of future cardiovascular health risks associated with pro-inflammation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2019
Publisher: Springer Science and Business Media LLC
Date: 17-07-2020
DOI: 10.1038/S41440-020-0514-1
Abstract: Hypertension is common in black populations and is known to be associated with low nitric oxide (NO) bioavailability. We compared plasma and urinary NO-related markers and plasma creatine kinase (CK) levels between young healthy black and white adults along with the associations of these markers with the urinary albumin-to-creatinine ratio (uACR), which is a surrogate marker of endothelial and kidney function. We included 1105 participants (20-30 years). We measured the uACR, plasma CK, plasma and urinary arginine, homoarginine, asymmetric (ADMA) and symmetric dimethylarginine (SDMA), urinary ornithine/citrulline, nitrate and nitrite, and malondialdehyde (MDA). In addition, the urinary nitrate-to-nitrite ratio (U
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Publisher: Springer Science and Business Media LLC
Date: 27-01-2011
DOI: 10.1038/JHH.2010.134
Abstract: Many mechanisms, including oxidative stress, contribute to hypertension. This study investigated the possible associations between oxidative stress, blood pressure and arterial stiffness in black South Africans. Ambulatory blood pressure measurements were taken for 101 black South African men and 99 women. The stiffness indices included ambulatory arterial stiffness index (AASI) and pulse pressure (PP). Reactive oxygen species (ROS) levels (P<0.0001) were higher in the African women compared with men. ROS levels were also higher in hypertensive compared with normotensive men. The 24 h systolic blood pressure (SBP P<0.01), 24 h diastolic blood pressure (DBP P<0.0001) and pulse wave velocity (PWV P<0.01) were significantly higher in African men compared with women. There were unadjusted positive associations of 24 h SBP (r=0.33 P=0.001), 24 h DBP (r=0.26 P=0.008) and 24 h PP (r=0.29 P=0.003) with ROS in African men only. A positive association between AASI and ROS existed only in hypertensive men (r=0.27 P=0.035), but became nonsignificant (B=0.0014 P=0.14) after adjustments. Adjusted, positive associations of 24 h SBP (B=0.181 P=0.018) and 24 h PP (B=0.086 P=0.050) with ROS were again only evident in African men. ROS is positively associated with SBP and PP in African men, suggesting that increased ROS levels may contribute to hypertension in this population group.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.AHJ.2022.06.007
Abstract: High dietary sodium intake is a leading cause of hypertension. A major source of dietary sodium is salt added to processed food products available in retail food environments. The fast-growing online grocery shopping setting provides new opportunities for salt reduction interventions that support consumers in choosing healthier options. The SaltSwitch Online Grocery Shopping randomized controlled trial is investigating the feasibility, acceptability, and effectiveness of a novel intervention for lowering salt consumption and blood pressure amongst people with hypertension who shop for groceries online. The intervention is based on a bespoke web browser extension that interfaces with a major retailer's online store to highlight and interpret product sodium content and suggest similar but lower-sodium alternatives. The primary outcome of interest is change in mean systolic blood pressure between in iduals randomized (1:1) to the intervention and control (usual online shopping) arms at 12 weeks. Secondary outcomes are diastolic blood pressure, spot urinary sodium and sodium:potassium ratio, sodium purchases, and dietary intake. Intervention implementation and lessons for future uptake will be assessed using a mixed methods process evaluation. Participants with hypertension who shop online for groceries and exhibit high sodium purchasing behavior are being recruited across Australia. A target s le size of 1,966 provides 80% power (2-sided alpha = 0.05) to detect a 2 mm Hg difference in systolic blood pressure between groups, assuming a 15 mm Hg standard deviation, after allowing for a 10% dropout rate. This trial will provide evidence on an innovative intervention to potentially reduce salt intake and blood pressure in people with hypertension. The intervention caters to in idual preferences by encouraging sustainable switches to similar but lower-salt products. If effective, the intervention will be readily scalable at low cost by interfacing with existing online retail environments.
Publisher: Springer Science and Business Media LLC
Date: 27-08-2016
DOI: 10.1038/JHH.2015.88
Abstract: Low plasma renin levels and augmented cardiovascular reactivity to stress are common in blacks and have been linked to the development of hypertension in this population. We (i) compared cardiovascular and plasma renin reactivity to a cold pressor test between a black and white population and (ii) investigated the associations between cardiovascular and plasma renin reactivity within the black and white populations. Our population consisted of 153 black and 188 white men and women (age range, 20-65 years). We measured blood pressure (BP), heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), Windkessel arterial compliance, and determined plasma renin levels at rest and during the cold pressor test. Reactivity was calculated for each participant as the percentage change from the resting value. We found lower renin and elevated BP in blacks compared with whites at rest and during stress (both, P<0.001). During stress, HR increased more in blacks (P<0.001), whereas SV (P<0.001) and arterial compliance (P=0.013) decreased more in blacks compared with whites. TPR reactivity was positively associated with renin reactivity in blacks only (β=0.17 P=0.041), while in whites diastolic BP reactivity was positively associated with renin reactivity (β=0.21 P=0.005). Although blacks had suppressed renin levels at rest and during acute stress, vascular resistance reactivity associated positively with renin reactivity only in the black population. These results suggest that low renin levels in blacks during rest and stress are linked to increased peripheral vascular responses to stress, which may contribute to elevated BP in blacks.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CYTO.2019.154894
Abstract: Inflammatory mediators have been implicated in the early stages of cardiovascular disease development, including hypertension. Since global reports reflect a higher hypertension prevalence in black than white populations, we hypothesise the involvement of specific inflammatory mediators. We therefore compared a detailed range of 22 inflammatory mediators between young black and white adults, and determined the relationship with blood pressure. We included 1197 adults (20-30 years 50% black 52% female) with detailed ambulatory blood pressures. Blood s les were analysed for 22 inflammatory mediators. For pro-inflammatory mediators, the black adults had higher C-reactive protein, interferon-inducible T-cell alpha chemoattractant, macrophage inflammatory protein 3 alpha (all p ≤ 0.008), but lower interferon-gamma, interleukin (IL)-1β, IL-8, IL-12, IL-17A, and tumour necrosis factor alpha (all p ≤ 0.048). For anti-inflammatory mediators the black group consistently had lower levels (IL-5, IL-10 and IL-13 (all p ≤ 0.012)), resulting in generally higher pro-to-anti-inflammatory ratios in black than white adults (p ≤ 0.001). In mediators with pro- and anti-inflammatory functions, the black group had lower granulocyte-macrophage colony-stimulating factor and IL-6 (both p ≤ 0.010). These patterns were confirmed after adjustment for age, sex and waist circumference, or when stratifying by hypertensive status, sex and socio-economic status. Multi-variable adjusted regression analyses and factor analysis yielded no relationship between inflammatory mediators and blood pressure in this young healthy population. Black and white ethnic groups each consistently presented with unique inflammatory mediator patterns regardless of blood pressure, sex or social class. No association with blood pressure was seen in either of the groups.
Publisher: Elsevier BV
Date: 02-2016
Publisher: Springer Science and Business Media LLC
Date: 16-11-2016
DOI: 10.1007/S00726-015-2128-5
Abstract: Nitric oxide (NO) synthesis capacity is determined by the availability of substrate(s) such as L-arginine and the influence of nitric oxide synthase (NOS) inhibitors, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). These factors may be important in black South Africans with a very high prevalence of hypertension. We compared ambulatory blood pressure (BP), markers of end organ damage and NO synthesis capacity markers [L-arginine, L-homoarginine, L-citrulline, L-arginine:ADMA, ADMA, SDMA and dimethylarginine (DMA)], between black and white teachers (n = 390). Associations of nighttime BP and markers of end organ damage with NO synthesis capacity markers were also investigated. Although black men and women had higher BP and albumin-to-creatinine ratio (ACR) (all p < 0.001), they also had higher L-arginine, L-homoarginine, L-arginine:ADMA and lower SDMA and DMA levels (all p < 0.05). Only in white men ADMA concentrations associated positively with nighttime systolic blood pressure (R (2) = 0.20, β = 0.26, p = 0.009), nighttime diastolic blood pressure (R (2) = 0.23, β = 0.27, p = 0.007), carotid intima media thickness (cIMT) (R (2) = 0.36, β = 0.22, p = 0.008) and ACR (R (2) = 0.14, β = 0.32, p = 0.001). Our findings suggest that despite an adverse cardiovascular profile in blacks, their NO synthesis capacity profile seems favourable, and that other factors, such as NO inactivation, may prove to be more important.
Publisher: MDPI AG
Date: 07-06-2018
DOI: 10.3390/NU10060736
Publisher: Elsevier BV
Date: 2022
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 07-2022
Publisher: Informa UK Limited
Date: 2005
DOI: 10.1080/08037050500210724
Abstract: Endothelin-1 (ET-1) has been found to be higher in hypertensive African Americans and obese hypertensive Caucasians compared to normotensive controls with an enhanced ET-1-dependent vasoconstrictor tone. ET-1 levels and the associations thereof with cardiovascular function in overweight/obese normotensive and hypertensive African women have not been investigated. It is therefore hypothesized that ET-1 levels are elevated in overweight/obese hypertensive African women compared to overweight/obese and lean normotensive controls. Additionally, it is hypothesized that these elevated ET-1 levels are associated with increased total peripheral resistance (TPR) and decreased arterial compliance (C(W)). A case-case control study was performed which included 98 African women. The subjects were ided into lean normotensive (lean NT), overweight/obese normotensive (OW/OB NT) and overweight/obese hypertensive (OW/OB HT). The Finometer apparatus was used to obtain a more elaborate cardiovascular profile and plasma immunoreactive ET-1 levels were determined. ET-1 levels were similar for the three groups. Although a decrease in vascular function was observed in the OW/OB HT group, no correlations were obtained between ET-1 and the cardiovascular profile, before and after adjusting for age. In African women, ET-1 levels did not differ between lean and overweight/obese and normotensive and hypertensive subjects. The lack of significant associations between ET-1 and decreased vascular function in the overweight/obese hypertensive group suggests that ET-1 is not implicated in obesity-related hypertension in African women.
Publisher: Wiley
Date: 05-05-2021
DOI: 10.1111/HIV.13111
Abstract: We aimed to determine whether people with human immunodeficiency virus (PWHIV) have increased measures of arterial injury [carotid intima‐media thickness (cIMT)] and large artery stiffness [carotid‐femoral pulse wave velocity (cfPWV)] when compared with their counterparts without HIV, and whether baseline markers of endothelial activation and cardiovascular risk are associated with cIMT and cfPWV after 5 years. We matched 126 PWHIV from North West Province, South Africa, to 126 without HIV according to age, sex and locality. Cardiovascular risk and endothelial function markers [soluble intracellular adhesion molecule (ICAM‐1) and soluble vascular cell adhesion molecule (VCAM‐1)] were measured at baseline and cIMT and cfPWV at follow‐up. This study included 21.4% men. The use of antiretroviral therapy (ART) increased from 44.1% at baseline to 81.4% at follow‐up. At follow‐up, cIMT ( P = 0.90) and cfPWV ( P = 0.35) were similar in the groups. Despite elevated ICAM‐1 and VCAM‐1 in the PWHIV (all P 0.001) at baseline, these markers did not associate with cIMT and cfPWV after 5 years. In multivariable‐adjusted regression analysis, cIMT associated positively with age ( β = 0.31, P = 0.002) and triglyceride: high‐density lipoprotein‐cholesterol ( β = 0.23, P = 0.016) in PWHIV. Mean arterial pressure (MAP) ( β = 0.28, P = 0.010) associated positively with cfPWV in the PWHIV. In the people without HIV, sex ( β = 0.31, P = 0.004) and glycated haemoglobin (HbA1c) ( β = 0.24, P = 0.026) associated with cIMT while age ( β = 0.17, P = 0.049), sex ( β = 0.29, P = 0.003), MAP ( β = 0.31, P = 0.001) and HbA1c ( β = 0.21, P = 0.041) associated positively with cfPWV. Measures of arterial structure and function were similar in Africans with HIV and their age, sex and locality matched controls. Traditional cardiovascular risk markers rather than elevated endothelial activation at baseline were independently associated with cIMT and cfPWV over 5 years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Elsevier BV
Date: 08-2022
Publisher: Oxford University Press (OUP)
Date: 18-10-2020
Publisher: Wiley
Date: 03-04-2023
Abstract: Hypertension is one of the most important and complex risk factors for cardiovascular diseases (CVDs). By using urinary peptidomics analyses, we aimed to identify peptides associated with hypertension, building a framework for future research towards improved prediction and prevention of premature development of CVD. We included 78 hypertensive and 79 normotensive participants from the African‐PREDICT study (aged 20–30 years), matched for sex (51% male) and ethnicity (49% black and 51% white). Urinary peptidomics data were acquired using capillary‐electrophoresis‐time‐of‐flight‐mass‐spectrometry. Hypertension‐associated peptides were identified and combined into a support vector machine‐based multidimensional classifier. When comparing the peptide data between the normotensive and hypertensive groups, 129 peptides were nominally differentially abundant (Wilcoxon p 0.05). Nonetheless, only three peptides, all derived from collagen alpha‐1(III), remained significantly different after rigorous adjustments for multiple comparisons. The 37 most significant peptides (all p ≤ 0.001) served as basis for the development of a classifier, with 20 peptides being combined into a unifying score, resulting in an AUC of 0.85 in the ROC analysis ( p 0.001), with 83% sensitivity at 80% specificity. Our study suggests potential value of urinary peptides in the classification of hypertension, which could enable earlier diagnosis and better understanding of the pathophysiology of hypertension and premature cardiovascular disease development.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Public Library of Science (PLoS)
Date: 13-03-2013
Publisher: Oxford University Press (OUP)
Date: 19-03-2018
DOI: 10.1093/IJE/DYY016
Publisher: Oxford University Press (OUP)
Date: 03-2010
DOI: 10.1530/EJE-09-0865
Abstract: Alarming increases in hypertension and type 2 diabetes among Africans accentuate the need to identify factors that could serve as targets for prevention or treatment. In Caucasian populations, asymmetric dimethylarginine (ADMA), the predominant endogenous nitric oxide synthase inhibitor, is associated with cardiovascular disease and insulin resistance (IR). ADMA's counterpart, symmetric dimethylarginine (SDMA), originally thought to be inert, was recently also linked with cardiovascular risk. Since little information regarding ADMA or SDMA is available for Africans, our aim was to explore the relationships of ADMA and SDMA with measures of arterial stiffness and IR in Africans and Caucasians from South Africa. The study consisted of 235 nonsmoking, nondiabetic, nonobese, human immunodeficiency virus-uninfected Africans ( n =64) and Caucasians ( n =171), aged 20–70 years. We measured blood pressure, pulse wave velocity, ADMA, SDMA, and IR (homeostasis model assessment, HOMA). African and Caucasian men had similar ADMA and SDMA, whereas Caucasian women had higher ADMA and SDMA than African women ( P .05). African men and Caucasian women indicated strong correlations of ADMA with arterial stiffness ( r =0.47, P =0.021 r =0.26, P =0.008), confirmed in multivariate analyses. Caucasian participants showed negative associations between SDMA and HOMA, being strongest in the men ( r =−0.41 P =0.002). Our results indicate that ADMA is independently associated with vascular dysfunction in African men and Caucasian women. A strong, independent negative association of SDMA with IR was found only in Caucasian participants. The molecular explanation for this is unclear, but these findings motivate experimental studies that could shed more light on these relationships.
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1016/J.DIABRES.2005.09.008
Abstract: Even though conclusive findings regarding the relationship between insulin and blood pressure (BP) have been made, several papers still report on finding weak or non-existing relationships in various population groups. These relationships are often weak, depend on the characteristics of the study population and are usually strongly confounded by obesity and age. Subsequently many investigators adjust via statistical methods for age and measures of obesity (such as body mass index). In the present study four different datasets were used (Australian Aboriginal people (N=675), Torres Strait Islanders (N=369), African women (N=94) and Caucasian women (N=112)) and showed very weak correlations in all groups after statistical adjustments for age and obesity (ranging from r=-0.04 to 0.13). All subjects were then ided into different age groups (15-29 years 30-40 years >40 years) and partial correlations were performed within each age group whilst adjusting only for obesity. Results still showed correlations (ranging from r=-0.29 to 0.27) with a similar trend with increasing age. More positive correlations were shown for the youngest groups, and more negative correlations for the oldest groups, with the middle-group (30-40 years) showing the weakest correlations-seeming to be in a transitional phase from a positive to negative correlation. It is therefore suggested that when the relationship between fasting insulin and BP is assessed, age stratification be used and not statistical adjustments.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
DOI: 10.1161/HYPERTENSIONAHA.113.03057
Abstract: Conflicting evidence exists on the relationship between blood pressure (BP) and insulin-like growth factor-1 (IGF-1). We reviewed available articles and pooled extrapolated regression coefficients for the association between BP and total IGF-1 as reported in the literature and included additional data from 912 in iduals from the general population. We identified 20 studies including 11 704 subjects. We also measured total IGF-1, insulin-like binding protein-3, and BP in 912 black and white men and women from South Africa (aged 20–70 years). When plotting positive and negative weighed regression coefficients (29 data points) against IGF-1, we found a significant positive relationship ( r =0.31 P .001 n=11 704) intercepting the 0 point at 191 ng/mL IGF-1, suggesting an inverse BP/IGF-1 relationship in low IGF-1 conditions, and a positive relationship in overtly high IGF-1 conditions. In conclusion, our findings suggest that the relationship between BP and IGF-1 is dependent on, or related to, IGF-1 concentrations, as an expression of direct or reverse causality. Low IGF-1 bioavailability (associated with aging and vascular deterioration), resistance to IGF-1, and the complex interplay between IGF-1 and other vasoactive hormones could mask the vasoprotective functions of IGF-1 in cross-sectional studies or could modify their functions in prospective studies.
Publisher: Oxford University Press (OUP)
Date: 10-12-2016
Abstract: Excessive alcohol intake is a risk factor for cardiovascular disease (CVD) and predicts cardiovascular and all-cause mortality. We determined which alcohol marker (self-reported alcohol intake, gamma-glutamyltransferase (GGT) or percentage carbohydrate deficient transferrin (%CDT)) relates best with mortality and predicts hypertension development over five years in black South Africans. This was a longitudinal study as part of the PURE (Prospective Urban and Rural Epidemiology) study in the North West Province, South Africa. We included 2010 participants and followed 1471 participants. Over five years, 230 deaths occurred, of which 66 were cardiovascular-related. At enrolment, participants completed questionnaires on alcohol intake (yes, for former and current use no, for alcohol never used). We measured blood pressure, collected blood s les and measured GGT and %CDT. When comparing hazard ratios (HRs) of self-report, GGT and %CDT, we found that only GGT predicted cardiovascular (HR = 2.76 (1.49-5.12)) and all-cause mortality (HR = 2.47 (1.75-3.47)) and hypertension development ((HR = 1.31 (1.06-1.62)). Participants self-reporting yes for alcohol intake had a 30% increased risk of developing hypertension (HR = 1.30 (1.07-1.60)) but not an increased risk for mortality. When adding both GGT and self-report in the prediction model for hypertension, only self-reporting of alcohol was significant (HR = 1.24 (1.01-1.53)). The alcohol marker, %CDT, did not show any significant association with mortality or hypertension development. GGT independently predicted cardiovascular and all-cause mortality, as well as hypertension development in black South Africans. Despite non-specificity to excessive alcohol consumption, GGT may be a useful general marker for hypertension development and mortality, also due to its significant association with self-reported alcohol intake.
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.ATHEROSCLEROSIS.2007.09.011
Abstract: To assess the risk factor pattern of the metabolic syndrome and its association with insulin resistance and hyperuricaemia in a sub-Saharan African population with different levels of urbanisation. Four hundred forty-eight black South African volunteers, men and women aged 15 years and older were investigated in a cross-sectional, comparative, population-based survey. Subjects were stratified into three groups representing different levels of urbanisation in rural and urban areas. The metabolic syndrome was defined according to IDF criteria. Factor analysis was used to examine the risk factor pattern of the metabolic syndrome. The prevalence of the metabolic syndrome was low and did not differ across the three groups. Factor analysis showed slight differences in the metabolic syndrome pattern between the groups. Hyperuricaemia-hypertriglyceridaemia was identified as distinct component in the rural and semiurban group whereas hyperinsulinaemia was loaded together with other risk factors. In the entire study population, five factors could be identified in the following sequence: obesity, hypertension, hyperuricaemia-hypertriglyceridaemia, hyperglycaemia and hyperinsulinaemia. Subjects with hyperuricaemia but not with insulin resistance exhibited an increased risk to develop the metabolic syndrome. Hyperuricaemia was revealed as additional component of the metabolic syndrome in sub-Saharan Africans and should be given more attention in prevention settings.
Publisher: Springer Science and Business Media LLC
Date: 19-04-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2022
DOI: 10.1161/HYPERTENSIONAHA.122.19144
Abstract: Influential guidelines currently define hypertension at different thresholds of blood pressure (BP). The global May Measurement Month initiative provides a unique opportunity to estimate the potential consequences of universal lowering of BP thresholds on the prevalence of hypertension based on a large, real-world, patient-level data set. The average of the second and third of 3 attended BP readings after 5 minutes of rest from 4 021 690 standardized, opportunistic BP screenings in various settings of the 2017 to 2019 May Measurement Month initiatives from 104 countries were analyzed to assess the demographic and phenotypic impact of 3 defined BP thresholds. The age- and sex-standardized median of the relative increase in rate of hypertension with a change of thresholds from ≥140/≥90 to ≥130/≥80 mm Hg was 72.3% (interquartile range, 59.3%–91.3%) among the participating countries. With a change from ≥140/≥90 to ≥120/≥70 mm Hg, the median range was 162.6% (interquartile range, 132.8%–202.6%). The increase in rate of hypertension was most pronounced in low-income (95.3% and 203.9%) and least pronounced in high-income countries (71.6% and 167.1%). The impact of a universal application of lower BP thresholds for the definition of hypertension would have an enormous impact on the prevalence of hypertension globally with large disparities between countries and substantial heterogeneity of demographic and phenotypic patterns, which should be confirmed in dedicated population studies. While focusing on lower BP targets may constitute an opportunity for early intervention, the potential socioeconomic consequences may pose unsurmountable obstacles for most health care systems worldwide.
Publisher: Elsevier BV
Date: 11-2023
Publisher: Springer Science and Business Media LLC
Date: 18-05-2016
DOI: 10.1038/HR.2016.48
Abstract: Adverse changes in retinal microvasculature caliber are associated with incident hypertension, coronary heart disease and stroke. The absence of a nocturnal dipping in arterial pressure may induce changes throughout the vascular tree, including the retinal microvasculature, but the later link is not sufficiently studied. We explored the relationship between retinal vessel caliber and dipping status in a group of black and white teachers. The study included black (n=68) and white (n=81) men (24-66 years) from the SABPA study. We measured 24 h ambulatory blood pressure and the percentage mean arterial pressure dipping(%MAPdip) was calculated as (diurnal MAP-nocturnal MAP)/diurnal MAP × 100. Retinal images were captured and the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) calculated. Black men demonstrated higher diurnal and nocturnal MAP (P⩽0.001) and a lesser %MAPdip compared with white men (P=0.047). When stratified by dipping status, black non-dippers (n=33) revealed an increased CRVE (P<0.001) compared with their dipper counterparts (n=35). In black men, CRVE was negatively (R
Publisher: Springer Science and Business Media LLC
Date: 28-07-2011
DOI: 10.1038/HR.2011.104
Abstract: The prognostic significance of blood pressure (BP) variability has lately enjoyed considerable attention. The need for early markers of cardiovascular dysfunction is imperative in black South Africans who have a significant risk for cardiovascular disease. We therefore compared 24-h BP variability with various traditional and advanced BP measurements, regarding their association with sub-clinical organ damage in black and white South Africans. The study included 409 African and Caucasian teachers aged 25-60 yrs. We measured office BP, 1-min continuous (finger) BP, ambulatory BP, BP reactivity and determined weighted 24-h BP variability. Albumin-to-creatinine ratio, Cornell product and carotid cross-sectional wall area (CSWA) were measures of organ damage. Africans had higher 24-h BP, BP variability, BP reactivity and sub-clinical organ damage (P<0.001). Correlations of BP variability with organ damage were overall weak when compared with other BP measurements. In normotensive groups, we found an independent association of 24-h systolic BP (SBP) variability with Cornell product only in Africans (r=0.37 P=0.01), confirmed in multiple regression models, with 24-h SBP included in the model. Only in hypertensive Caucasians, a significant correlation between CSWA and 24-h SBP variability was evident (r=0.30 P=0.01), although CSWA indicated stronger correlations with office or 24-h SBP than 24-h SBP variability. To conclude, 24-h SBP variability could potentially be an effective measure for the early detection of normotensive Africans at increased risk for the development of cardiovascular complications. Its usefulness based on associations with target organ damage in hypertensive groups seems to be less than traditional office or 24-h BP measurements.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.THROMRES.2015.08.022
Abstract: Insulin-like growth factor-1 (IGF-1) has vasculoprotective effects and can directly oppose endothelial dysfunction in several ways. To improve our understanding on the potential contribution of reduced IGF-1 to the development of vascular endothelial damage, we investigated the link between bioavailable IGF-1 and von Willebrand factor (vWF) as a marker of endothelial damage. We performed this study in black South African school teachers, known to be prone to hypertension. From the larger Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study we included 179 black and 207 white non-diabetic men and women (aged 44.5 ± 9.96 years). We measured ambulatory blood pressure and determined IGF-1, insulin-like growth factor binding protein 3 (IGFBP-3) and vWF antigen from blood s les. We used the molar IGF-1/IGFBP-3 ratio as an estimate of bioavailable IGF-1. Black in iduals presented higher blood pressure and vWFag and lower IGF-1 than the white group (all p < 0.001). In multivariate-adjusted analyses, vWFag was inversely associated with IGF-1 (R(2) = 0.18 β = -0.17 p = 0.044) and IGF-1/IGFBP-3 (R(2) = 0.18 β = -0.17 p = 0.030) in blacks, with no associations in whites. Since IGF-1 is attenuated and vWFag elevated in diabetes, we included patients with diabetes (n = 38) and the aforementioned associations found in blacks remained robust. The inverse association between bioavailable IGF-1 and vWF in black South Africans suggests that suppressed IGF-1 may result in endothelial damage independent of traditional risk factors.
Publisher: Georg Thieme Verlag KG
Date: 12-2007
Abstract: The risk for insulin resistance and subsequent type 2 diabetes varies between different ethnic populations due to differences in the genetic and environmental background. However, obesity and unhealthy lifestyle, crucial determinants of insulin resistance, are on the rise throughout all population groups though the susceptibility towards those factors may differ. Up to the present day it is not clear whether insulin resistance is based on metabolic changes due to lifestyle modifications or rather an ethnic and thus genetic grounded phenomenon. Genetic variations in secretion products of the active fat tissue (adipokines), a different pathophysiology of changes in glucose metabolism and the deep impact of urbanization (environmental factors) are discussed as primary determinants for differences in manifestation of insulin resistance between Caucasian and African populations. These factors may be influenced or modified by a central theme: visceral obesity. This mini review will elaborate on these issues illustrated by observations from Caucasian and African cohorts.
Publisher: Oxford University Press (OUP)
Date: 31-08-2017
DOI: 10.1093/AJH/HPX141
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2020
DOI: 10.1161/HYPERTENSIONAHA.119.14344
Abstract: The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring nighttime blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events. We analyzed nighttime blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the J-HOP study (Japan Morning Surge-Home Blood Pressure). During a follow-up period of 7.6±3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive, and 80.7% of participants were using antihypertensive medication. Nighttime home systolic blood pressure (SBP) was higher compared to nighttime ambulatory SBP (123.0±14.6 versus 120.3±14.4 mm Hg, P .001). Nocturnal hypertension was defined as nighttime home or ambulatory SBP of ≥120 mm Hg. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events: total cardiovascular events (coronary artery disease and stroke events 1.78 [1.00–3.15]) and stroke (2.65 [1.14–6.20]), independent of office SBP. These results were absent with nocturnal hypertension defined by ABPM. This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP) is a predictor of future cardiovascular events.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.DIABRES.2011.05.011
Abstract: To investigate the relationship between nocturnal blood pressure and chronically elevated blood glucose to determine if these elevated blood glucose concentrations contribute to a non-dipping blood pressure, especially in high-risk groups such as Africans. Nocturnal blood pressures and blood glucose levels of 41 non-dipping African and 28 non-dipping Caucasian men were investigated. Ambulatory systolic (SBP) and diastolic blood pressure (DBP) were measured and blood collected in sodium fluoride tubes from the antebrachial vein to determine serum glucose and glycosylated hemoglobin A1c (HbA1c) percentage. The estimated average glucose (eAG) was determined from HbA1c percentage with a regression formula. The African non-dippers had higher blood pressures (p<0.001) and elevated HbA1c (p=0.037) and eAG (p=0.041) levels compared to the Caucasians. In single, partial and multiple regression analyses nighttime (00:00-04:00) SBP correlated positively with HbA1c (p=0.069) and eAG (p<0.001) in the African men. No correlations were found in the Caucasian men. Sensitivity analysis confirmed that the association between nighttime SBP (00:00-04:00) and eAG was independent of carotid intima-media thickness in the African men (R(2)=0.617 β=0.438 p=0.008). The blunted nocturnal decline in SBP during the early morning hours is associated with chronically elevated blood glucose in non-dipper African men.
Publisher: Wiley
Date: 16-11-2019
DOI: 10.1111/ECI.13039
Abstract: Information regarding the effect of leptin on the vasculature in young healthy adults at risk for cardiovascular disease development is limited. We therefore examined the associations between measures of subclinical atherosclerosis (carotid intima-media thickness, carotid cross-sectional wall area), large artery stiffness (pulse wave velocity) and a measure of endothelial dysfunction (von Willebrand factor [vWF]) with leptin in young healthy men and women. In a cross-sectional study in South Africa involving 820 normotensive in iduals (337 men and 483 women) aged 20-30 years, we measured carotid intima-media thickness, carotid cross-sectional wall area, pulse wave velocity, vWF from citrated plasma and leptin from serum. Despite sevenfold higher leptin in women than men (P < 0.001), only in young healthy men, we observed negative, independent associations between measures of carotid wall thickness (carotid intima-media thickness: R In young healthy men, we found a beneficial inverse association between measures of carotid wall thickness and circulating leptin, thereby supporting a potential vascular protective role of leptin.
Publisher: Informa UK Limited
Date: 23-03-2017
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.NUMECD.2014.02.005
Abstract: Simple, low-cost central obesity measures may help identify in iduals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify in iduals with hypertension, pre-diabetes, or dyslipidaemia 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population and 3) assess which measure best predicts 5-year CVD risk. Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m(2), men 20.9 ± 4.3 kg/m(2)) median WC women 81.9 cm (interquartile range 61-103), men 74.7 cm (63-87 cm), all P 0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa.
Publisher: Elsevier BV
Date: 03-2007
DOI: 10.1016/J.REGPEP.2006.10.006
Abstract: Ghrelin, known for its orexigenic activity, also have functions such as vasodilation and a growth hormone releasing action. It is uncertain whether these functions change with increasing age. This study aimed to determine whether ghrelin levels differ between young and older women with different levels of obesity and secondly whether the associations of ghrelin with metabolic syndrome (MS) components, adipocytokines, coagulation factors, and cortisol change with increasing age. Caucasian women (N=107) were ided into young (19-29 years) and older groups (30-56 years). Fasting ghrelin, leptin, adiponectin, glucose, insulin, cortisol, fibrinogen and plasminogen activator inhibitor-1 (PAI-1) levels were determined. Blood pressure (BP), body mass index and waist circumferences were measured. Older lean women showed lower levels of ghrelin (p<0.05) than young lean women, with no differences regarding BP, obesity, lipids, adipokines or insulin resistance (IR). Ghrelin levels of older women remained constant with increasing obesity, but younger women showed significantly reduced ghrelin levels in obese groups. Only younger women showed significant correlations between ghrelin and leptin, adiponectin, fibrinogen and PAI-1 (adjusted for age, obesity and menstrual phase), whereas both age groups showed significant correlations with IR. In younger women factor analysis grouped ghrelin with coagulation factors and all MS components. In older women ghrelin was absent from the MS cluster, but was associated with lower BP, cortisol and IR. Ghrelin levels were not significantly elevated in lean older women, and did not change with increased obesity in older women--as were observed in younger women. The functions of ghrelin also seem to change with increased age since only in young women ghrelin was associated with obesity, coagulation factors and leptin.
Publisher: Springer Science and Business Media LLC
Date: 17-11-2022
DOI: 10.1038/S41440-022-01097-7
Abstract: Cardiovascular disease (CVD) affects in iduals across the lifespan, with multiple cardiovascular (CV) risk factors increasingly present in young populations. The underlying mechanisms in early cardiovascular disease development are complex and still poorly understood. We therefore employed urinary proteomics as a novel approach to gain better insight into early CVD-related molecular pathways based on a CVD risk stratification approach. This study included 964 apparently healthy (no self-reported chronic illnesses, free from clinical symptoms of CVD) black and white men and women (aged 20-30 years old) from the African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) study. Cardiovascular risk factors used for stratification included obesity, physical inactivity, tobacco use, high alcohol intake, hyperglycemia, dyslipidemia and hypertension. Participants were ided into low (0 risk factors), medium (1-2 risk factors) and high (≥3 risk factors) CV risk groups. We analyzed urinary peptidomics by capillary electrophoresis time-of-flight mass spectrometry. After adjusting for ethnicity, sex and age, 65 sequenced urinary peptides were differentially expressed between the CV risk groups (all q-values ≤ 0.01). These peptides included a lower abundance of collagen type I- and III-derived peptides in the high compared to the low CV risk group. With regard to noncollagen peptides, we found a lower abundance of alpha-1-antitrypsin fragments in the high compared to the low CV risk group (all q-values ≤ 0.01). Our findings indicate lower abundances of collagen types I and III in the high compared to the low CV risk group, suggesting potential early alterations in the CV extracellular matrix.
Publisher: Clinics Cardive Publishing
Date: 28-02-2019
Publisher: American Medical Association (AMA)
Date: 06-2022
Publisher: Springer Science and Business Media LLC
Date: 14-10-2022
DOI: 10.1038/S41440-022-01051-7
Abstract: We investigated whether diabetes mellitus (DM) affects the efficacy of a low-dose triple combination pill and usual care among people with mild-moderate hypertension. TRIUMPH (TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension) was a randomised controlled open-label trial of patients requiring initiation or escalation of antihypertensive therapy. Patients were randomised to a once-daily low-dose triple combination polypill (telmisartan-20mg/amlodipine-2.5 mg/chlorthalidone-12.5 mg) or usual care. This analysis compared BP reduction in people with and without DM, both in the intervention and control groups over 24-week follow-up. Predicted efficacy of prescribed therapy was calculated (estimation methods of Law et al.). The trial randomised 700 patients (56 ± 11 yrs, 31% DM). There was no difference in the number of drugs prescribed or predicted efficacy of therapy between people with DM and without DM. However, the observed BP reduction from baseline to week 24 was lower in those with DM compared to non-diabetics in both the triple pill (25/11 vs 31/15 mmHg, p ≤ 0.01) and usual care (17/7 vs 22/11 mmHg, p ≤ 0.01) groups, and these differences remained after multivariable adjustment. DM was a negative predictor of change in BP (β-coefficient -0.08, p = 0.02). In conclusion, patients with DM experienced reduced efficacy of BP lowering therapies as compared to patients without DM, irrespective of the type of BP lowering therapy received.
Publisher: Springer Science and Business Media LLC
Date: 15-01-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 12-04-2019
Publisher: Massachusetts Medical Society
Date: 15-12-2016
DOI: 10.1056/NEJMC1612304
Publisher: Wiley
Date: 14-02-2021
DOI: 10.1111/JCH.14211
Publisher: Elsevier BV
Date: 07-2005
DOI: 10.1016/J.NUT.2004.12.007
Abstract: Early changes in vascular function could be associated with stunting, which may contribute to the development of cardiovascular diseases in later life. In this study we tested the hypothesis that stunting may be related to changes in cardiovascular function in African children ages 10 to 15 y. In the Transition and Health during Urbanization in South Africa in Children study, the health status of children in the North-West Province of South Africa was studied. It was an epidemiologic, cross-sectional study in which 583 black non-stunted and 192 stunted children (stature below the fifth percentile for age) of both sexes ages 10 to 15 y were recruited from 44 schools. Blood pressure was monitored with the Finapres (finger-arterial pressure) apparatus and by means of the Fast Modelflo software program measurements for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, and arterial compliance were obtained. Dietary intake data were collected with a 24-h dietary recall questionnaire. Nutrient coding was the same for all recalls and macro- and micronutrients were calculated. Anthropometric measurements were done according to standard methods. There were no significant differences in systolic blood pressure and diastolic blood pressure between stunted and non-stunted children after correction for body mass index and heart rate. Stroke volume, arterial compliance, and cardiac output were significantly lower and total peripheral resistance was significantly higher in stunted children than in non-stunted children. No significant differences in dietary intake could be detected, although dietary intakes were slightly lower in the stunted children. We found that compliance, a marker of vascular function, is significantly lower in stunted children. Stunting was related to early changes in cardiovascular function in African children ages 10 to 15 y.
Publisher: Pan American Health Organization
Date: 15-07-2020
Abstract: La hipertensión arterial es una causa modificable muy prevalente de enfermedades cardiovasculares, accidentes cerebrovasculares y muerte. Medir con exactitud la presión arterial es fundamental, dado que un error de medición de 5 mmHg puede ser motivo para clasificar incorrectamente como hipertensas a 84 millones de personas en todo el mundo. En la presente declaración de posición se resumen los procedimientos para optimizar el desempeño del observador al medir la presión arterial en el consultorio, con atención especial a los entornos de ingresos bajos o medianos, donde esta medición se ve complicada por limitaciones de recursos y tiempo, sobrecarga de trabajo y falta de suministro eléctrico. Es posible reducir al mínimo muchos errores de medición con una preparación adecuada de los pacientes y el uso de técnicas estandarizadas. Para simplificar la medición y prevenir errores del observador, deben usarse tensiómetros semiautomáticos o automáticos de manguito validados, en lugar del método por auscultación. Pueden ayudar también la distribución de tareas, la creación de un área específica de medición y el uso de aparatos semiautomáticos o de carga solar. Es fundamental garantizar la capacitación inicial y periódica de los integrantes del equipo de salud. Debe considerarse la implementación de programas de certificación de bajo costo y fácilmente accesibles con el objetivo de mejorar la medición de la presión arterial.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.FOODRES.2017.06.054
Abstract: Selenium is an important co-factor for the optimal functioning of the antioxidant enzyme, glutathione peroxidase (GPx). Studies investigating the associations of selenium with blood pressure (BP) and hemodynamic measures are sparse. This study investigated whether 24h blood pressure, vascular resistance, arterial compliance and arterial stiffness relate to both serum selenium and GPx activity. In this cross-sectional study selenium levels, GPx activity, ambulatory blood pressure and arterial stiffness of 200 black and 209 white school teachers from South Africa were measured. Serum selenium levels were significantly lower in black compared to white teachers (p<0.001), independent of sex. One in 10 black men and one in five black women were selenium deficient (<8μg/100ml). Only in white men inverse independent associations of 24h systolic BP (β=-0.19 p=0.039) and 24h diastolic BP (β=-0.21 p=0.029) with selenium were found. In the same group, an inverse association between carotid-dorsalis pedis pulse wave velocity (cd-PWV) and GPx activity (β=-0.23 p=0.017) were also found. To conclude, lower serum selenium levels in black populations from the same geographical region as their white counterparts may impact on the loss of the vasculoprotective effects of selenium and selenoproteins such as GPx.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Springer Science and Business Media LLC
Date: 06-07-2021
Publisher: Elsevier BV
Date: 06-2019
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-020404
Abstract: The WHO’s global targets for non-communicable disease reduction recommend consumption of g salt/day. In 2016, South Africa was the first country to legislate maximum salt levels in processed foods. South Africa’s salt iodisation fortification programme has successfully addressed iodine deficiency but information is dated. Simultaneous monitoring of sodium reduction and iodine status is required to ensure compatibility of the two public health interventions. A nested cohort design within WHO’s 2015 Study on global AGEing and adult health (n=2887) including in iduals from households across South Africa. Randomly selected adults (n=875) provided 24-hour and spot urine s les for sodium and iodine concentration analysis (the primary and secondary outcome measures, respectively). Median 24-hour urinary iodine excretion (UIE) and spot urinary iodine concentrations (UIC) were compared by salt intakes of g/day, 5–9g/dayand g/day. Median daily sodium excretion was equivalent to 6.3 g salt/day (range 1–43 g/day) 35% had urinary sodium excretion values within the desirable range ( g salt/day), 37% had high values (5–9 g salt/day) and 28% had very high values ( g salt/day). Median UIC was 130 µg/L (IQR=58–202), indicating population iodine sufficiency (≥100 µg/L). Both UIC and UIE differed across salt intake categories (p .001) and were positively correlated with estimated salt intake (r=0.166 and 0.552, respectively both p .001). Participants with salt intakes of g/day were not meeting the Estimated Average Requirement for iodine intake (95 µg/day). In a nationally representative s le of South African adults, the association between indicators of population iodine status (UIC and UIE) and salt intake, estimated using 24-hour urinary sodium excretion, indicate that low salt intakes may compromise adequacy of iodine intakes in a country with mandatory iodisation of table salt. The iodine status of populations undergoing salt reduction strategies needs to be closely monitored to prevent re-emergence of iodine deficiency.
Publisher: Elsevier
Date: 2019
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.IJCARD.2012.05.035
Abstract: Vascular calcification is believed to be due to the conversion of vascular smooth muscle cells into osteoblast-like cells and is associated with mortality. Since hypertension and related mortality in Africans is a concern, we investigated associations between a marker of osteoblastic activity, alkaline phosphatase (ALP), and measures of arterial structure and function in hypertensive African men. This study included 79 participants. We conducted 24h ambulatory blood pressure and carotid intima-media thickness (cIMT) measurements. cIMT was obtained with an intra-observer variability of 0.04 mm and the cross-sectional wall area (CSWA) was calculated. ALP was measured in serum. ALP was within its reference range (101.6 vs. 30.0-120.0 U/L), however cIMT was higher when this group was stratified and compared to gender and age-specific reference values. In univariate and partial regressions, and confirmed with multiple regression analyses, 24h systolic blood pressure (β=0.289, p=0.018), 24h pulse pressure (β=0.387, p=0.002), but not 24h diastolic blood pressure (β=0.073, p=0.58), were positively associated with ALP. In addition, mean cIMT (β=0.322, p=0.006) and CSWA (β=0.285, p=0.013) also correlated positively with ALP after adjusting for significant covariates, and after excluding participants with diabetes, renal dysfunction or a HIV positive status. Serum alkaline phosphatase is adversely associated with measures of arterial structure and function in hypertensive African men.
Publisher: Springer Science and Business Media LLC
Date: 24-07-2020
Publisher: Elsevier BV
Date: 02-2019
Publisher: Clinics Cardive Publishing
Date: 05-09-2017
Publisher: Springer Science and Business Media LLC
Date: 24-07-2013
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 08-2023
Publisher: Wiley
Date: 23-09-2016
DOI: 10.1111/ECI.12674
Abstract: The link between impaired lung function and cardiovascular outcome is well established in European and American populations. It is possible that this association may be driven by a systemic spillover of inflammation occurring within the lungs. As several studies have found an increased level of inflammatory markers in African populations, we aimed to establish the contribution of lung function in predicting all-cause and cardiovascular mortality in Africans, whilst taking inflammatory markers into account. We followed 1442 black South Africans from the North West Province participating in the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study, over a five-year period. Spirometry, cardiovascular and metabolic measures were performed, and cardiovascular mortality as well as all-cause mortality used as endpoints. In univariate Cox regression models, both forced expiratory volume in 1-s (FEV FVC, but not FEV
Publisher: Elsevier BV
Date: 10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2020
DOI: 10.1161/HYPERTENSIONAHA.120.14874
Abstract: Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening c aign aiming to improve awareness of blood pressure at the in idual and population level. Adults (≥18 years) recruited through opportunistic s ling were screened at sites in 92 countries during May 2019. Ideally, 3 blood pressure readings were measured for each participant, and data on lifestyle factors and comorbidities were collected. Hypertension was defined as a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants’ mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1 508 130 screenees 482 273 (32.0%) had never had a blood pressure measurement before and 513 337 (34.0%) had hypertension, of whom 58.7% were aware, and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to /90 mm Hg, and 28.9% to /80 mm Hg. Of all those with hypertension, 31.7% were controlled to /90 mm Hg, and 350 825 (23.3%) participants had untreated or inadequately treated hypertension. Of those taking antihypertensive medication, half were taking only a single drug, and 25% reported using aspirin inappropriately. This survey is the largest ever synchronized and standardized contemporary compilation of global blood pressure data. This c aign is needed as a temporary substitute for systematic blood pressure screening in many countries worldwide.
Publisher: Academy of Science of South Africa
Date: 27-11-2013
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.NUMECD.2006.04.006
Abstract: The association between PAI-1(act) and markers of the metabolic syndrome is well established in Caucasian populations, but data on African subjects is lacking. The aim of this study was to investigate possible differences between the association of PAI-1(act) and markers of the metabolic syndrome in Caucasian and African women. Cross-sectional data were collected from 95 African and 114 Caucasian women in the Potchefstroom district of the North West Province, South Africa. Plasma PAI-1(act) was almost twice as high in Caucasians compared to Africans (10.2 versus 5.2 U/mL, p<0.001). Correlations between markers of the metabolic syndrome and PAI-1(act) were remarkably stronger in Caucasians than in Africans. In multivariate regression analyses 56% of the variance of PAI-1(act) could be explained by metabolic syndrome variables in the Caucasian group compared to 12% in the African women. Waist circumference was the strongest independent predictor of PAI-1(act) in both groups. This study showed lower PAI-1(act) in African than in Caucasian women, along with less associations of PAI-1(act) with markers of the metabolic syndrome in the African than in the Caucasian women. The role of PAI-1(act) in the metabolic syndrome may be less prominent in Africans than in Caucasians.
Publisher: Springer Science and Business Media LLC
Date: 21-07-2018
DOI: 10.1007/S00394-018-1791-1
Abstract: There is global consensus on the benefits of reducing excessive salt intake. Indeed, lower salt intake associates with reduced arterial stiffness, a well-established predictor of cardiovascular risk, in older populations. Whether high habitual salt intake in healthy normotensive youth may already contribute to increased arterial stiffness is unknown. We, therefore, determined whether estimated salt intake is associated with large artery stiffness in young healthy black and white adults. We included 693 black and white adults (51% black 42% men), aged 20-30 years. Participants were normotensive based on clinic blood pressure, and no previous diagnosed chronic illnesses. We measured carotid femoral pulse wave velocity (cfPWV) and determined estimated salt intake based on 24 h urinary sodium excretion. We found estimated salt consumption of > 5 g/day in 47% of our population, whereas 21% consumed > 10 g/day. In multivariable-adjusted regression analyses a positive association existed between estimated salt intake and cfPWV in the total group (Adj. R Excessive salt intake is positively associated with large artery stiffness-independent of blood pressure-in young adults, especially in black in iduals. Our results suggest a potential contributory role of salt consumption towards early vascular aging.
Publisher: Wiley
Date: 08-06-2021
DOI: 10.1111/MICC.12714
Abstract: Lifestyle risk factors vary between socioeconomic status (SES) groups and may influence cardiovascular function differently. The retinal microvasculature allows for monitoring early changes in cardiovascular health, and therefore, we investigated whether retinal vessel calibers associate differently with modifiable risk factors in different SES groups. We included 1064 young adults (aged 20–30 years) grouped by low and high SES. The central retinal artery and vein equivalents (CRAE, CRVE) were determined from fundus images captured using the Dynamic Retinal Vessel Analyzer (Imedos Systems GmbH, Jena, Germany). We collected anthropometry, self‐reported alcohol consumption, and biochemical data. Retinal vessel calibers did not differ between SES groups ( p ≥ .80) after adjusting for sex and ethnicity. Unique independent associations were observed in the low SES group, where CRAE ( β = 0.08, p = .042) and CRVE ( β = .14, p = .001) associated positively with cotinine and body mass index, respectively. In the high SES group, CRAE ( β = –0.09, p = .027) associated negatively with alcohol consumption. At young ages, retinal vessel calibers associated differently with modifiable lifestyle risk factors within each SES group. Our data highlight the importance of detecting adverse lifestyle risk factors among young adults from erse socioeconomic settings to improve prevention of cardiovascular disease.
Publisher: Wiley
Date: 14-03-2012
DOI: 10.1111/J.1469-8986.2012.01362.X
Abstract: Dissociation between β-adrenergic behavioral and physiological defensive active coping (AC) responses was associated with cardiometabolic risk in urban but not rural African males. Whether this is partly driven by underlying neuroendocrine dysfunction is not certain. We aimed to assess the association between coping style, urbanization, and neuroendocrine function. Blood pressure (BP) and serum stress hormones were assessed across levels of urbanization (rural vs. urban) and coping style (active vs. passive) in 178 Black African men. Urban men demonstrated increased hypertension prevalence, α-adrenergic hemodynamic pattern, lower testosterone levels, and a larger cortisol:testosterone ratio (Cort:Test) compared to their rural counterparts. This was particularly evident in urban AC men where cortisol and Cort:Test explained 36-40% of the variance in BP. Dissociation between behavioral and physiological β-adrenergic neuroendocrine responses in urban AC African men was shown. A stressful urban environment might induce an apparent loss of physiological control, thereby facilitating disturbed neuroendocrine AC responses, which could increase cardiovascular disease risk.
Publisher: AOSIS
Date: 20-09-2018
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.ATHEROSCLEROSIS.2010.12.015
Abstract: There is an emerging burden of cardiovascular disease among urban black Africans in South Africa, which has been largely explained by the transition from traditional African lifestyles to more westernized behavior. We examined the role of health behaviors in explaining the excess burden of sub clinical vascular disease seen in black Africans compared to Caucasians. This was a cross-sectional study, comprising of urban African teachers (n=192 black, 206 Caucasian) working for one of the four Kenneth Kaunda Education districts in the North West Province, South Africa. Conventional cardiovascular risk factors, 24 h ambulatory blood pressure and objectively measured physical activity (Actical® accelerometers), smoking (confirmed by serum cotinine), and alcohol (serum gamma glutamyl transferase) were assessed. The main outcome was a marker of sub-clinical vascular disease, mean carotid intima media thickness (mCIMT), measured using high resolution ultrasound. Compared with Caucasians, the black Africans demonstrated higher mCIMT (age and sex adjusted β=0.044, 95% CI, 0.024-0.064 mm). The blacks also had higher 24h systolic and diastolic blood pressure, triglycerides, adiposity, and C-reactive protein. In addition, blacks were less physically active (790.0 kcal/d vs 947.3 kcal/d, p<0.001), more likely to smoke (25% vs 16.3%, p=0.002), and demonstrated higher alcohol abuse (gamma glutamyl transferase, 66.6 μ/L vs 27.2 μ/L, p<0.001) compared with Caucasians. The difference in mCIMT between blacks and Caucasians was attenuated by 34% when conventional risk factors were added to the model and a further 18% when health behaviors were included. There is an excess burden of sub clinical vascular disease seen in black Africans compared to Caucasians, which can be largely explained by health behaviors and conventional risk factors.
Publisher: Oxford University Press (OUP)
Date: 22-11-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2020
DOI: 10.1161/ATVBAHA.120.313133
Abstract: Early vascular aging reflects increased arterial stiffness of central blood vessels at young chronological ages and powerfully predicts cardiovascular events and mortality, independent of routine brachial blood pressure and other risk factors. Since ethnic disparities exist in routine blood pressure, in hypertension and cardiovascular outcomes, this review evaluates major studies comparing arterial stiffness through the life course between different ethnic groups or races (which have no biological definition)—in children, adolescents, young, and middle-aged adults and the very elderly. Most report that compared with white European-origin s les, populations of black African descent have increased central arterial stiffness throughout different life stages, as well as a more rapid increase in arterial stiffness at young ages. Exceptions may include African Caribbean origin people in Europe. Differences in vascular structure and function are clearest, where obesity, socioeconomic, and psychosocial factors are most marked. Few studies evaluate a wider spectrum of ethnic groups or factors contributing to these ethnic disparities. Genetic effects are not obvious maternal risk and intergenerational studies are scarce. Nevertheless, across all ethnic groups, for given levels of blood pressure and age, some people have stiffer central arteries than others. These in iduals are most at risk of vascular events and mortality and, therefore, may benefit from early, as yet untested, preventive action and treatment.
Publisher: Wiley
Date: 03-07-2019
DOI: 10.1111/JCH.13586
Publisher: Wiley
Date: 09-08-2016
DOI: 10.1111/ECI.12663
Abstract: Black populations exhibit lower concentrations of the cardioprotective peptide, insulin-like growth factor-1 (IGF-1), and are more prone to develop hypertensive heart disease than whites. We therefore determined whether lower IGF-1 in black in iduals relates to a marker of cardiac overload and systolic dysfunction, namely N-terminal prohormone B-type natriuretic peptide (NT-proBNP). We included 160 black and 195 white nondiabetic South African men and women (aged 44·4 ± 9·81 years) and measured ambulatory blood pressure, NT-proBNP, IGF-1 and insulin-like growth factor-binding protein-3 (IGFBP-3). Although the black group presented elevated ambulatory blood pressure accompanied by lower IGF-1 compared to the white group (all P < 0·001), we found similar NT-proBNP concentrations (P = 0·72). Furthermore, in blacks we found a link between NT-proBNP and systolic blood pressure (SBP) (R(2) = 0·37 β = 0·28 P < 0·001), but not with IGF-1. In the white group, NT-proBNP was inversely associated with IGF-1 (R(2) = 0·39 β = -0·22 P < 0·001) after adjusting for covariates and potential confounders. As IGF-1 is attenuated in diabetes, we added the initially excluded patients with diabetes (n = 38), and the aforementioned associations remained robust. Contrary to the white group, we found no association between NT-proBNP and IGF-1 in black adults. Our findings suggest that SBP and other factors may play a greater contributory role in cardiac pathology in blacks.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.IJCARD.2013.07.191
Abstract: Low testosterone, acute and chronic stress and hypercoagulation are all associated with hypertension and hypertension-related diseases. The interaction between these factors and future risk for coronary artery disease in Africans has not been fully elucidated. In this study, associations of testosterone, acute cardiovascular and coagulation stress responses with fibrinogen and von Willebrand factor in African and Caucasian men in a South African cohort were investigated. Cardiovascular variables were studied by means of beat-to-beat and ambulatory blood pressure monitoring. Fasting serum-, salivary testosterone and citrate coagulation markers were obtained from venous blood s les. Acute mental stress responses were evoked with the Stroop test. The African group demonstrated a higher cardiovascular risk compared to Caucasian men with elevated blood pressure, low-grade inflammation, chronic hyperglycemia (HbA1c), lower testosterone levels, and elevated von Willebrand factor (VWF) and fibrinogen levels. Blunted testosterone acute mental stress responses were demonstrated in African males. In multiple regression analyses, higher circulating levels of fibrinogen and VWF in Africans were associated with a low T environment (R(2) 0.24-0.28 p≤0.01), but only circulating fibrinogen in Caucasians. Regarding endothelial function, a low testosterone environment and a profile of augmented α-adrenergic acute mental stress responses (diastolic BP, D-dimer and testosterone) were associated with circulating VWF levels in Africans (Adj R(2) 0.24 p<0.05). An interdependence between acute mental stress, salivary testosterone, D-dimer and vascular responses existed in African males in their association with circulating VWF but no interdependence of the independent variables occurred with fibrinogen levels.
Publisher: Springer Science and Business Media LLC
Date: 29-06-2022
DOI: 10.1186/S12903-022-02291-2
Abstract: Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs). Our systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Medline, Embase, Global Health, CINAHL, Emcare, Scopus, Web of Science, WHO website, Google Advanced and Google Scholar were searched for experimental and observational studies published between 1995 and 2021 in English. Quality assessment and data extraction of the articles were performed by two independent reviewers. The primary outcome was decayed, missing, and filled teeth/surfaces [dmft(s)/DMFT(S)] scores. Seven meta-analyses were conducted. The search yielded 1178 publications and after removing duplicates, 753 remained. A further 648 publications were excluded after screening titles and abstracts. 105 publications were reviewed in full and 34 were included. Narrative synthesis showed school-based interventions had a positive effect on oral health outcomes. Meta-analysis showed a significant positive effect on dental caries measured by DMFT scores (standardised mean difference (SMD) = − 0.33 95% CI − 0.56 to − 0.10 P = 0.005), net increment in DMFS scores (SMD = − 1.09 95% CI − 1.91 to − 0.27 P = 0.009), dmft and DMFT/S score 1 (Risk Ratio = 0.70 95% CI 0.53 to 0.94 P = 0.02) and plaque scores (SMD = − 0.32 95% CI − 0.46 to − 0.18 P 0.00001). Non-significant positive effect was observed for dental caries measured by net increment in DMFT scores (SMD = − 0.34 95% CI − 0.69 to 0.02 P = 0.06) and DMFS scores (SMD = − 0.26 95% CI − 0.70 to 0.18 P = 0.24), and gingival health (SMD = 0.12 95% CI − 0.32 to 0.55 P = 0.60). Certainty of evidence was assessed as very low for all oral health outcomes. School-based interventions can be effective in reducing the burden of oral disease among primary school children in LMICs, with skills-based education, teacher training, provision of access to oral health services and parental engagement emerging as particularly promising. Further research is required to provide evidence of effectiveness of primary school-based interventions to improve oral health. Systematic review registration The title of this review was registered with PROSPERO (registration number: CRD42020202599).
Publisher: Oxford University Press (OUP)
Date: 09-2022
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.ATHEROSCLEROSIS.2012.01.045
Abstract: The N-terminal prohormone B-type natriuretic peptide (NT-proBNP) is involved in the regulation of volume load and secreted when systemic cardiac overload occurs. Fibulin-1 on the other hand is a component of many extracellular matrix proteins including those present in atherosclerotic lesions, expressed in elastin-containing fibres of blood vessels, and also in the heart. Due to an alarming prevalence of hypertensive heart disease in black South Africans, we investigated the associations of NT-proBNP with fibulin-1 and markers of arterial stiffness in Africans and Caucasians. We included 231 Africans and 238 Caucasians from South Africa aged 22-77 years. Serum NT-proBNP and fibulin-1 levels were determined, and arterial compliance and pulse wave velocity were measured. Africans had significantly higher blood pressure and NT-proBNP levels than Caucasians and African men had higher fibulin-1 levels than Caucasian men. In single regression analysis, NT-proBNP was significantly associated with fibulin-1 in African men and Caucasian women. NT-proBNP correlated negatively with arterial compliance in all groups except Caucasian women. After partial adjustments, the association between NT-proBNP and fibulin-1 strengthened in African men only. After full adjustment in multiple regression analysis, the association of NT-proBNP with fibulin-1 was confirmed in African men (R(2)=0.41 β=0.26 p<0.01) and also in younger women (R(2)=0.34 β=0.251 p=0.012). Only Africans indicated a significant independent association between NT-proBNP and fibulin-1, suggesting that cardiovascular alterations are already present in this relatively young African population as opposed to Caucasians.
Publisher: Springer Science and Business Media LLC
Date: 2003
Publisher: MDPI AG
Date: 09-12-2022
DOI: 10.3390/JCDD9120447
Abstract: Elevated homocysteine (Hcy) increases cardiovascular disease (CVD) risk. Our objective was to emphasize Hcy’s contribution in hypertension and CVD management by determining H-type hypertension (hypertension with Hcy ≥ 10 µmol/L) and associations between Hcy, blood pressure (BP) and estimates of vascular function among Black South Africans. We included 1995 adults (63% female). Plasma Hcy and cardiovascular measures (systolic and diastolic BP (SBP, DBP), pulse pressure, heart rate (HR), carotid-radialis pulse wave velocity (cr-PWV), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1) were quantified. Five Hcy-related polymorphisms (cystathionine β-synthase (CBS 844ins68, T833C, G9276A) methylenetetrahydrofolate reductase (MTHFR C677T) and methionine synthase (MTR A2756G)) were genotyped. Hcy was µmol/L in 41% (n = 762), and of the 47% (n = 951) hypertensives, 45% (n = 425) presented with H-type. Hcy was higher in hypertensives vs. normotensives (9.86 vs. 8.78 µmol/L, p 0.0001, effect size 0.56) and correlated positively with SBP, DBP, cr-PWV and ICAM-1 (r 0.19, p 0.0001). Over Hcy quartiles, SBP, DBP, HR, cr-PWV and ICAM-1 increased progressively (all p-trends ≤ 0.001). In multiple regression models, Hcy contributed to the variance of SBP, DBP, HR, cr-PWV and ICAM-1. H-type hypertensives also had the lowest MTHFR 677 CC frequency (p = 0.03). Hcy is positively and independently associated with markers of vascular function and raised BP.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1093/AJCN/NQAA008
Abstract: Excessive alcohol use is the third leading cause of mortality in the United States, where alcohol use consistently increased over the last decades. This trend is currently maintained, despite regulatory policies aimed to counteract it. While the increased health risks resulting from alcohol use are evident, some open questions regarding alcohol use and its consequences in the US population remain. The current work aims to evaluate the relation between alcohol consumption trends over a period of 15 y with all-cause and cause-specific mortality. In addition, we evaluate the adequacy of the current alcohol recommended limits according to the 2015-2020 US Dietary Guidelines for Americans (USDGA). This was a prospective population-based study defined by the NHANES conducted over the period 1999-2014 linked to US mortality registry in 2015. The s le, composed of 34,672 participants, was observed for a median period of 7.8 y, totaling 282,855 person-years. In the present s le, 4,303 deaths were observed. Alcohol use increased during the period 1999-2014. Alcohol use above the current US recommendations was associated with increased all-cause and cause-specific mortality risk, ranging from 39% to 126%. A proportion of these deaths, ranging from 19% to 26%, could be theoretically prevented if US citizens followed current guidelines, and 13% of all-cause deaths in men could be avoided if the current US guidelines for women (1 standard drink/d) were applied to them. The present study provides evidence in support of limiting alcohol intake in adherence to the USDGA recommendations.
Publisher: Informa UK Limited
Date: 07-01-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Publisher: Springer Science and Business Media LLC
Date: 29-09-2020
DOI: 10.1186/S40795-020-00379-Y
Abstract: Though Ghana has high hypertension prevalence, the country lacks current national salt consumption data required to build and enhance advocacy for salt reduction. We explored the characteristics of a randomly selected sub s le that had valid urine collection, along with matched survey, anthropometric and BP data ( n = 839, mean age = 60y), from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE), Ghana Wave 3, n = 3053). We also investigated the relationship between salt intake and blood pressure (BP) among the cohort. BP was measured in triplicate and 24 h urine was collected for the determination of urinary sodium (Na), potassium (K), creatinine (Cr) and iodine levels. Hypertension prevalence was 44.3%. Median salt intake was 8.3 g/day, higher in women compared to men (8.6, interquartile range (IQR) 7.5 g/day vs 7.5, IQR 7.4 g/day, p 0.01), younger participants (18–49 y) compared to older ones (50+ y) (9.7, IQR 7.9 g/day vs 8.1, IQR 7.1 g/day, p 0.01) and those with higher Body Mass Index (BMI) ( 30 kg/m 2 ) compared to a healthy BMI (18.5–24.9 kg/m 2 ) (10.04, IQR 5.1 g/day vs 6.2, IQR 5.6 g/day, p 0.01). More than three quarters (77%, n = 647) of participants had salt intakes above the WHO maximum recommendation of 5 g/d, and nearly two thirds (65%, n = 548) had daily K intakes below the recommended level of 90 mmol. Dietary sodium to potassium (Na: K) ratios above 2 mmol/mmol were positively associated with increasing BP with age. Population-based interventions to reduce salt intake and increase K consumption are needed.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
DOI: 10.1038/JHH.2011.103
Abstract: The aetiology for an increasing incidence of hypertensive cardiovascular disease amongst Africans in southern Africa is unclear. Hypertension may be induced by inadequate release of L-arginine-derived nitric oxide impairing vascular tone regulation. In addition, asymmetric dimethylarginine (ADMA) is associated with cardiovascular disease. We compared profiles of L-arginine in African and Caucasian men of similar age with cardiovascular risk factors. We studied 163 Caucasian and 132 African men, respectively, (20 to 70 years) measuring serum L-arginine, ADMA, creatinine, urea, symmetric dimethylarginine (SDMA) and blood pressure. L-arginine levels were significantly lower, whereas blood pressure and pulse wave velocity were significantly higher in African men. Simple linear regression showed ADMA more strongly associated with L-arginine in Caucasians (r=0.59 vs 0.19), whereas association of SDMA with L-arginine was significant only in Caucasians (r=0.43 vs 0.001). The stronger association of L-arginine with ADMA in Caucasian men was confirmed by multiple regression analysis (β=0.46 vs 0.25).Our findings show that the relationship of cardiovascular risk factors with serum L-arginine and some of its catabolites is different in African and Caucasian men and that this may be associated with a relatively higher prevalence of hypertension in African men.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Publisher: Public Library of Science (PLoS)
Date: 08-01-2021
DOI: 10.1371/JOURNAL.PONE.0244807
Abstract: The prevalence of hypertension is increasing in low- and middle-income countries, however statistics are generally derived from cross sectional surveys that utilize different methodologies and population s les. We investigated blood pressure (BP) changes over 11–12 years in a large cohort of adults aged 50 years and older (n = 820) included in the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE Ghana) Wave 1 (2007/8) with follow up in Wave 3 (2019). Participants’ BP were measured in triplicate and a survey completed at both time points. Survey instruments collected information on sociodemographic characteristics, lifestyle, health behaviors and chronic conditions. While no significant difference was found in systolic BP between Waves 1 and 3, diastolic BP decreased by 9.7mmHg (mean = 88.6, 15.4 to 78.9, 13.6 respectively) and pulse pressure increased by 9.5mmHg (44.8, 13.7 to 54.3, 14.1). Awareness of hypertension increased by 37%, from (20% to 57%), but no differences were found for the proportion of hypertensives receiving treatment nor those that had controlled BP. Mixed effects modelling showed a decrease in diastolic BP was associated with increasing age, living in rural areas and having health insurance. Factors associated with an increased awareness of hypertension were residing in urban areas, having health insurance and increasing body mass index. While diagnosis of hypertension has improved over time in Ghana, there is an ongoing need to improve its treatment in older adults.
Publisher: Wiley
Date: 13-06-2015
DOI: 10.1111/JCH.12599
Publisher: Elsevier BV
Date: 06-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Publisher: Wiley
Date: 17-12-2014
DOI: 10.1111/JCH.12237
Publisher: Springer Science and Business Media LLC
Date: 10-03-2005
Abstract: High leptin levels are often observed in human obesity and are implicated in obesity-related hypertension. Leptin levels have been found to be higher in hypertensive obese African-American women compared to normotensive African-American women, but a direct association between leptin and blood pressure could not be obtained. Additionally, increased adiposity has been associated with higher aortic stiffness in obese African-American women, but leptin was not included in the study. The effects of leptin on cardiovascular function in African women have not yet been determined. We hypothesised that leptin is directly associated with blood pressure and decreased arterial compliance and that leptin levels are significantly higher in hypertensive overweight/obese African women compared to normotensive overweight/obese African women. A case-case control study was performed which included 98 African women. The subjects were ided into lean normotensive (lean NT), overweight/obese normotensive (OW/OB NT) and overweight/obese hypertensive (OW/OB HT). The Finometer apparatus was used to obtain a more elaborate cardiovascular profile. Serum leptin and insulin levels as well as the HOMA-IR index were determined. Various anthropometric measures were obtained. Leptin levels were elevated (P < or = 0.05) in the OW/OB NT and HT groups compared to the lean NT group, but were similar in the OW/OB NT and HT groups. After adjusting for obesity, insulin resistance, hyperinsulinaemia and age, a direct positive correlation was obtained between leptin and systolic blood pressure (SBP) (P < or = 0.05 r = 0.68) in the OW/OB HT group. Additionally, leptin also correlated negatively with arterial compliance (P< or = 0.05 r = -0.76) and positively with pulse pressure (P < or = 0.05 r = 0.71) in the OW/OB HT group. In conclusion, even though leptin levels were the same in OW/OB HT and NT African women, leptin was directly and positively associated with SBP and pulse pressure and negatively with C(W) only in OW/OB HT African women, independent of obesity, insulin-resistance, hyperinsulinaemia and age.
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JASH.2013.04.005
Abstract: Reactive oxygen species (ROS) play a fundamental role in angiogenesis, and in turn, angiogenic growth factors also affect ROS. Angiogenesis and ROS are intricately involved in vascular deterioration. Since black populations are known to have elevated oxidative stress and hypertension, we determined whether relationships exist between angiogenic growth factors and serum peroxides in Africans and Caucasians and evaluated the relationships with cardiovascular measurements. We measured vascular endothelial growth factor-A (VEGF), angiopoietin 2 (Ang-2), and serum peroxides in Africans (N = 262) and Caucasians (N = 364) aged 20 to 70 years. Africans displayed higher blood pressure, serum peroxide levels, VEGF, and Ang-2 (all P ≤ .002) than similarly aged Caucasians (P = .44). In multivariable adjusted analyses, Ang-2 was independently associated with serum peroxides in African men (R² = 0.31 β = 0.21 P = .014) and women (R² = 0.09 β = 0.22 P = .025) and VEGF with serum peroxides in African men (R² = 0.12 β = 0.24 P = .014), with no statistically significant associations in Caucasians. Cardiovascular measurements did not associate with serum peroxides or angiogenic factors in any subgroup. Significant independent relationships exist between angiogenic growth factors and serum peroxides only in Africans who also displayed an unfavorable cardiovascular profile when compared with Caucasians. These results suggest that interplay between ROS and angiogenesis occur in African in iduals that may form part of the mechanisms involved in vascular deterioration.
Publisher: Wiley
Date: 07-2018
DOI: 10.1111/JCH.13329
Publisher: Oxford University Press (OUP)
Date: 10-02-2014
DOI: 10.1093/AJH/HPT288
Abstract: Increased urinary albumin excretion reflects general vascular damage and predicts adverse cardiovascular and renal outcomes. Albuminuria can be determined from easily collected spot urine s les, especially in low-resource settings. However, no prognostic evidence exists for Africans. We followed clinical outcomes in 1,061 randomly selected non diabetic, human immunodeficiency virus (HIV)-negative Africans (mean age: 51.5 years 62.0% women). Baseline urinary albumin-to-creatinine ratio was assessed from spot urine s les. Over a median follow-up of 4.52 years, 132 deaths occurred, of which 47 were cardiovascular related. The urinary albumin-to-creatinine ratio averaged 6.1 μg/mg (5th to 95th percentile interval 1.2-70.0). In multivariable-adjusted analyses, urinary albumin excretion predicted all-cause mortality (hazard ratio (HR), 1.26 95% confidence interval (CI), 1.07-1.48 P = 0.006), and a tendency existed for cardiovascular mortality (HR, 1.26 95% CI, 0.97-1.63 P = 0.087), which seemed to be driven by fatal stroke (HR, 1.72 95% CI, 1.17-2.54 P = 0.006) rather than cardiac mortality (HR, 0.67 95% CI, 0.41-1.07 P = 0.094). The predictive value remained in 528 hypertensives for both all-cause (HR, 1.38 95% CI, 1.13-1.69 P = 0.001) and cardiovascular (HR, 1.45 95% CI, 1.07-1.96 P = 0.017) mortality, again driven by stroke. Our findings also remained significant after we excluded participants with macroalbuminuria, those on antihypertensive treatment, as well as participants who died within 1 year after enrollment. In nondiabetic HIV-negative Africans, albuminuria predicts all-cause and stroke mortality.
Publisher: Wiley
Date: 13-07-2020
DOI: 10.1111/ECI.13330
Publisher: Wiley
Date: 19-04-2022
DOI: 10.5694/MJA2.51498
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 04-08-2018
DOI: 10.1007/S00394-018-1800-4
Abstract: In the Original publication of the article Fig. 1 was published incorrectly. The correct figure is given below. The original article has been corrected.
Publisher: Georg Thieme Verlag KG
Date: 18-10-2007
Abstract: Ethnic differences in obesity and obesity related disorders prompted us to search for possible contributors. The impact of the novel cardiovascular risk factor asymmetric dimethylarginine (ADMA) has been never determined in the African population. The present observational study aimed to compare ADMA levels between healthy African (102) and Caucasian women (115) from South Africa, and its impact on glucose metabolism. All participants underwent an oral glucose tolerance test with measurements of glucose, insulin, C-peptide, proinsulin and free fatty acids before and after 30, 60, 90, 120 minutes. Fasting serum ADMA was measured by ELISA assay and obesity was determined by anthropometry. Serum ADMA did not differ between the ethnic groups. After stratification according to ADMA quartiles Caucasian women in the upper quartile had significantly higher body mass index and waist circumference as well as elevated insulin resistance, insulin, C-peptide and proinsulin levels with no differences in serum glucose compared to women in the lowest quartile. There was a significant stronger postchallenge insulin response in Caucasian women of the upper quartile. No differences were found in African women. Despite similar ADMA levels in both ethnic groups ADMA was positively correlated with parameters of glucose metabolism in the Caucasian but not in the African women from South Africa.
Publisher: Springer Science and Business Media LLC
Date: 28-11-2014
DOI: 10.1038/JHH.2013.124
Abstract: It is known that low testosterone (T) and high cortisol levels are associated with hypertension as well as with chronic stress, linking stress with elevated blood pressure (BP). However, the association between acute stress-, chronic stress responses and BP is not clear in Africans. Therefore, we examined the association between cortisol, psychological distress and BP responses in low- and high-T male subgroups. Beat-to-beat and ambulatory blood pressure (ABPM) and electrocardiogram measures were obtained. Serum s les were collected and analyzed for sex hormones and cortisol. Chronic psychological distress was verified with the General Health Questionnaire and acute stress with the cold pressor test. More chronic psychological distress was observed in both low- and high-T Africans compared with the Caucasians. The low-T Africans tended to have more ischemic events (P=0.06) and ABPM values (P⩽0.01) than any of the other groups. Both chronic distress (cortisol) and acute stress (total peripheral resistance cold pressor responses) were associated with ABPM in the low-T African group. Acute and chronic stress may contribute to increased BP in low-T African men. Their cortisol and vascular responses supported a tendency for ischemia, increasing their risk for coronary artery disease.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.JASH.2016.08.007
Abstract: Limited number of studies on salt intake has been conducted in the South Africa. The present study established the sodium and potassium excretion (24-hour urine collection) of three different South African populations. In total, 692 successful 24-hour urine collections were analyzed for sodium, potassium, and iodine levels. The median sodium and potassium excretion was 122.9 and 33.5 mmol/d, respectively, and the median salt intake was 7.2 g/d. The majority (92.8%) of the population did not meet the recommended potassium intake/d, and 65.6% consumed more than 6 g of salt/d. Potassium excretion showed a linear relationship with salt intake (P-trend ≤ .001). The median sodium-to-potassium ratio was 3.5. These findings support the South African government's sodium reduction legislation, as well as global initiatives. More consideration should be given to promoting the intake of potassium-rich foods, as this may have a greater public health impact than focusing only on dietary sodium reduction.
Publisher: Hogrefe Publishing Group
Date: 07-2004
DOI: 10.1024/0300-9831.74.4.285
Abstract: Numerous observational studies showed associations of antioxidants (vitamins C and E) and folate intake with a reduced risk of cardiovascular disease, but randomized controlled clinical trials have generally not supported this hypothesis. The objective of this study was to investigate the effects of a daily dosage of 1000 mg vitamin C, 800 mg vitamin E, and 10 mg folate on markers of vascular function in 31 young healthy male adults. Cardiovascular values after a 12-week vitamin (14 subjects) or placebo (17 subjects) intervention were compared to baseline values. Cardiovascular parameters (blood pressure, stroke volume, heart rate, cardiac output, vascular resistance, arterial compliance) were measured continuously after an overnight fast under controlled circumstances with a Finometer device. Our main finding was a significant decrease (p = 0.03) in systolic blood pressure in the experimental group. No statistically significant changes were observed within other cardiovascular variables of the experimental group, but possible beneficial decreases in diastolic blood pressure and increases in arterial compliance after 12 weeks of vitamin supplementation were indicated. In conclusion, beneficial effects of antioxidants and folate were observed probably because the supplementation was used by young healthy subjects under carefully controlled conditions.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.REGPEP.2011.04.003
Abstract: Ageing is associated with elevated adiponectin levels. Our aim was to assess whether age-related increase in adiponectin is associated with a decrease in renal function. The study comprised African (N=277) and Caucasian (N=326) men and women. Adiponectin levels, estimated creatinine clearance rate and obesity indices were determined. African men revealed significantly higher adiponectin levels compared to Caucasian men (p<0.01), reflecting the lower adiposity levels of the African men. No difference in obesity measures (p=0.92) and adiponectin levels (p=0.27) was observed between African and Caucasian women. A significant increase in adiponectin levels with ageing was observed in both African men and women (p<0.01). To the contrary, progressive ageing seems not to be significantly related to elevated adiponectin levels within Caucasians. Renal impairment decreased significantly within all of the groups (p<0.01). Single regression analyses performed in all specified groups revealed significant associations between adiponectin and estimated creatinine clearance, however a multiple regression model revealed that insulin resistance had the strongest association with adiponectin within all the groups. In conclusion, age-related rise in adiponectin levels observed in Africans may not be due to renal impairment.
Publisher: Informa UK Limited
Date: 05-2014
DOI: 10.3109/08037051.2014.901008
Abstract: Increased angiogenic factors [vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2)] have been associated with vascular dysfunction and hypertension. Black Africans undergoing rapid urbanization present with elevated blood pressure (BP) and we aimed to determine whether angiogenic factors are elevated in urban versus rural Africans with normal and elevated BP. Africans (n = 272), matched for gender and age, were recruited from rural and urban communities in South Africa. Omron HEM-757 BP data were obtained and angiogenic markers in plasma and serum were determined. Urban African men displayed a higher (43.90%) hypertension prevalence compared with their rural counterparts (18.52%) and disturbed angiongenic factors. Adjusted VEGF-A concentrations were higher in urban men and women compared with their rural counterparts. Similar VEGF-A levels were observed in rural and urban hypertensives. Logistic regression analysis demonstrated that VEGF-A and Ang-2 levels were associated with psychosocial stress but not with hypertensive status in Africans [odds ratios 1.01-1.09 (95% CI 1.01-1.15), p ≤ 0.05]. Psychosocial stress per se was associated with disturbed VEGF-A and Ang-2. We suggest that hyperkinetic BP may act as compensatory mechanism when chronic psychosocial stress prevails, affecting vascular functioning and subsequent increased cardiovascular disease risk.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.JASH.2014.12.003
Abstract: Evidence of the relationship between left ventricular hypertrophy and urinary albumin excretion is contradictory and limited in black adults in whom hypertensive heart disease is common. We aimed to investigate the relationship between subclinical left ventricular hypertrophy and albuminuria in non-diabetic hypertensive blacks. Urinary albumin-to-creatinine ratio (UACR) was determined from 8-hour overnight urine collection. We recorded ambulatory blood pressure and 12-lead electrocardiogram during a typical working day. Cornell product (P = .002), UACR (P = .042), 24-hour systolic pressure (P < .0001), and 24-hour pulse pressure (P < .0001) were higher in the hypertensive group. Cornell product was associated with UACR in single (r = 0.25 P = .012), partial (P trend = .002), and multiple regression (β = 0.326 P = .0005) analyses in the hypertensive group only, even below the threshold for microalbuminuria and independent of 24-hour systolic pressure. Urinary albumin excretion is associated with subclinical left ventricular hypertrophy in non-diabetic hypertensive blacks and may be a useful marker of early cardiovascular disease in blacks.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Publisher: Wiley
Date: 08-01-2020
DOI: 10.1111/JCH.13775
Publisher: Informa UK Limited
Date: 29-09-2011
DOI: 10.3109/10641963.2011.561897
Abstract: In Africans, arterial stiffness progression seems more pronounced compared to Caucasians. We compared the arterial stiffness profiles of different age groups and focused on muscular arteries and two more central arterial segments in African and Caucasian people from South Africa. In African (N = 374) and Caucasian (N = 376) participants (20-70 years), we measured carotid-radial (C-R) and carotid-dorsalis pedis (C-DP) pulse wave velocity (PWV) and aortic characteristic impedance (Zao). Major findings were that normotensive and high-normal/hypertensive (HT) Caucasians indicated increased trends of C-R PWV with aging (P = .029 and P = .067), not seen in the African groups (P = .122 and P = .526). Both ethnic groups showed significant increases of C-DP PWV and Zao with aging. High-normal/hypertensive Africans had significantly stiffer arteries than hypertensive Caucasians for almost all age groups, and for all stiffness measures. African C-R PWV correlated significantly with blood pressure (BP), but not with age. Opposite results were observed for Caucasians. In conclusion, the stiffness of muscular arteries is already elevated in young Africans, in both those with normal or elevated BP. This is possibly due to an earlier deterioration during childhood, or perhaps already present from birth. Also, in Caucasians stiffness seems more age-related, while in Africans it seems to be more pressure-related.
Publisher: Oxford University Press (OUP)
Date: 11-10-2022
DOI: 10.1093/CVR/CVAC130
Abstract: Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
Publisher: Springer Science and Business Media LLC
Date: 20-04-2020
DOI: 10.1038/S41591-020-0807-6
Abstract: A double burden of malnutrition occurs when in iduals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of % in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2020
DOI: 10.1038/S41371-019-0287-7
Abstract: Mounting evidence supports the central role of oxidative stress and inflammation in obesity and the development of hypertension. However, most studies focusing on the non-enzymatic antioxidants, such as uric acid and bilirubin, and their relationship with obesity and hypertension were done in older populations with overt cardiovascular disease. The aim of this study was therefore to compare measures of cardiovascular function (blood pressure and arterial stiffness) and non-enzymatic antioxidants (uric acid and bilirubin) between young healthy lean and overweight/obese men and women and to investigate the link between these variables. We grouped 967 men and women (aged 20-30 years) according to body mass index (BMI) categories (lean BMI < 25 kg/m
Publisher: Elsevier BV
Date: 09-2023
Publisher: South African Medical Association NPC
Date: 20-01-2014
DOI: 10.7196/SAMJ.7739
Abstract: The prevalence of HIV is the highest in sub-Saharan Africa South Africa (SA) is one of the most affected countries with the highest number of adults living with HIV infection in the world. Besides the traditional risk factors for cardiovascular disease (CVD) in the general population, in people living with HIV there are specific factors - chronic inflammation, metabolic changes associated with the infection, therapy, and lipodystrophy - that potentially increase the risk for developing CVD. This study proposes a screening discriminant model to identify the most important risk factors for the development of CVD in a cohort of 140 HIV-infected black Africans from the North West Province, SA. Anthropometric measures, systolic blood pressure, diastolic blood pressure and the carotid-dorsalis pedis pulse wave velocity were determined. Blood was analysed to determine the levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, triglycerides (TGs) and glucose. Partial least squares discriminant analysis was performed as a supervised pattern recognition method. Independent Student's t-tests were further employed to compare the means of risk factors on interval scales for comparison of categorical risk factors between groups, chi2 tests were used. A TG:HDL-C ratio > or = 1.49, TC:HDL-C ratio > or = 5.4 and an HDL-C level < or = 0.76 mmol/l indicated CVD risk in this cohort of patients living with HIV. The results have important health implications for black Africans living with HIV as these lipid levels may be a useful indicator of the risk for CVD.
Publisher: MDPI AG
Date: 20-03-2020
DOI: 10.3390/JCM9030844
Abstract: Proteinic arginine dimethylation (PADiMe) is a major post-translational modification. Proteolysis of asymmetric and symmetric PADiMe products releases asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), respectively, two endogenous atherogenic substances. SDMA, ADMA, and its major metabolite dimethylamine (DMA) are eliminated by the kidney. The urinary concentrations of DMA+ADMA, SDMA, and DMA+ADMA+SDMA are useful measures of the whole-body asymmetric and symmetric PADiMe, respectively. Urinary (DMA+ADMA)/SDMA is an index of the asymmetric to symmetric PADiMe balance. In two bi-ethnic studies, the ASOS (39 black boys, 41 white boys) and the African-PREDICT (292 black young men, 281 white young men) studies, we investigated whether ethnicity is a major determinant of PADiMe, and whether PADiMe is associated with blood pressure and ethnicity-dependent growth and inflammatory factors, including HDL. DMA, ADMA, and SDMA were measured in spot urine s les by gas chromatography–mass spectrometry, and their excretion was corrected for creatinine excretion. In black boys, creatinine-corrected DMA, DMA+ADMA, and DMA+ADMA+SDMA concentrations were lower by 11.7%, 9.5%, and 7.6% (all p 0.05), respectively, compared to the white boys, and 3.4%, 2.0%, and 1.8% lower (all p 0.05), respectively, in black compared to white men. (DMA+ADMA)/SDMA did not differ between black boys and black men, but was higher in white boys compared to white men. ADMA did not differ between black and white boys, or between black and white men. Creatinine-corrected SDMA excretion was lower in black boys compared to white boys (by 8%) and to white men (by 3.1%). None of the PADiMe indices were associated with blood pressure in either study. IGF-binding protein 3 correlated inversely with all PADiMe indices in the black men only. Our study showed that asymmetric proteinic arginine dimethylation is higher in white boys than in black boys, and that this difference disappears in adulthood. ADMA metabolism and SDMA excretion were lower in the black subjects compared to the white subjects, suggesting ethnicity-dependent hepatic and renal elimination of ADMA and SDMA in the childhood. The results of our study may have clinical relevance beyond atherosclerosis, such as in growth and inflammation, which have not been sufficiently addressed thus far.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2019
DOI: 10.1038/S41371-018-0089-3
Abstract: An exaggerated morning blood pressure surge (MBPS) has independent predictive value for cardiovascular mortality and is suggested to be prevalent in elderly hypertensive patients: men and white populations. To better understand the MBPS profile in a young and normotensive population, we evaluated the MBPS in young adults and explored associations with demographic, cardiovascular and health behaviour measurements. We included 845 black (n = 439) and white (n = 406) men and women aged between 20 and 30 years. We calculated the sleep-trough and dynamic morning surge, and compared demographic data, health behaviours and ambulatory blood pressure according to MBPS quartiles. In the total group, higher waist circumference, socioeconomic score, lean mass, ambulatory blood pressure (24-h, daytime blood pressure) and increased night-time dipping (all p < 0.05) were found in the highest sleep-trough and dynamic morning surge quartiles. In the total white group, particularly men, both sleep-trough and dynamic morning surge were higher than the black group (all p < 0.013). More black participants were non-dippers than whites (44% vs 34% p = 0.004). In multivariable adjusted regression in the total group, we found no consistent associations of MBPS with demographic and health behaviour measurements. MBPS related independently and positively with night-time percentage dipping in all ethnic groups (all p < 0.01). Ethnic differences in MBPS is evident in young adults, with a higher, but normal MBPS in white men. A non-dipping night-time pattern in young black adults (with reduced MBPS) and a higher MBPS (observed in dippers) may serve as potential risk factors for cardiovascular disease.
Publisher: Springer Science and Business Media LLC
Date: 03-12-2020
DOI: 10.1038/S41371-020-00453-9
Abstract: Lower nitric oxide (NO) bioavailabilty associates with hypertension in patients and elderly populations. With hypertension known to develop earlier in black populations, we compared both plasma and urinary NO-related markers and their associations with central systolic blood pressure (cSBP) and arterial stiffness in healthy young black and white adults. We included healthy black and white men and women (n = 1110 20-30 years) and measured cSBP and pulse wave velocity (PWV), along with both plasma and urinary arginine, homoarginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), as well as urinary ornithine/citrulline, nitrite and nitrate. In addition, the urinary nitrate-to-nitrite ratio (U
Publisher: Research Square Platform LLC
Date: 03-02-2023
DOI: 10.21203/RS.3.RS-2366159/V1
Abstract: Introduction: The VALID BP project was initiated to increase the availability of validated blood pressure measuring devices (BPMDs). The goal is to eliminate non validated BPMDs and minimise over- and underdiagnosis of hypertension caused by inaccurate readings. This study was undertaken to assess the potential return on investment in the VALID BP project. Methods: The Framework to Assess the Impact of Translational health research was applied to the VALID BP project. One of the three methods used included a cost benefit analysis to monetise past research investment and model future research costs, implementation costs and benefits. Analysis was based on reasoned assumptions about potential impacts from availability and use of validated BPMDs (assuming an end goal of 100% validated BPMDs available in Australia by 2028) and improved skills leading to more accurate BP measurement. Results: After five years, with 20% attribution of benefits, there is a potential $1.29 return for every dollar spent if the proportion of validated BPMDs and staff trained in proper BP measurement technique increased from 20–60%. After eight years (2020–2028) and assuming universal validation and training coverage, the returns would be $3.20 per dollar spent (not including cost of side-effects of unnecessary medication or downstream patient impacts from unmanaged hypertension). Conclusion: This modelled economic analysis indicates there will be positive downstream economic benefits if the availability of validated BPMDs is increased. The findings support ongoing efforts toward a universal regulatory framework for BPMDs and can be considered within more detailed future economic analyses.
Publisher: Elsevier BV
Date: 09-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Publisher: Hindawi Limited
Date: 27-05-2022
DOI: 10.1155/2022/9998891
Abstract: Background. The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined in idual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk factors. Methods. Within the CREDENCE cohort with adjudicated fracture outcomes, we assessed the association of in idual factors with fracture using Cox regression models. We used the Akaike information criteria (AIC) and Schwartz Bayes Criterion (SBC) to assess six separate variable sets based on hypothesized associations with fracture, namely, traditional osteoporosis, exploratory general population findings, cardiovascular risk, CKD-mineral and bone disorder, diabetic osteodystrophy, and an all-inclusive set containing all variables. Results. Fracture occurred in 135 (3.1%) participants over a median 2.35 [1.88–2.93] years. Independent fracture predictors were older age (hazard ratio [HR] 1.04, confidence interval [CI] 1.01–1.06), female sex (HR 2.49, CI 1.70–3.65), previous fracture (HR 2.30, CI 1.58–3.34), Asian race (HR 1.74, CI 1.09–2.78), vitamin D therapy requirement (HR 2.05, CI 1.31–3.21), HbA1c (HR 1.14, CI 1.00–1.32), prior cardiovascular event (HR 1.60, CI 1.10–2.33), and serum albumin (HR 0.41, CI 0.23–0.74) (lower albumin associated with greater risk). The goodness of fit of the various hypothesis sets was similar (AIC range 1870.92–1849.51, SBC range 1875.60–1948.04). Conclusion. Independent predictors of fracture were identified in the CREDENCE participants with type 2 diabetes and CKD. Fracture prediction was not improved by models built on alternative pathophysiology hypotheses compared with traditional osteoporosis predictors.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.IJCARD.2012.03.014
Abstract: 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. 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. 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. Double product may not be a good marker of increased cardiovascular risk when compared to systolic blood pressure in African and Caucasian men.
Publisher: Wiley
Date: 15-12-2015
DOI: 10.1111/JCH.12455
Publisher: Oxford University Press (OUP)
Date: 11-07-2018
Abstract: The endogenous steroidal inhibitor of sodium–potassium-dependent adenosine triphosphate and natriuretic hormone, marinobufagenin, plays a physiological role in ionic homeostasis. Animal models suggest that elevated marinobufagenin adversely associates with cardiac and renal, structural and functional alterations. It remains uncertain whether marinobufagenin relates to the early stages of target organ damage development, especially in young adults without cardiovascular disease. We therefore explored whether elevated 24-hour urinary marinobufagenin excretion was related to indices of subclinical target organ damage in young healthy adults. This cross-sectional study included 711 participants from the African-PREDICT study (black 51%, men 42%, 24.8 ± 3.02 years). We assessed cardiac geometry and function by two-dimensional echocardiography and pulse wave Doppler imaging. 24-Hour urinary marinobufagenin and sodium excretion were measured, and the estimated glomerular filtration rate determined. Across marinobufagenin excretion quartiles, left ventricular mass ( P 0.001), end diastolic volume ( P 0.001), stroke volume ( P = 0.004) and sodium excretion ( P 0.001) were higher within the fourth compared with the first quartile. Partial regression analyses indicated that left ventricular mass ( r = 0.08, P = 0.043), end diastolic volume ( r = 0.10, P = 0.010) and stroke volume ( r = 0.09, P = 0.022) were positively related to marinobufagenin excretion. In multivariate-adjusted regression analysis, left ventricular mass associated positively with marinobufagenin excretion only in the highest marinobufagenin excretion quartile (adjusted R 2 = 0.20 β = 0.15 P = 0.043). This relationship between left ventricular mass and marinobufagenin excretion was evident in women (adjusted R 2 = 0.06 β = 0.127 P = 0.015) but not in men (adjusted R 2 = 0.06 β = 0.007 P = 0.92). Left ventricular mass positively and independently associates with marinobufagenin excretion in young healthy adults with excessively high marinobufagenin excretion. Women may be more sensitive to the effects of marinobufagenin on early structural cardiac changes.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2004
Publisher: Wiley
Date: 05-12-2022
DOI: 10.5694/MJA2.51350
Publisher: Elsevier BV
Date: 07-2018
Publisher: Georg Thieme Verlag KG
Date: 22-12-2009
Abstract: This study was aimed to compare prevalences of the metabolic syndrome in Africans using five definitions as proposed by the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel (ATPIII)], the American College of Endocrinology (ACE), and the International Diabetes Federation (IDF). A further objective was to identify difficulties in classifying Africans with the metabolic syndrome and to suggest specific areas where criteria adjustments for identifying Africans should be made. A case-case-control cross-sectional study involved 102 urban African women. Except for microalbumin data, all data necessary for classification of the metabolic syndrome were collected, including fasting and 2-h glucose and insulin, anthropometric measurements, blood pressure, and lipids. The metabolic syndrome prevalences ranged from 5.4% (EGIR), 15.7% (ATPIII), >or=19.4% (WHO), 24.8% (IDF) to 25.5% (ACE). Only 2.9% (n=3) had a triglyceride level >or=1.69 mmol/l, but 58.8% (n=60) had a HDL-level or=140/90 or used hypertension medication. It seems as if the classification of hypertension, insulin resistance and hyperglycemia might have been adequate, but body composition and dyslipidemia criteria need adjustment for Africans. Since neither definition seems completely suitable for Africans it is suggested that clinical emphasis should rather be on treating any specific cardiovascular disease risk factor that is present, than on diagnosing a patient with the metabolic syndrome.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.DIABRES.2009.04.014
Abstract: Ageing is associated with increased insulin and C-peptide levels. Due to a lack of data, our first aim was to establish whether this also holds true for Africans from South Africa. Our second aim was to determine whether an association between insulin/C-peptide levels and blood pressure exist within an African and Caucasian population with increasing age, as well as to establish gender differences. African men and women (N=260) and Caucasian men and women (N=369) were recruited and stratified into age groups (18-35 years, 36-45 years and >45 years). ANCOVAs and partial correlations were performed. Results showed opposing changes in insulin/C-peptide levels of African and Caucasian men with increasing age. Insulin/C-peptide tended to decrease in African men, whereas insulin tended to increase and C-peptide increased significantly (p=0.03) in Caucasian men. Despite similar obesity levels, the oldest African women had significantly lower insulin (p<0.01) and C-peptide (p<0.01) levels compared to their Caucasian counterparts. In conclusion, insulin/C-peptide levels tended to decrease in the African population with increasing age. Despite significantly lower levels of insulin, blood pressure levels of African men seems to be affected more detrimentally compared to their Caucasian counterparts, leaving them more vulnerable for the development of cardiovascular diseases.
Publisher: Public Library of Science (PLoS)
Date: 23-01-2013
Publisher: Springer Science and Business Media LLC
Date: 07-12-2022
Publisher: Oxford University Press (OUP)
Date: 12-2013
DOI: 10.1093/IJE/DYT198
Publisher: Springer Science and Business Media LLC
Date: 14-08-2020
DOI: 10.1186/S12916-020-01723-6
Abstract: After its outbreak in China, the novel COronaVIrus Disease 19 is spreading across the globe. It is an emergency the world has never seen before. The attention of health systems is mainly focused on COronaVIrus Disease 19 patients and on the risk that intensive care units might be overwhelmed by the serious pulmonary complications. Different countries are also attempting to establish infection prevention and control strategies which proved effective in China where the outbreak was initially reported. We reflect on important lessons to be learnt from different countries. The effects that infection prevention and control strategies, such as social distancing or isolation, can have on the care of millions of patients with non-communicable diseases, who may be indirectly affected, have not been taken into consideration so much. When dealing with COronaVIrus Disease 19, policy makers and healthcare personnel should consider the indirect effects on the treatment of non-communicable diseases.
Publisher: Informa UK Limited
Date: 30-08-2021
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.THROMRES.2011.10.034
Abstract: Elevated soluble urokinase-type plasminogen activator receptor (suPAR) indicates an inflammatory state caused by conditions such as HIV and cancer. Recently suPAR was identified as an indicator of cardiovascular disease (CVD). CVD is highly prevalent in black South Africans, but the potential role of suPAR is unknown. We investigated suPAR as a possible marker of arterial stiffness in Africans and Caucasians. This study involved 207 Africans and 314 Caucasians (aged 20-70 yrs). C-reactive protein (CRP) and suPAR were determined in fasting blood s les. We measured blood pressure, pulse wave velocity (PWV) and Windkessel arterial compliance (Cwk). Africans displayed higher suPAR, CRP, PWV and lower Cwk (p<0.001) compared to Caucasians. SuPAR was elevated in Africans irrespective of gender and smoking. We found strong relationships between PWV and suPAR (r=0.27 p<0.001) and Cwk and suPAR (r=-0.39 p<0.001) in the whole group, but found no independent relationship of any arterial stiffness measure and suPAR in Africans after adjustment for confounders. Caucasian men indicated a weak significant independent association between Cwk and suPAR (β=-0.09 p=0.028). Africans had higher levels of suPAR and arterial stiffness than Caucasians (p<0.001), but there was no independent relationship between arterial stiffness and suPAR in the Africans. It is speculated that due to the inflammatory role of suPAR, it will have stronger relationships with atherosclerosis, which has not yet manifested in this relatively young population group. SuPAR may therefore not be an ideal early marker of cardiovascular dysfunction, but may rather indicate established CVD.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2021
DOI: 10.1038/S41440-020-00566-1
Abstract: This study investigated associations of brachial and central blood pressure (BP) with detailed renin-angiotensin-aldosterone system (RAAS) components in a healthy young population stratified according to ethnicity and sex. We included healthy black men (n = 285) and women (n = 304) and white men (n = 278) and women (n = 305) aged 20-30 years old. We derived central systolic BP (cSBP), measured clinic and 24-h systolic and diastolic BP. Aldosterone and equilibrium angiotensin levels were assessed and used for calculating angiotensin-derived markers for plasma renin activity (PRA-S, Angiotensin I + Angiotensin II), angiotensin-converting enzyme (ACE-S, Angiotensin II/Angiotensin I), and two markers for adrenal effects of angiotensin II, the aldosterone-to-renin ratio (ARR-S, Aldosterone/PRA-S) and the aldosterone-to-angiotensin II-ratio (AA2-R, Aldosterone/Angiotensin II)
Publisher: Elsevier BV
Date: 10-2020
Publisher: Informa UK Limited
Date: 23-04-2011
DOI: 10.3109/10641963.2010.531842
Abstract: The aim was to determine whether blood glucose or cholesterol is the more prominent contributor to cardiovascular dysfunction in 101 African men and 99 African women. We measured ambulatory daytime blood pressure (BP), carotid intima-media thickness (CIMT), and determined blood glucose and lipids in serum. High-density lipoprotein cholesterol (HDL) (p = 0.002) and HDL: total cholesterol (HDL:TC) (p ≤ 0.001) were significantly lower, while serum glucose (p ≤ 0.001) was significantly higher in men. In single, partial, and multiple regression analysis, BP correlated positively with blood glucose in men. Furthermore, CIMT (B = -0.50 p = 0.009) correlated negatively with HDL:TC in men. While in women CIMT (B = 0.346 p = 0.015) correlated positively with glucose. In conclusion, subclinical atherosclerosis is significantly related to an unfavorable HDL profile in men, whereas in women, this link is stronger with fasting glucose.
Publisher: AOSIS
Date: 12-2016
Publisher: Informa UK Limited
Date: 21-10-2020
Publisher: Massachusetts Medical Society
Date: 06-07-2017
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.CLNU.2018.05.008
Abstract: The relationship between total body iron and cardiovascular disease remains controversial and information absent in black sub-Saharan Africans in whom alcohol consumption tends to be high. The level of total body iron is tightly regulated, however this regulation is compromised by high alcohol intake causing iron loading. The aim of this study is to investigate total body iron, as represented by serum ferritin, and its interaction with measures of alcohol intake in predicting all-cause and cardiovascular mortality. We followed health outcomes for a median of 9.22 years in 877 randomly selected HIV negative African women (mean age: 50.4 years). One hundred and five deaths occurred of which 40 were cardiovascular related. Ferritin averaged 84.0 (5th to 95th percentile interval, 7.5-533.3) ng/ml and due to the augmenting effect of inflammation, lowered to 75.3 (6.9-523.2) ng/ml after excluding 271 participants with high-sensitivity C-reactive protein (CRP) levels (above 8 mg/l). CRP increased by quartiles of ferritin in the total group (P trend = 0.002), but this relationship was absent after excluding the 271 participants with high CRP values (P trend = 0.10). Ferritin, gamma-glutamyl transferase and carbohydrate deficient transferrin (all P < 0.0001) were higher in drinkers compared to non-drinkers, but CRP was similar (P = 0.77). In multivariable-adjusted analyses, ferritin predicted both all-cause (hazard ratio, 2.08 95% confidence interval, 1.62-2.68 P < 0.0001) and cardiovascular (1.94 1.29-2.92 P = 0.002) mortality. In participants with CRP levels below or equal to 8 mg/l, the significant relationship remained between ferritin and all-cause (2.51 1.81-3.49 P < 0.0001) and cardiovascular mortality (2.34 1.45-3.76 P = 0.0005). In fully adjusted models, interactions existed between ferritin and gamma-glutamyl transferase, self-reported alcohol use and carbohydrate deficient transferrin in predicting all-cause (P ≤ 0.012) and cardiovascular mortality (P ≤ 0.003). Iron loading in African women predicted all-cause and cardiovascular mortality and the intake of alcohol seems mechanistically implicated.
Publisher: Elsevier BV
Date: 2015
No related grants have been discovered for Aletta Schutte.