Abstract
The aim of this study was to assess whether the pulse pressures (PPs) in people of African and South Asian descent differ from those of the European-origin White (henceforth, White) in the UK. A systematic literature review was carried out using MEDLINE 1966–2006 and EMBASE 1980–2006. The meta-analysis was performed using Cochrane review manager software (RevMan version 4.2; Oxford, UK). Thirteen studies were examined. Results for African descent men (n=9 studies) and women (n=7) indicated that African men and women had a higher mean PP than their White counterparts. Overall weighted mean difference (WMD) in PP was 1.68 (95% confidence interval: [0.38, 2.98 mm Hg]; P=0.01) in men and 2.01 ([0.39, 3.63 mm Hg]; P<0.001) in women. South Asian men (n=7 studies) had a lower mean PP than White men (−1.94; [−3.56, –0.32 mm Hg]; P=0.02), whereas no significant difference was found between South Asian and White women (n=5 studies) (−0.40; [−3.22, 2.39 mm Hg]; P=0.77). Separate data were available for Indians (n=5 studies), Bangladeshis (n=4) and Pakistanis (n=3). Bangladeshis had a lower PP than Whites (men, −5.61; [−6.87, –4.36 mm Hg]; P<0.001) (women, −5.21; [−8.67, −1.75 mm Hg]; P=0.003). Pakistani men had a lower PP than White men (−3.33 mm Hg; [−5.67, −1.00]; P<0.001). The WMD was nonsignificantly lower in Indian men (−0.76 mm Hg), Indian women (−0.80 mm Hg) and Pakistani women (−2.06 mm Hg). The higher PP found among African descent people may contribute to their more frequent hypertension complications. However, the lower PP in South Asian populations, particularly in Bangladeshis and Pakistani men, indicates that PP is unlikely to contribute to their higher risk of cardiovascular disease in the UK.
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References
Gill PS, Kai J, Bhopal RS, Wild S . Health care needs assessment: Black and Minority Ethnic Groups. In: Raftery J (ed). Health Care Needs Assessment. The Epidemiologically Based Needs Assessment Reviews. Third Series. Radcliffe Medical Press Ltd: Abingdon, (in press), available at: http://www.hcna.radcliffe-online.com/bemgframe.htm.
Bhopal R . Glossary of terms relating to ethnicity and race: for reflection and debate. J Epidemiol Community Health 2003; 58: 441–445.
Agyemang C, Bhopal RS . Is the blood pressure of South Asian adults in the UK higher or lower than that in European white adults? A review of cross-sectional data. J Hum Hypertens 2002; 16: 739–751.
Agyemang C, Bhopal R . Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data. J Hum Hypertens 2003; 17: 523–534.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.
Madhavan S, Ooi WL, Cohen H, Alderman MH . Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension 1994; 23: 395–401.
Franklin SS, Khan SA, Wong ND, Larson MG, Levy D . Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation 1999; 100: 354–360.
Mitchell GF, Moye LA, Braunwald E, Rouleau JL, Bernstein V, Geltman EM et al. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and ventricular enlargement. Circulation 1997; 96: 4254–4260.
Domanski M, Mitchell G, Pfeffer M, Neaton JD, Norman J, Svendsen K et al. Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 2002; 287: 2677–2683.
Nichols W, O’Rourke M . McDonald's Blood Flow in Arteries. Lea & Febiger: Philadelphia, PA, 1998.
Paultre F, Mosca L . Association of blood pressure indices and stroke mortality in isolated systolic hypertension. Stroke 2005; 36: 1288–1290.
Meade TW, Brozovic M, Chakrabarti R, Haines AP, North WR, Stirling Y . Ethnic group comparisons of variables associated with ischaemic heart disease. Br Heart J 1978; 40: 789–795.
Sever PS, Peart WS, Meade TW, Davies IB, Gordon D . Ethnic differences in blood pressure with observation on noradrenaline and renin. Clin Exp Hypertens 1979; 1: 733–744.
Haines AP, Boorof A, Goldenberg E . Blood pressure, smoking, obesity and alcohol consumption in blacks and whites in general practice. J Hum Hypertens 1987; 1: 39–46.
Primatesta P, Bost L, Poulter NR . Blood pressure levels and hypertension status among ethnic groups in England. J Hum Hypertens 2000; 14: 143–148.
Cruickshank JK, Mbanya JC, Wilks R, Balkau B, Forrester T, Anderson SG et al. Hypertension in four African-origin populations: current ‘Rule of Halves’, quality of blood pressure control and attributable risk of cardiovascular disease. J Hypertens 2001; 19: 41–46.
McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA . Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J 1988; 60: 390–396.
Miller GJ, Kotecha S, Wilkinson WH, Wilkes H, Stirling Y, Sanders TA et al. Dietary and other characteristics relevant for coronary heart disease in men of Indian, West Indian and European descent in London. Atherosclerosis 1988; 70: 63–72.
Cruickshank JK, Cooper J, Burnett M, MacDuff J, Drubra U . Ethnic differences in fasting plasma C-peptide and insulin in relation to glucose tolerance and blood pressure. Lancet 1991; 338: 842–847.
McKeigue PM, Shah B, Marmot MG . Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991; 337: 382–386.
Knight TM, Smith Z, Whittles A, Sahota P, Lockton JA, Hogg G et al. Insulin resistance, diabetes, and risk markers for ischaemic heart disease in Asian men and non-Asian in Bradford. Br Heart J 1992; 67: 343–350.
Chaturvedi N, McKeigue PM, Marmot MG . Resting and ambulatory blood pressure differences in Afro-Caribbeans and Europeans. Hypertension 1993; 22: 90–96.
Williams R, Bhopal R, Hunt K . Health of a Punjabi ethnic minority in Glasgow: a comparison with the general population. J Epidemiol Community Health 1993; 47: 96–102.
Cappuccio FP, Cooj DG, Atkinson RW, Wicks PD . The Wandsworth Heart and Stroke Study. A population based survey of cardiovascular risk factors in different ethnic groups. Methods and baseline findings. Nutr Metab Cardiovasc Dis 1998; 8: 371–385.
Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999; 319: 215–220.
Whitty CJ, Brunner EJ, Shipley MJ, Hemingway H, Marmot MG . Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study. Atherosclerosis 1999; 142: 279–286.
Karlsen S, Primatesta P, McMum A . Blood pressure. Chapter 7. In: Erens B, Primatesta P, Prior G (eds). Health Survey for England: The Health of Minority Ethnic Groups ‘99. The Stationary Office: London, 2001, pp 175–197.
Lane D, Beevers DG, Lip GYH . Ethnic differences in blood pressure and prevalence of hypertension in England. J Hum Hypertens 2002; 16: 267–273.
Chaudhury M, Zaninotto P . Blood pressure. Chapter 7. In: Sproston K, Mindell J (eds). The Health of Minority Ethnic Groups: Health Survey for England 2004. The Stationary Office: London, 2006, pp 205–215.
Agyemang C, Bhopal R, Bruijnzeels M, Redekop WK . Does nocturnal blood pressure fall in people of African and South Asian descent differ from that in European white populations? A systematic review and meta-analysis. J Hypertens 2005; 23: 913–920.
Abernethy J, Borhani NO, Hawkins CM, Crow R, Entwisle G, Jones JW et al. Systolic blood pressure as an independent predictor of mortality in the Hypertension Detection and Follow-up Program. Am J Prev Med 1986; 2: 123–132.
Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000; 160: 1085–1089.
Rogers RG, Onge JM . Race/ethnic and sex differentials in pulse pressure among us adults. Ethn Dis 2005; 15: 601–606.
Din-Dzietham R, Couper D, Evans G, Arnett DK, Jones DW . Arterial stiffness is greater in African Americans than in Whites: evidence from the Forsyth County, North Carolina, ARIC cohort. Am J Hypertens 2004; 17: 304–313.
Li S, Chen W, Srinivasan SR, Berenson GS . Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa heart study. Hypertension 2004; 43: 541–546.
Toto-Moukouo JJ, Achimastos A, Asmar RG, Hugues CJ, Safar ME . Pulse wave velocity in patients with obesity and hypertension. Am Heart J 1986; 112: 136–140.
Patel KC, Bhopal RS (eds) The Epidemic of Coronary Heart Disease in South Asian Populations: Causes and Consequences. South Asian Health Foundation: London, 2004, P145.
Bhopal R, Rahemtulla T, Sheikh A . Persistent high stroke mortality in Bangladeshi populations. BMJ 2005; 331: 1096–1097.
Senior PA, Bhopal R . Ethnicity as a variable in epidemiological research. BMJ 1994; 309: 327–330.
Agyemang C, Bhopal R, Bruijnzeels M . Negro, Black, Black African, African Caribbean, African American or what? Labelling African origin populations in the health arena in the 21st century. J Epidemiol Community Health 2005; 59: 1014–1018.
Acknowledgements
We thank Dr Paola Zaninotto (University College London) for providing age-adjusted PP values for both Health Survey for England 1999 and 2004 and Dr Deirdre Lane (University of Birmingham) for providing age-adjusted PP values for the Birmingham Factory Screen cohort. We thank Professor Karien Stronks and Dr Irene van Valkengoed (Amsterdam Medical Centre) and Dr A de Jonge (University of Nijmegen) for providing very useful comments on an earlier draft. We are also indebted to the reviewer who provided comments that helped to improve an earlier version of this paper.
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Agyemang, C., Bhopal, R. & Redekop, W. Does the pulse pressure in people of European, African and South Asian descent differ? A systematic review and meta-analysis of UK data. J Hum Hypertens 21, 598–609 (2007). https://doi.org/10.1038/sj.jhh.1002191
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DOI: https://doi.org/10.1038/sj.jhh.1002191
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