Article

Racial Differences in Incident Heart Failure During Antihypertensive Therapy

Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA.
Circulation Cardiovascular Quality and Outcomes (Impact Factor: 5.66). 02/2011; 4(2):157-64. DOI: 10.1161/CIRCOUTCOMES.110.960112
Source: PubMed

ABSTRACT

Blacks have a higher prevalence of heart failure (HF) than nonblacks, possibly reflecting a greater burden of HF risk factors, including hypertension. Although HF incidence is significantly higher in blacks during long-term follow-up of young adults, the relationship of incident HF to race in hypertensive patients undergoing treatment is unclear.
Incident HF was evaluated in 497 black and 8199 nonblack hypertensive patients with no history of HF randomly assigned to losartan- or atenolol-based treatment. During 4.7±1.1 years mean follow-up, HF hospitalization occurred in 265 patients (3.0%); 5-year HF incidence was significantly greater in black than nonblack patients (7.0 versus 3.1%, P<0.001). In Cox multivariate analyses adjusting for randomized treatment, age, sex, the presence of the strain pattern on the baseline ECG, and other HF risk factors treated as standard covariates, and for incident myocardial infarction, in-treatment QRS duration, diastolic and systolic pressure, Cornell product, and Sokolow-Lyon voltage criteria for left ventricular hypertrophy (LVH) treated as time-varying covariates, black race remained associated with a 130% increased risk of developing new HF (hazard ratio 2.30, 95% confidence interval 1.24 to 4.28).
Incident HF is substantially more common among black than nonblack hypertensive patients. The increased risk of developing new HF in blacks persists after adjusting for the higher prevalence of HF risk factors in blacks, for treatment effects and in-treatment blood pressure, and for the known predictive value of the ECG strain pattern and in-treatment ECG LVH and QRS duration for incident HF in this population. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.

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    • "It is a major risk factor for coronary artery disease all-cause mortality even in the absence of symptoms and other cardiovascular risk factors [26]. The effect is even more prominent in black patients [27] where it was found to be associated with greater relative and attributable risk than the traditional risk factors for coronary disease [28]. "
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    ABSTRACT: Left ventricular hypertrophy (LVH) is an independent cardiovascular risk factor in patients with essential hypertension. The main objective of this study was to assess the echocardiographic prevalence of left ventricular hypertrophy in patients with hypertension, its risk factors and effect of antihypertensive drugs on its prevalence. A hospital based cross sectional study was conducted on 200 hypertensive patients on treatment in southwest Ethiopia. A pretested structured questionnaire was used to collect data from participants and their clinical records. Blood pressure and anthropometric measurements were taken according to recommended standards. Left ventricular mass was measured by transthoracic echocardiography. Associations between categorical variables were assessed using chi-square test and odds ratio with 95% confidence interval. Logistic regression model was done to identify risks factors of LVH. P values of < 0.05 were considered as statistically significant. The mean age, systolic blood pressure, diastolic blood pressure and body mass index were 55.7 +/- 11.3 years, 139.2 +/- 7.7 mmHg, 89.2 +/- 5.7 mmHg and 24.2 +/- 3.4 Kg/m2 respectively. The overall prevalence of LVH among these study subjects was 52%. Age >=50 years (OR: 3.49, 95% CI 1.33-9.14, P = 0.011), female gender (OR: 7.69, 95% CI 3.23-20.0, P < 0.001), systolic blood pressure >=140 mmHg (OR: 2.85, 95% CI 1.27-6.41, P = 0.011), and duration of hypertension (OR: 3.59, 95% CI 1.47-8.76, P = 0.005) were independent predictors of left ventricular hypertrophy. Angiotensin converting enzyme (ACE) inhibitors were the only antihypertensive drugs associated with lower risk of left ventricular hypertrophy (OR: 0.08, 95%CI 0.03-0.19, p < 0.001). Left ventricular hypertrophy was found to be highly prevalent in hypertensive patients in Ethiopia. ACE inhibitors were the only antihypertensive drugs associated with reduced risk of LVH. We thus recommend strategies to early detect and treat hypertension and to timely screen for LVH among patients with hypertension. Multicenter prospective studies in Africa settings would be ideal to identify the best antihypertensive agents in black Africans.
    Full-text · Article · Jan 2014 · BMC Research Notes
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    • "Atrial fibrillation (AF) is the most common type of persistent arrhythmia in the United States, with prevalence likely to rise and a burgeoning national healthcare cost burden [1]. Despite its familiarity, the well-known associated risk factors such as advancing age, hypertension [2], heart failure [3], diabetes [4], and larger body mass index [5] fail to fully account for the burden of risk leading to AF [6]. Recently, race and related genetic variants have been suggested as novel susceptibility factors contributing to the development of AF [7]. "
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    ABSTRACT: Background. It has been observed that African American race is associated with a lower prevalence of atrial fibrillation (AF) compared to Caucasian race. To better quantify the association between African American race and AF, we performed a meta-analysis of published studies among different patient populations which reported the presence of AF by race. Methods. A literature search was conducted using electronic databases between January 1999 and January 2011. The search was limited to published studies in English conducted in the United States, which clearly defined the presence of AF in African American and Caucasian subjects. A meta-analysis was performed with prevalence of AF as the primary endpoint. Results. In total, 10 studies involving 1,031,351 subjects were included. According to a random effects analysis, African American race was associated with a protective effect with regard to AF as compared to Caucasian race (odds ratio 0.51, 95% CI 0.44 to 0.59, P < 0.001). In subgroup analyses, African American race was significantly associated with a lower prevalence of AF in the general population, those hospitalized or greater than 60 years old, postcoronary artery bypass surgery patients, and subjects with heart failure. Conclusions. In a broad sweep of subjects in the general population and hospitalized patients, the prevalence of AF in African Americans is consistently lower than in Caucasians.
    Full-text · Article · Apr 2012 · Cardiology Research and Practice
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    • "Atrial fibrillation (AF) is the most common type of persistent arrhythmia in the United States, with prevalence likely to rise and a burgeoning national healthcare cost burden [1]. Despite its familiarity, the well-known associated risk factors such as advancing age, hypertension [2], heart failure [3], diabetes [4], and larger body mass index [5] fail to fully account for the burden of risk leading to AF [6]. Recently, race and related genetic variants have been suggested as novel susceptibility factors contributing to the development of AF [7]. "

    Full-text · Article · Apr 2012
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