Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Neurology, University of Florida, Gainesville, Florida, USA.
Am J Hypertens. 2022 Aug 1;35(8):715-722. doi: 10.1093/ajh/hpac046.
Race and geographic differences in the prevalence and predictors of hypertension in stroke survivors have been reported, but apparent treatment-resistant hypertension (aTRH) among stroke survivors by race (African ancestry vs. non-Hispanic Caucasians) and by geography (continental Africa vs. the United States) are under studied.
This is a cross-sectional study using ethically approved stroke registries from the University of Florida and the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Univariate and multivariate regression was used to evaluate for differences in prevalence of aTRH and associations with clinical covariates.
Harmonized data were available for 3,365 stroke survivors of which 943 (28.0%) were indigenous Africans, 558 (16.6%) African Americans, and 1,864 (55.4%) non-Hispanic Caucasians with median ages (interquartile range) of 59 (49-68), 61 (55-72), and 70 (62-78) years, P < 0.0001. The overall frequency of aTRH was 18.5% (95% confidence interval [CI]: 17.2%-19.8%) with 42.7% (95% CI: 39.6%-46.0%) among indigenous Africans, 16.1% (95% CI: 13.2%-19.5%) among African Americans, and 6.9% (95% CI: 5.8%-8.2%) among non-Hispanic Caucasians, P < 0.0001. Five factors associated with aTRH: age, adjusted odds ratio (95% CI) of 0.99 (0.98-0.99), female sex 0.70 (0.56-0.87), cigarette smoking 1.98 (1.36-2.90), intracerebral hemorrhage 1.98 (1.57-2.48), and Black race namely indigenous Africans 4.42 (3.41-5.73) and African Americans 2.44 (1.81-3.29).
Future studies are needed to investigate the contribution of socioeconomic disparities in the prevalence aTRH in those with African Ancestry to explore the long-term impact, and evaluate effective therapeutic interventions in this subpopulation.
已有研究报道了种族和地理位置差异对中风幸存者高血压患病率和预测因素的影响，但中风幸存者中明显的治疗抵抗性高血压（aTRH）在种族（非洲裔与非西班牙裔白种人）和地理位置（非洲大陆与美国）方面的研究较少。
这是一项使用佛罗里达大学和加纳库马西夸梅·恩克鲁玛科技大学伦理批准的中风登记处进行的横断面研究。采用单变量和多变量回归评估 aTRH 的患病率差异及其与临床协变量的关联。
共有 3365 名中风幸存者的数据可供分析，其中 943 名（28.0%）为土生土长的非洲人，558 名（16.6%）为非裔美国人，1864 名（55.4%）为非西班牙裔白种人，中位数年龄（四分位距）分别为 59（49-68）岁、61（55-72）岁和 70（62-78）岁，P＜0.0001。总体 aTRH 频率为 18.5%（95%置信区间[CI]：17.2%-19.8%），土生土长的非洲人占 42.7%（95% CI：39.6%-46.0%），非裔美国人占 16.1%（95% CI：13.2%-19.5%），非西班牙裔白种人占 6.9%（95% CI：5.8%-8.2%），P＜0.0001。有五个因素与 aTRH 相关：年龄，调整后的优势比（95% CI）为 0.99（0.98-0.99），女性为 0.70（0.56-0.87），吸烟为 1.98（1.36-2.90），颅内出血为 1.98（1.57-2.48），黑种人即土生土长的非洲人和非裔美国人分别为 4.42（3.41-5.73）和 2.44（1.81-3.29）。
需要进一步研究以探讨非洲裔人群中社会经济差异对 aTRH 患病率的影响，以探讨其长期影响，并评估该亚人群的有效治疗干预措施。
