Kamin Mukaz Debora, Guo Boyi, Long D Leann, Judd Suzanne E, Plante Timothy B, McClure Leslie A, Wolberg Alisa S, Zakai Neil A, Howard George, Cushman Mary
Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Res Pract Thromb Haemost. 2022 Dec 19;7(1):100016. doi: 10.1016/j.rpth.2022.100016. eCollection 2023 Jan.
Reasons for increased risk of hypertension in Black compared with White people are only partly understood. D-dimer, a thrombo-inflammatory marker higher in Black individuals, is also higher in people with hypertension. However, the impact of D-dimer on racial disparities in risk of incident hypertension has not been studied.
To assess whether D-dimer is associated with the risk of incident hypertension, whether the association between D-dimer and the risk of incident hypertension differs by race, and whether the biology reflected by D-dimer explains racial disparities in the risk of incident hypertension.
This study included 1867 participants in the REasons for Geographic And Racial Differences in Stroke cohort study without baseline hypertension and with a second visit 9.4 years after baseline. Risk ratios of incident hypertension by baseline D-dimer level were estimated, a D-dimer-by-race interaction was tested, and the mediating effect of D-dimer (which represents underlying biological processes) on the association of race and hypertension risk was assessed.
The risk of incident hypertension was 47% higher in persons in the top quartile than in those in the bottom quartile of D-dimer (risk ratio [RR]: 1.47; 95% CI: 1.23-1.76). The association was partly attenuated after adjusting for sociodemographic and adiposity-related risk factors (RR: 1.22; 95% CI: 1.02-1.47). The association of D-dimer and hypertension did not differ by race, and D-dimer did not attenuate the racial difference in the risk of incident hypertension.
D-dimer concentration reflects pathophysiology related to the development of hypertension. Specific mechanisms require further study and may involve adiposity.
与白人相比，黑人高血压风险增加的原因仅得到部分理解。D - 二聚体是一种血栓炎症标志物，在黑人个体中较高，在高血压患者中也较高。然而，D - 二聚体对高血压发病风险种族差异的影响尚未得到研究。
评估D - 二聚体是否与高血压发病风险相关，D - 二聚体与高血压发病风险之间的关联是否因种族而异，以及D - 二聚体所反映的生物学特性是否能解释高血压发病风险的种族差异。
本研究纳入了1867名来自中风地理和种族差异原因队列研究的参与者，这些参与者在基线时无高血压，且在基线后9.4年进行了第二次随访。估计了根据基线D - 二聚体水平得出的高血压发病风险比，检验了D - 二聚体与种族的交互作用，并评估了D - 二聚体（代表潜在生物学过程）对种族与高血压风险关联的中介作用。
D - 二聚体处于最高四分位数的人群发生高血压的风险比处于最低四分位数的人群高47%（风险比[RR]：1.47；95%置信区间[CI]：1.23 - 1.76）。在调整社会人口学和肥胖相关风险因素后，这种关联部分减弱（RR：1.22；95% CI：1.02 - 1.47）。D - 二聚体与高血压的关联在不同种族之间没有差异，并且D - 二聚体并未减弱高血压发病风险的种族差异。
D - 二聚体浓度反映了与高血压发生相关的病理生理学。具体机制需要进一步研究，可能涉及肥胖。
