Preventive cardiology
Comparison of Cardiovascular Risk Factors for High Brachial Pulse Pressure in Blacks Versus Whites (Charleston Heart Study, Evans County Study, NHANES I and II Studies)

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We examined whether the risk factors for increased brachial pulse pressure (PP) are similar for blacks and whites. Many studies have reported the strong association of increased brachial PP and the prevalence of cardiovascular disease. Participants were from 4 major epidemiologic studies in the United States (26,083 subjects): Charleston Heart Study, Evans County Heart Study, the National Health and Nutrition Examination Survey (NHANES) I study, and the NHANES II study. At baseline, there was no history or clinical evidence of coronary heart disease (CHD). The CHD mortality as a function of brachial PP and the association of traditional risk factors for CHD with PP were analyzed for each of the 4 studies and for the 4 studies combined. Multiple regression analysis showed that the most significant predictors of high brachial PP are body mass index ≥30 kg/m2 (regression coefficient 3.79, p <0.0001), diabetes mellitus (5.14, p <0.0001), serum total cholesterol ≧240 mg/dl (0.51, p <0.0157), age (0.60, p <0.0001), gender (−1.77, p <0.0001), and race (3.75, p <0.0001). In conclusion, the same risk factors for CHD (namely, increase in body mass index ≧30 kg/m2, diabetes mellitus, hypercholesterolemia, and age) are significantly associated with high brachial PP for blacks and whites. These risk factors were stronger in whites compared with blacks. However, female gender and age variables were even more associated with brachial PP in blacks. Smoking was significant but not reflected in peripheral brachial PP as it is in aortic PP.

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Methods

Participants were from 4 major epidemiologic studies in the United States (26,083 subjects) that at baseline examination had no history or clinical evidence of CHD.

Results

Table 1 presents age, diabetes mellitus, smoking, obesity, and high cholesterol by brachial PP category for whites, blacks, and the races combined. Age was associated with increasing PP for both race groups. The prevalence of diabetes mellitus, obesity, and high cholesterol each increased significantly with PP for both race groups. Cigarette smoking was inversely related to PP for both whites and blacks. Blacks were more likely to have diagnosed diabetes mellitus. The prevalence of obesity was

Discussion

The media of the aorta and large arteries is often altered by atherosclerosis. Atherosclerosis in some cases may be a contributing factor to aortic stiffness and wide brachial PP. If atherosclerosis is present, the atheroma is most pronounced immediately adjacent and extending into the inner portion of the media, and it may amplify stiffening of the aorta.6, 7 This condition leads to degeneration of elastic tissue, eventual loss of interstitial glucosaminoglycans, and accumulation of collagen

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This work was supported in part by the Black Pooling Project, National Institutes of Health Grant 1R01HL072377, Bethesda, Maryland.

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