Association of Genetic West African Ancestry, Blood Pressure Response to Therapy, and Cardiovascular Risk Among Self-Reported Black Individuals in the Systolic Blood Pressure Reduction Intervention Trial (SPRINT)
Association of Genetic West African Ancestry, Blood Pressure Response to Therapy, and Cardiovascular Risk Among Self-Reported Black Individuals in the Systolic Blood Pressure Reduction Intervention Trial (SPRINT)
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DOI：
10.1001/jamacardio.2020.6566
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发表时间：
2020-11-13
期刊：
影响因子：
24
通讯作者：
Pandey, Ambarish
中科院分区：
文献类型：
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作者：
Rao, Shreya;Segar, Matthew W.;Pandey, Ambarish
这项对Syphilis血压干预试验数据的事后分析确定了西非血统比例与抗高血压药物治疗反应、血压控制、肾功能重要性自我认定的黑人种族与较高的高血压患病率和较差的血压（BP）相关与其他种族/族裔群体相比。遗传西非血统对这些种族差异的贡献似乎还没有完全确定。目的在Syringe血压干预试验（SPRINT）中，确定自认为黑人中西非血统的比例与抗高血压药物治疗反应、血压控制、肾功能和不良心血管（CV）事件风险之间的关系。设计、设置和参与者SPRINT试验的这一事后分析纳入了来自一项多中心研究的数据，该研究使用106个双等位基因常染色体祖先信息遗传标记估计了自认为具有西非血统比例的黑人参与者。招募于2010年10月20日开始，2015年8月20日结束。数据分析时间为2020年5月至2020年9月。主要结果和测量在调整潜在混杂因素后，使用线性混合效应模型，在西非血统比例的三分位数中评估试验随访时BP和肾功能参数的轨迹。多变量校正的考克斯模型评价了西非血统与复合CV事件（非致死性心肌梗死、CV死亡和心力衰竭事件）风险的相关性。结果在当前分析的2466名参与者中（1122名女性[45.5%];中位西非血统，81% [四分位数范围，73%-87%]），在平均（SD）3.2（0.9）年的随访中，有120起复合CV事件（4.9%）。基线时，平均（SD）高密度脂蛋白胆固醇水平较高（三分位数3：56.5 [15.0] mg/dL vs三分位数1：54.2 [14.9] mg/dL; P = .006），吸烟率（从不吸烟：三分位数3：367 [47.9%] vs三分位数1：372 [42.2%]; P = .009）和平均（SD）脆性风险评分（三分位数3：16.7 [9.7] vs三分位数1：18.1 [10.2]; P = 0.01）较低，并且基线BP在西非血统的增加的三分位数之间没有差异。随访时，强化治疗组或标准治疗组中，西非血统三分位数的BP纵向轨迹、肾功能参数或左心室质量（心电图康奈尔电压）均无差异。在校正后的考克斯模型中，校正潜在混杂因素后，较高的西非血统与复合CV事件的较低风险相关（西非血统每高5%校正后的风险比，0.92 [95% CI，0.85-0.99]）。结论和相关性在参加SPRINT的自我报告的黑人个体中，血压、肾功能和左心室质量随时间变化的轨迹在西非血统比例的三分位数之间没有差异。较高比例的西非血统与CV事件风险适度降低相关。这些研究结果表明，外在的和结构性的社会因素，比遗传血统，可能是主要的驱动力的完善的种族差异心血管健康与hypertension.Question之间的SPRINT参与者自认为是黑色的，什么是全球遗传西非血统与抗高血压药物，血压控制和心血管疾病的后果？全球西非血统的比例与抗高血压药物的反应，血压控制或肾功能随时间的变化无显着相关。较高比例的西非血统与心血管事件风险的适度降低相关。这些发现强调了非生物风险因素的重要性，包括社会经济地位，环境因素，教育程度，行为特征，结构性种族主义和获得医疗保健，在现有的高血压控制和下游不良心血管风险的差异。
This post hoc analysis of data from the Systolic Blood Pressure Intervention Trial determines the association between the proportion of West African ancestry with response to antihypertensive medication, blood pressure control, kidney function, and risk of adverse cardiovascular events among self-identified Black individuals.Importance Self-identified Black race is associated with higher hypertension prevalence and worse blood pressure (BP) control compared with other race/ethnic groups. The contribution of genetic West African ancestry to these racial disparities appears not to have been completely determined. Objective To determine the association between the proportion of West African ancestry with the response to antihypertensive medication, BP control, kidney function, and risk of adverse cardiovascular (CV) events among self-identified Black individuals in the Systolic Blood Pressure Intervention Trial (SPRINT). Design, Setting, and Participants This post hoc analysis of the SPRINT trial incorporated data from a multicenter study of self-identified Black participants with available West African ancestry proportion, estimated using 106 biallelic autosomal ancestry informative genetic markers. Recruitment started on October 20, 2010, and ended on August 20, 2015. Data were analyzed from May 2020 to September 2020. Main Outcomes and Measures Trajectories of BP and kidney function parameters on follow-up of the trial were assessed across tertiles of the proportion of West African ancestry using linear mixed-effect modeling after adjustment for potential confounders. Multivariable adjusted Cox models evaluated the association of West African ancestry with the risk of composite CV events (nonfatal myocardial infarction, CV death, and heart failure event). Results Among 2466 participants in the current analysis (1122 women [45.5%]; median West African ancestry, 81% [interquartile range, 73%-87%]), there were 120 composite CV events (4.9%) over a mean (SD) of 3.2 (0.9) years of follow-up. At baseline, mean (SD) high-density lipoprotein cholesterol levels were higher (tertile 3: 56.5 [15.0] mg/dL vs tertile 1: 54.2 [14.9] mg/dL; P = .006), smoking prevalence (never smoking: tertile 3: 367 [47.9%] vs tertile 1: 372 [42.2%]; P = .009) and mean (SD) Framingham Risk scores (tertile 3: 16.7 [9.7] vs tertile 1: 18.1 [10.2]; P = .01) were lower, and baseline BP was not different across increasing tertiles of West African ancestry. On follow-up, there was no evidence of differences in longitudinal trajectories of BP, kidney function parameters, or left ventricular mass (Cornell voltage by electrocardiogram) across tertiles of West African ancestry in either intensive or standard treatment arms. In adjusted Cox models, higher West African ancestry was associated with a lower risk of a composite CV event after adjustment for potential confounders (adjusted hazard ratio per 5% higher West African ancestry, 0.92 [95% CI, 0.85-0.99]). Conclusions and Relevance Among self-reported Black individuals enrolled in SPRINT, the trajectories of BP, kidney function, and left ventricular mass over time were not different across tertiles of the proportion of West African ancestry. A higher proportion of West African ancestry was associated with a modestly lower risk for CV events. These findings suggest that extrinsic and structural societal factors, more than genetic ancestry, may be the major drivers of the well-established racial disparity in cardiovascular health associated with hypertension.Question Among SPRINT participants self-identified as Black, what are the associations of global genetic West African ancestry with response to antihypertensive medication, blood pressure control, and cardiovascular outcomes? Findings Global West African ancestry proportion was not significantly associated with response to antihypertensive medication, blood pressure control, or kidney function changes over time. A higher proportion of West African ancestry was associated with a modestly lower risk for cardiovascular events. Meaning These findings highlight the greater importance of nonbiological risk factors-including socioeconomic status, environmental factors, educational attainment, behavioral characteristics, structural racism, and access to health care-in existing disparities in hypertension control and downstream adverse cardiovascular risk.