Introduction:
It is well known that African Americans (Afr-Am) have a higher prevalence of hypertension (HTN) compared to Whites. Few studies have compared Afr-Am and Whites for the prevalence of left ventricular hypertrophy (LVH; a marker of long-standing hypertension) in young ischemic stroke patients with and without a history of hypertension to assess hypertension severity and undiagnosed longstanding hypertension. We hypothesized that the prevalence of LVH by echocardiography would be higher in Afr-Am than in their White counterparts.
Methods:
We identified 1033 patients from a population-based case control study of young patients with first-time ischemic stroke (age 18 to 49 years old, enrolled from 1992-2006) from the Baltimore-Washington area. Patients (n=191, 16%) without an echocardiogram were excluded yielding an analysis sample of 842. Prevalence of LVH by echocardiography (Echo-LVH) were determined in those with and without a history of HTN, stratified by sex and race. Age-adjusted odds ratios and 95% confidence intervals comparing Afr-Am and Whites for the prevalence of Echo-LVH were calculated by logistic regression.
Results:
Of the 842 young stroke patients included in this study, the median age was 43.0, 55.2% were men, and 48.7 % were Afr-Am. Echo-LVH was common in young patients with ischemic stroke, even patients without a prior history of hypertension. Afr-Am women, both with and without a history of HTN, had higher age-adjusted prevalence of LVH than White women. Afr-Am men with no history of HTN had higher age-adjusted prevalence of Echo-LVH than White men. Afr-Am men with history of HTN had the highest prevalence of LVH, but the age-adjusted comparison with White men with HTN did not achieve statistical significance.
Conclusions:
The evidence suggests that Afr-Am have greater end organ damage from HTN, even among those who do not have an established diagnosis of HTN. These findings emphasize the need for earlier screening and treatment of HTN in young Afr-Am adults.
Collagen Metabolism in Extracellular Matrix May Be Involved in Arterial Stiffness in Older Hypertensive Patients with Left Ventricular Hypertrophy