Hypertension guidelines and coronary artery calcification among South Asians: Results from MASALA and MESA.

• Authors: Jaideep Patel, Pauley Heart Center, VCU Medical Center, United States.; Anurag Mehta, Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Georgia, United States.; Mahmoud Al Rifai, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States.; Michael J Blaha, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States.; Khurram Nasir, Division of Cardiology, Houston Methodist Hospital, United States.; John W McEvoy, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States.; Ambarish Pandey, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, E5.730F, Dallas, TX 75390, United States.; Alka M Kanaya, Department of Medicine, University of California, San Francisco, United States.; Namratha R Kandula, Department of Internal Medicine, Northwestern University, United States.; Salim S Virani, Section of Cardiology, Department of Medicine, Baylor College of Medicine, United States.; Antonio Abbate, Pauley Heart Center, VCU Medical Center, United States.; Gregory Hundley, Pauley Heart Center, VCU Medical Center, United States.; Laurence Sperling, Emory University; Parag H Joshi, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States.
• Journal Title: Am J Prev Cardiol
• Volume: Volume 6
• Publisher: Elsevier B.V. | 2021-06, Pages 100158-100158
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.ajpc.2021.100158
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: ASCVD; Ethnic; Hypertension; Prevention; Risk; South Asian

Abstract

Untreated hypertension may contribute to increased atherosclerotic cardiovascular disease (ASCVD) risk in South Asians (SA). We assessed HTN prevalence among untreated adults free of baseline ASCVD from the MASALA & MESA studies. The proportion of participants who received discordant recommendations regarding antihypertensive pharmacotherapy use by the 2017-ACC/AHA and JNC7 Guidelines across CAC score categories in each race/ethnic group was calculated. Compared with untreated MESA participants (n = 3896), untreated SA (n = 445) were younger (55±8 versus 59±10 years), had higher DBP (73±10 versus 70±10 mmHg), total cholesterol (199±34 versus 196±34 mg/dL), statin use (16% versus 9%) and CAC=0 prevalence (69% versus 58%), with fewer current smokers (3% versus 15%) and lower 10-year-ASCVD-risk (6.4% versus 9.9%) (all p<0.001). A higher proportion of untreated MASALA and MESA participants were diagnosed with hypertension and recommended anti-hypertensive pharmacotherapy according to the ACC/AHA guideline compared to JNC7 (all p<0.001). Overall, discordant BP treatment recommendations were observed in 9% SA, 11% Whites, 15% Blacks, 10% Hispanics, and 9% Chinese-American. In each race/ethnic group, the proportion of participants receiving discordant recommendation increased across CAC groups (all p<0.05), however was highest among SA (40% of participants). Similar to other race/ethnicities, a higher proportion of SA are recommended anti-hypertensive pharmacotherapy by ACC/AHA as compared with JNC7 guidelines. The increase was higher among those with CAC>100 and thus may be better at informing hypertension management in American South Asians.