UK research has uncovered clear differences in the development of hypertension between South Asian and East Asian adults.
The findings from 3,400 adults enrolled in UK Biobank suggest South Asian and East Asian adults living in the country may have distinct trajectories to developing hypertension as well as outcomes.
Data on patients with at least two blood pressure measurements recorded in their GP notes as well as information on future heart disease events, including heart attacks, stroke and peripheral artery disease from hospitalisation and outpatient care records was used to develop a model to assess patterns of blood pressure and how that related to cardiovascular disease risk.
It showed that South Asian adults living in the UK underwent earlier and faster increases in blood pressure compared to East Asian adults.
On average, South Asian men were also projected to reach a systolic blood pressure of 130 mmHg or higher, 10 years sooner than East Asian men at 36 compared with 46 years.
In women, the gap was seven years (45 vs 52 years), the researchers reported in Hypertension.
For South Asian adults, high blood pressure seen in early adulthood was associated with higher lifetime cardiovascular disease risks.
By contrast in East Asian adults, higher blood pressure in midlife was associated with higher atherosclerotic cardiovascular disease risk; even at ages 65 and older, high blood pressure was associated with heightened risk of stroke, the researchers said.
Systolic blood pressure in East Asian adults ages 65 years or older was significantly linked to all types of stroke risk.
And young adulthood diastolic blood pressure was strongly linked to peripheral artery disease in South Asian adults with a 2.18 times higher risk per standard deviation increase.
The team also found that South Asian adults had higher blood pressure readings and were at least three times more likely to be on antihypertensive medications compared to East Asian adults.
Within UK Biobank, participants who self-identified as originating from India, Pakistan, Bangladesh, Bhutan, Maldives, Nepal or Sri Lanka are defined as South Asian and those who self-identified as originating from China are defined as East Asian
Study author Dr Pradeep Natarajan, an associate professor at Harvard Medical School, said: ‘These findings demonstrate the need to tailor blood pressure screenings and treatment timing for different Asian subpopulations to advance personalised care and prevention strategies for historically understudied communities.
‘Distinct age-related blood pressure patterns provide valuable insights to better manage cardiovascular risks and improve care for diverse populations.’
Dr Nilay Shah, a cardiologist who was chair of the American Heart Association’s position statement on cardiovascular health in Asian Americans said the paper highlighted important evidence to support the notion that cardiovascular risk factors like hypertension are not uniformly experienced among the diverse communities that are frequently labelled under the label ‘Asian’.
The findings should also prompt greater exploration of differences in social risk factors that may explain the differences in hypertension and CVD outcomes among self-reported Asian ethnicity groups, he added.
‘Ultimately, these findings from a UK population of Asian adults suggest a complex interplay of social factors and genetics resulting in varying experiences of hypertension in Asian populations.
‘There is much, much more work to be done to understand cardiovascular risk factors and outcomes experienced by Asian populations.’
