Role of Ethnicity and Sex in Hypertension-Mediated Organ Damage in a Dual-Ethnic Cohort of Individuals With Hypertension

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BACKGROUND: Ethnic and sex disparities in hypertension-mediated organ damage (HMOD) have been described. However, the intersection between ethnicity and sex in this context has not been extensively investigated. Moreover, whether activation of the renin-angiotensin-aldosterone system and aldosterone in particular could play a role is still unknown. Here, we aimed to investigate the intersection of sex and ethnicity with vascular and renal-HMOD, and its association with aldosterone. METHODS: Individuals with primary hypertension and self-defined ethnicity Black/White were included, and assessed for anthropometry, biochemistry, and vascular (carotid-femoral pulse wave velocity [cf-PWV]) and renal-HMOD (microalbuminuria/decreased filtration rate). Multivariate logistic, linear regression, and inverse probability weighting analyses were performed to study associations with cf-PWV/kidney damage, using the less affected group as reference. Associations of aldosterone were examined using adjusted-Pearson correlations. RESULTS: Overall, 654 individuals (age, 44 years) divided into 4 intersectional categories (Black women, Black men, White women, and White men) were included. Multivariate and inverse probability weighting analyses showed higher cf-PWV in Black women (β=1.25 m/s [95% CI, 0.77–1.73]) compared with White men and higher odds of kidney damage in Black individuals (Black men odds ratio, 4.16 [95% CI, 1.48–11.96] and Black women odds ratio, 3.83 [95% CI, 1.40–1.48]), compared with White women. Aldosterone was associated with kidney damage regardless of ethnicity and sex (odds ratio, 1.02 [95% CI, 1.01–1.03]), and showed a modest correlation with cf-PWV only in Black individuals (ρ=0.20, P =0.001). CONCLUSIONS: There are sex and ethnic differences in vascular and renal-HMOD, with Black women having increased cf-PWV and Black individuals having higher odds of kidney damage. Whether aldosterone could play an independent role in ethnicity-related HMOD differences would require further investigation.

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