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Cited by 1,366Blood Pressure and Hypertension StudiesSodium Intake and HealthCardiovascular Health and Disease Prevention

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Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis

Open access
Modesti, Pietro Amedeo, Reboldi, Gianpaolo, Cappuccio, Francesco P., Agyemang, Charles, Remuzzi, Giuseppe, Rapi, Stefano, Perruolo, Eleonora, Parati, Gianfranco, ESH Working Group on CV Risk in Low Resource Settings·2016·PLOS ONE
DOI 10.1371/journal.pone.0147601PMC PMC4725677
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Abstract

BACKGROUND: People of Sub Saharan Africa (SSA) and South Asians(SA) ethnic minorities living in Europe have higher risk of stroke than native Europeans(EU). Study objective is to provide an assessment of gender specific absolute differences in office systolic(SBP) and diastolic(DBP) blood pressure(BP) levels between SSA, SA, and EU. METHODS AND FINDINGS: We performed a systematic review and meta-analysis of observational studies conducted in Europe that examined BP in non-selected adult SSA, SA and EU subjects. Medline, PubMed, Embase, Web of Science, and Scopus were searched from their inception through January 31st 2015, for relevant articles. Outcome measures were mean SBP and DBP differences between minorities and EU, using a random effects model and tested for heterogeneity. Twenty-one studies involving 9,070 SSA, 18,421 SA, and 130,380 EU were included. Compared with EU, SSA had higher values of both SBP (3.38 mmHg, 95% CI 1.28 to 5.48 mmHg; and 6.00 mmHg, 95% CI 2.22 to 9.78 in men and women respectively) and DBP (3.29 mmHg, 95% CI 1.80 to 4.78; 5.35 mmHg, 95% CI 3.04 to 7.66). SA had lower SBP than EU(-4.57 mmHg, 95% CI -6.20 to -2.93; -2.97 mmHg, 95% CI -5.45 to -0.49) but similar DBP values. Meta-analysis by subgroup showed that SA originating from countries where Islam is the main religion had lower SBP and DBP values than EU. In multivariate meta-regression analyses, SBP difference between minorities and EU populations, was influenced by panethnicity and diabetes prevalence. CONCLUSIONS: 1) The higher BP in SSA is maintained over decades, suggesting limited efficacy of prevention strategies in such group in Europe;2) The lower BP in Muslim populations suggests that yet untapped lifestyle and behavioral habits may reveal advantages towards the development of hypertension;3) The additive effect of diabetes, emphasizes the need of new strategies for the control of hypertension in groups at high prevalence of diabetes.

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Crossref · 10.1371/journal.pone.0147601

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Figures

Fig 1 Flow chart of the selection process. Flow chart of the selection process according to the PRISMA Statement [24].
Fig 1 Flow chart of the selection process. Flow chart of the selection process according to the PRISMA Statement [24].CC BY · PubMed Central
Fig 2 SBP differences between minority groups and EU participants by panethnicity and gender. Subgroup comparisons of the weighted mean difference of systolic blood pressure (BP) between minority groups and EU participants by panethnicity and gender. Diamonds denote the pooled estimates and 95% confidence intervals. SSA = Sub-Saharan Africans; SA = South Asians; EU = Europeans, “n” is the number of comparisons available for each subgroup.
Fig 2 SBP differences between minority groups and EU participants by panethnicity and gender. Subgroup comparisons of the weighted mean difference of systolic blood pressure (BP) between minority groups and EU participants by panethnicity and gender. Diamonds denote the pooled estimates and 95% confidence intervals. SSA = Sub-Saharan Africans; SA = South Asians; EU = Europeans, “n” is the number of comparisons available for each subgroup.CC BY · PubMed Central
Fig 3 DBP differences between minority groups and EU participants by panethnicity and gender. Subgroup comparisons of the weighted mean difference of diastolic blood pressure (BP) between minority groups and EU participants by panethnicity and gender. Diamonds denote the pooled estimates and 95% confidence intervals. SSA = Sub-Saharan Africans; SA = South Asians; EU = Europeans, “n” is the number of comparisons available for each subgroup.
Fig 3 DBP differences between minority groups and EU participants by panethnicity and gender. Subgroup comparisons of the weighted mean difference of diastolic blood pressure (BP) between minority groups and EU participants by panethnicity and gender. Diamonds denote the pooled estimates and 95% confidence intervals. SSA = Sub-Saharan Africans; SA = South Asians; EU = Europeans, “n” is the number of comparisons available for each subgroup.CC BY · PubMed Central
Fig 4 BP differences between subjects originating from SA countries and EU participants by dominant religion in the country of origin. Subgroup comparisons of the weighted mean difference of systolic and diastolic blood pressure between South Asians (SA) and European (EU) participants by dominant religion in the country of origin. The term "others" refers to comparisons performed between EU participants and subjects who originated from countries with a different dominant religion. Diamonds denote the pooled estimates and 95% confidence intervals, “n” is the number of comparisons available for each subgroup.
Fig 4 BP differences between subjects originating from SA countries and EU participants by dominant religion in the country of origin. Subgroup comparisons of the weighted mean difference of systolic and diastolic blood pressure between South Asians (SA) and European (EU) participants by dominant religion in the country of origin. The term "others" refers to comparisons performed between EU participants and subjects who originated from countries with a different dominant religion. Diamonds denote the pooled estimates and 95% confidence intervals, “n” is the number of comparisons available for each subgroup.CC BY · PubMed Central
Fig 5 Gender specific meta-regression model. Women (number of comparisons = 28). Intercept: -8.260 mmHg (-12.167 to -4.352; p<0.001); Ethnicity: 8.695 mmHg (3.751 to 13.640; p = 0.001); Difference in Diabetes Prevalence: 0.543 mmHg (0.207 to 0.880; p = 0.002). Proportion of between-study variance explained (Adjusted R-squared) = 45.81%; joint test for all covariates F = 9.79, p<0.0017. Men (number of comparisons = 31). Intercept: -7.730 mmHg (-10.268 to -5.193; p<0.001); Ethnicity: 8.496 mmHg (5.234 to 11.759); p<0.001); Difference in Diabetes Prevalence: 0.481 mmHg (0.162 to 0.600; p<0.001). Proportion of between-study variance explained (Adjusted R-squared) = 60.73%; joint test for all covariates F = 18.04, p<0.001.
Fig 5 Gender specific meta-regression model. Women (number of comparisons = 28). Intercept: -8.260 mmHg (-12.167 to -4.352; p<0.001); Ethnicity: 8.695 mmHg (3.751 to 13.640; p = 0.001); Difference in Diabetes Prevalence: 0.543 mmHg (0.207 to 0.880; p = 0.002). Proportion of between-study variance explained (Adjusted R-squared) = 45.81%; joint test for all covariates F = 9.79, p<0.0017. Men (number of comparisons = 31). Intercept: -7.730 mmHg (-10.268 to -5.193; p<0.001); Ethnicity: 8.496 mmHg (5.234 to 11.759); p<0.001); Difference in Diabetes Prevalence: 0.481 mmHg (0.162 to 0.600; p<0.001). Proportion of between-study variance explained (Adjusted R-squared) = 60.73%; joint test for all covariates F = 18.04, p<0.001.CC BY · PubMed Central

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Research works printed but not linked: 2

  1. C Barba, 2004, Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies, Lancet, 363, 157, 10.1016/S0140-6736(03)15268-3 · DOI · Paper page
  2. P Dorairaj, 2003, Obesity and cardiovascular and metabolic disorders among South Asians living in India: Higher risk at BMI levels that are normal for western population, Circulation, 108, 773

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Metadata

Authors
Modesti, P. A., Reboldi, G., Cappuccio, F. P., Agyemang, C., Remuzzi, G., Rapi, S., Perruolo, E., Parati, G., & ESH Working Group on CV Risk in Low Resource Settings
Affiliations
  • University of Florence (IT)
  • University of Perugia (IT)
  • University Hospital Coventry (GB)
  • University of Amsterdam (NL)
  • Mario Negri Institute for Pharmacological Research (IT)
  • IRCCS Istituto Auxologico Italiano (IT)
Corresponding author
Modesti, Pietro Amedeo
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2016-01-25
Volume
11
Issue
1
Pages
e0147601
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0147601
PMC
PMC4725677
OpenAlex
W2257818166
Cited by
1,366
References
83
Citations by year
2026: 104 · 2025: 146 · 2024: 164 · 2023: 179 · 2022: 220 · 2021: 240 · 2020: 185 · 2019: 76 · 2018: 39 · 2017: 7 · 2016: 5
FWCI
7.48
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • Florence Research (University of Florence) (submittedVersion, cc-by-nc-nd)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, cc-by)
  • BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Lund University Publications (Lund University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
blood pressure, ethnic minorities in Europe, sub-Saharan Africans, South Asians, hypertension, systolic blood pressure, diastolic blood pressure, panethnicity, Islam, diabetes prevalence, stroke risk, gender differences, lifestyle factors, hypertension prevention, Muslim population
MeSH terms
Adult, Blood Pressure, Ethnicity, Europe, Female, Humans, Male

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