C-Reactive Protein and Incident Hypertension in Black and White Americans in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort Study

Timothy B Plante; D Leann Long; Boyi Guo; George Howard; April P Carson; Virginia J Howard; Suzanne E Judd; Nancy Swords Jenny; Neil A Zakai; Mary Cushman

doi:10.1093/ajh/hpaa215

C-Reactive Protein and Incident Hypertension in Black and White Americans in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort Study

Am J Hypertens. 2021 Aug 9;34(7):698-706. doi: 10.1093/ajh/hpaa215.

Authors

Timothy B Plante¹, D Leann Long², Boyi Guo², George Howard², April P Carson³, Virginia J Howard³, Suzanne E Judd², Nancy Swords Jenny⁴, Neil A Zakai^{1

4}, Mary Cushman^{1

4}

Affiliations

¹ Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
² Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
³ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁴ Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.

Abstract

Background: More inflammation is associated with greater risk incident hypertension, and Black United States (US) adults have excess burden of hypertension. We investigated whether increased inflammation as quantified by higher C-reactive protein (CRP) explains the excess incidence in hypertension experienced by Black US adults.

Methods: We included 6,548 Black and White REasons for Geographic and Racial Differences in Stroke (REGARDS) participants without hypertension at baseline (2003-2007) who attended a second visit (2013-2016). Sex-stratified risk ratios (RRs) for incident hypertension at the second exam in Black compared to White individuals were estimated using Poisson regression adjusted for groups of factors known to partially explain the Black-White differences in incident hypertension. We calculated the percent mediation by CRP of the racial difference in hypertension.

Results: Baseline CRP was higher in Black participants. The Black-White RR for incident hypertension in the minimally adjusted model was 1.33 (95% confidence interval 1.22, 1.44) for males and 1.15 (1.04, 1.27) for females. CRP mediated 6.6% (95% confidence interval 2.7, 11.3%) of this association in females and 19.7% (9.8, 33.2%) in males. In females, CRP no longer mediated the Black-White RR in a model including waist circumference and body mass index, while in males the Black-White difference was fully attenuated in models including income, education and dietary patterns.

Conclusions: Elevated CRP attenuated a portion of the unadjusted excess risk of hypertension in Black adults, but this excess risk was attenuated when controlling for measures of obesity in females and diet and socioeconomic factors in males. Inflammation related to these risk factors might explain part of the Black-White disparity in hypertension.

Keywords: C-reactive protein; blood pressure; hypertension; inflammation; preventive medicine; racial disparities.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Black or African American* / statistics & numerical data
C-Reactive Protein* / analysis
Cohort Studies
Female
Geography
Health Status Disparities*
Humans
Hypertension* / blood
Hypertension* / ethnology
Incidence
Inflammation
Male
Race Factors
Risk Factors
Stroke / ethnology
United States / epidemiology
White People* / statistics & numerical data

Substances

C-Reactive Protein

Grants and funding

U01 NS041588/NS/NINDS NIH HHS/United States