Research Article
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Journal of Heart and Cardiovascular Research
Correlations between Pulse Pressure and Anthropometric Indices of Obesity: Cross-sectional Study in a Congolese Southwest Port City Abstract Background: Correlation between markers of obesity and the pulse pressure (PP) remains a subject of debate. Aim: To assess whether the association between PP and the parameters defining obesity is modified by gender, age, sedentary and hypertension status in an apparently healthy Congolese Black Population. Methods: 397 apparently healthy men and women randomly selected during the MACRIS Study. Multivariate linear regression models were used to assess the association between PP and the parameters defining obesity, waist circumference, waist-hip ratio and body mass index (BMI). These models were adjusted for age, sex, heart rate, diabetes mellitus, physical inactivity, smoking status and blood pressure. The interactions were tested to highlight the modifying effect of age, gender, sedentary and hypertension status. Results: Waist circumference was associated with PP only in hypertensive, sedentary and less than 55 years old participants respectively. Gender had no modifying effect in the relationship between the PP and obesity parameters. BMI and waist-hip ratio were not associated with PP. Conclusion: Our study shown that waist circumferences were the only markers of obesity significantly associated with the PP. However, the strength of these associations was significantly different according to age, sedentary and hypertension status. Keywords: Pulse pressure; Obesity; Hypertension Received: January 16, 2017; Accepted: March 02, 2017; Published: March 15, 2017
Introduction Hypertension (HTN) and obesity often coexist [1-4]. When hypertensive subjects are compared with normotensive, one of the main differences is the awesome increase of the prevalence of obesity among hypertensive [5]. Furthermore, weight gain seems to be one of the main determinants of blood pressure increase with age [3,4]. HTN and obesity share many socio-ecological and epidemiological similarities. First, they are diseases of civilization, corollaries of profound changes that accompanied the 45,000 years of evolution from Homo sapiens sapiens, to which physical activity was the pledge of survival [6], to the today human who uses more neurons than muscles to live and survive, and
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Kianu Phanzu Bernard1, Mpembele Mabaka Evelyne1, Kianu Phanzu Bernard1, Kintoki Vita Eleuthère1, Mbutiwi Ikwa Ndol Fiston2, M’buyamba Kabangu JeanRéné1 and Longo-Mbenza Benjamin3 1 University Clinics of Kinshasa, Unit of cardiology, Kinshasa, Democratic Republic of Congo 2 University of Kikwit, Faculty of medicine, Democratic Republic of Congo 3 Waler Sisulu University, Faculty of Health Sciences, Mthata, Republic of South Africa
Corresponding author: Kianu Phanzu Bernard
[email protected] 22 Avenue Wenge, Quartier Righini, Commune de Lemba, B.P. 1038 Kinshasa 1, Democratic Republic of Congo. Tel: +243 997 622 019
Citation: Bernard KP, Evelyne MM, Bernard KP, et al. Correlations between Pulse Pressure and Anthropometric Indices of Obesity: Cross-sectional Study in a Congolese Southwest Port City. J Heart Cardiovasc Res. 2017, 1:1.
therefore, has reduced physical activity and increased energy intake. Second, the relevance of both hypertension and obesity, as important public health challenges, is increasing worldwide [4]. Third, there are ethnic disparities in the prevalence and cardiovascular health impact of both. Thus, for example, HTN is experiencing a more dramatic growth in blacks, affecting younger people, with poorer blood pressure control, and singularly moving early to cardiovascular complications [7-10]. Obesity also is more prevalent in Blacks than in Caucasians, and would be associated with a higher cardiovascular risk in Blacks [11].
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Journal of Heart and Cardiovascular Research
The diagnosis of HTN, whether by office or by out-of-office BP monitoring is based on the values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) [12,13]. The target values of the management of high blood pressure also relate these parameters. Even if no recommendation today suggests considering pulse pressure (PP), either for diagnosis or for monitoring the treatment of high blood pressure, there has been increased recognition of PP having a more important predictive value of increased cardiovascular morbidity and mortality these last years. Indeed, Epidemiologic surveys and clinical studies have demonstrated a close relationship between increased PP and target organ damage including urinary albumin excretion [14,15]. Decline in glomerular filtration rate [16,17], left ventricular hypertrophy [18,19] and endothelial dysfunction [19,20]. PP has also been recognized as predictor of atrial fibrillation [19,21], heart failure [19], impairment in neurocognitive function and dementia [22] and cardiovascular events onset and recurrence [19,23-26]. Thus, PP would prove to be a better marker of cardiovascular risk than other blood pressure parameters. Studies have demonstrated that various modalities of PP measures (central or peripheral, clinic or ambulatory) have statistically similar predictive value. There is an association between obesity and cardiovascular risk, of which PP is a recognized marker. Whether this association differs between abdominal and general obesity is controversial. Indeed, some studies have suggest that measures of abdominal obesity are best correlated with cardiovascular risk [27-31], discouraging the use of the BMI, whereas some others have failed to demonstrate this superiority of measures of abdominal obesity to that of general obesity [32-36]. Another debate about the correlation between obesity and pulse pressure, and therefore cardiovascular risk, concerns the existence of modifying factors of this correlation. Most cited by authors, without them from being unanimous, are age [26], gender [3,37,38] and ethnicity [3,37]. In sub-Saharan Africa, studies on the PP are rare. The only one, to our knowledge, that has addressed this issue has found no correlation at all between obesity and pulse pressure [39], reviving debate about the existence of this correlation and casting doubt on the existence of this association in Sub-Saharan Africa. Therefore, this study aimed to assess whether the association between PP and the parameters defining obesity is modified by gender, age, sedentary and hypertension status in an apparently healthy Congolese Black Population.
Methods and Data Collection This study is part of the MACRIS study. Data collection has been described elsewhere [40]. Pulse pressure was defined as the difference between SBP and DBP. Mean blood pressure was defined as the sum of diastolic blood pressure and the third of the pulse pressure. Waist Circumference (WC) and The WaistHip Ratio (WHR) were considered as parameters of abdominal obesity, while BMI was considered for general obesity. General obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m², BMI is the ratio of weight to height squared. Abdominal obesity (AO) has been defined by a waist
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circumference greater than or equal to 94 cm for men and greater than or equal to 80 cm for women.
Statistical Analysis Continuous variables were presented as mean ± standard deviation (SD) or median (interquartile range) based on their distribution. Categorical variables were expressed as percentages. Sociodemographic and clinical characteristics of the study population have been described for all subjects and by gender and quartiles of the PP (≤ 36 mmHg, 3690 b/min, % Weight, kg Height, cm BMI, kg/m² General obesity, % Waist Circumference, cm Abdominal Obesity, % Diabetes mellitus, % HTN, %
Whole group (n=397) 37 (28-54) 29.2 57.2 13.6 6.6 65.7 27.7 83.4 16.6 8.1 ± 1.6 77.6 13.6 8.8 18.4 48.1 4 131 ± 30 81 ± 16 98 ± 20 50 ± 19 81 ± 11 17.6 65.7 ± 14.2 164 ± 15 24.8 ± 6.9 14.9 86 ± 14 53.2 10.1 40.8
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Women (n=253) 36 (27-50) 25.3 56.5 18.2 4 64 32 82.2 17.8 8.4 ± 1.3 76.3 14.2 9.5 9.9 41.1 4.7 128 ± 28 80 ± 16 96 ± 18 49 ± 20 82 ± 11 19.8 65.2 ± 14.8 160 ± 9 25.7 ± 7.7 18.2 87 ± 15 70.8 10.7 36
Hommes Men (n=144) 41 (31-57) 36.1 28.3 5.6 11.1 68.8 20.1 85.4 14.6 7.6 ± 1.8 79.9 12.5 7.6 33.3 60.4 2.8 135 ± 32 84 ± 17 101 ± 21 51 ± 19 78 ± 12 13.9 66.5 ± 13.1 171 ± 20 23.1 ± 4.8 9 84 ± 13 22.2 9 41.7
p 0.023 0.001 0.002 0.41
