title: Ethnic differences in arterial wave reflections and normative equations for augmentation index.
abstract: Data regarding ethnic differences in wave reflections, which markedly affect the central pressure profile, are very limited. Furthermore, because age, heart rate, and body height are strong determinants of augmentation index, relating single measurements to normative data (in which augmentation index values correspond with average population values of its determinants) is challenging. We studied subject-level data from 10 550 adults enrolled in large population-based studies. In a healthy reference sample (n=3497), we assessed ethnic differences in augmentation index (ratio of second/first systolic peaks) and generated equations for adjusted z scores, allowing for a standardized comparison between individual augmentation index measurements and the normative population mean from subjects of the same age, sex, ethnic population, body height, and heart rate. After adjustment for age, body height, heart rate, and mean arterial pressure, African blacks (women: 154%; men: 138%) and Andean Hispanics (women: 152%; men: 133%) demonstrated higher central (aortic) augmentation index values than British whites (women: 140%; men: 128%), whereas American Indians (women: 133%; men: 122%) demonstrated lower augmentation index (all P<0.0001), without significant differences between Chinese and British whites. Similar results were found for radial augmentation index. Nonlinear ethnic/sex-specific equations for z scores were successfully generated to adjust individual augmentation index values for age, body height, and heart rate. Marked ethnic differences in augmentation index exist, which may contribute to ethnic differences in hypertensive organ damage. Our study provides normative data that can be used to complement the interpretation of individual hemodynamic assessments among men and women of various ethnic populations, after removing the effect of various physiological determinants.
authors.affiliation: Division of Cardiology, University of Pennsylvania/Philadelphia Veterans Affairs Medical Center, PA, USA. julio.chirinos@uphs.upenn.edu
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: Jan G
authors.initials: JG
authors.lastname: Kips
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.forename: Josefina
authors.initials: J
authors.lastname: Medina-Lezama
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Woodiwiss
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Norton
authors.lastname: Yasmin
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.forename: Ji-Guang
authors.initials: JG
authors.lastname: Wang
authors.forename: John R
authors.initials: JR
authors.lastname: Cockcroft
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Ian B
authors.initials: IB
authors.lastname: Wilkinson
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.forename: Carmel M
authors.initials: CM
authors.lastname: McEniery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000502:physiology*; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D001794:Blood Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000502:physiology; D005260:Female; D006439:Hemodynamics; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008365:Manometry / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D011673:Pulsatile Flow / Q000502:physiology*; D011674:Pulse / Q000706:statistics & numerical data; D017534:Radial Artery / Q000502:physiology*; D012044:Regression Analysis; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult