Defensive coping and renovascular disease risk - Adrenal fatigue in a cohort of Africans and Caucasians: The SABPA study.
BACKGROUND
Defensive coping is an established cardiovascular risk factor in Africans. Additionally, chronic, excessive or inadequate hypothalamic-pituitary-adrenal axis (HPAA) stress responses could either increase or decrease cortisol responses, which may relate to renal impairment. We scrutinised the relationship between urinary cortisol levels and renovascular disease risk in Africans and Caucasians utilising defensive coping.


METHODS
Africans (n=168) and Caucasians (n=207) from the SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study were included in our analyses, excluding HIV positive, diabetic, renal impairment, and cortisone users. The Coping Strategy Indicator questionnaire assessed preferred coping responses. Ambulatory blood pressure was recorded together with 8h fasting blood and urine sampling. Renovascular disease risk markers included the albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).


RESULTS
The main findings revealed that Caucasians with high cortisol showed augmented renovascular disease risk. Conversely, Africans revealed low cortisol levels whilst 21.84% reported experience of severe stress, possibly depicting HPAA hypoactivity. Additionally, these Africans with low cortisol revealed increased ACR and decreased eGFR, which was further enhanced by defensive coping.


CONCLUSIONS
Defensive coping enhanced renovascular risk in Africans, especially in those with lower cortisol, which may be due to HPAA dysfunction and/or adrenal fatigue.
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa. Electronic address: 20273371@nwu.ac.za.
Andrea
A
de Kock
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa; Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa. Electronic address: leone.malan@nwu.ac.za.
Leoné
L
Malan
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa; Psychobiology Group, Department of Epidemiology and Public Health, University College of London, 1-19 Torrington Place, London WC1E 6BT, UK. Electronic address: m.hamer@ucl.ac.uk.
Mark
M
Hamer
Statistical Consultation Services, North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa. Electronic address: marike.cockeran@nwu.ac.za.
Marike
M
Cockeran
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa. Electronic address: nico.malan@nwu.ac.za.
Nico T
NT
Malan
D000223:Adaptation, Psychological; D000328:Adult; D000704:Analysis of Variance; D044383:Black People / Q000523:psychology*; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D015331:Cohort Studies; D003674:Defense Mechanisms; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology; D012372:ROC Curve; D057566:Self Report; D044465:White People / Q000523:psychology*
D006854:Hydrocortisone
Adrenal fatigue; Coping; Cortisol; Ethnicity; Hypothalamic–pituitary–adrenal axis; Renovascular disease