title: Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis.
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.
  
  
  RESULTS
  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.
authors.affiliation: Dept of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
authors.forename: Pietro Amedeo
authors.initials: PA
authors.lastname: Modesti
authors.affiliation: Dept of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.affiliation: University of Warwick, Warwick Medical School, and University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom.
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Cappuccio
authors.affiliation: Dept of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Dept. of Medicine, Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.affiliation: Dept of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rapi
authors.affiliation: Dept of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Perruolo
authors.affiliation: Dept of Health Sciences, University of Milano-Bicocca, Dept. of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico, Milano, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005006:Ethnicity; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male