Racial Differences in Arterial Stiffness are Mainly Determined by Blood Pressure Levels: Results From the ELSA‐Brasil Study

BACKGROUND Black people have a higher risk of developing hypertension and presenting higher vascular stiffening. Our aim was to investigate whether the association between race and aortic stiffness could be explained by differences in the primary risk factors. METHODS AND RESULTS We analyzed data from 11 472 adults (mean age, 51.9±8.9; 53.8% female) self-reported as white (n=6173), brown (n=3364), or black (n=1935). Their carotid-to-femoral pulse wave velocity (cf-PWV) as well as clinical and anthropometric parameters were measured. cf-PWV was higher in blacks than in whites or browns (men: white, 9.63±1.81; brown, 9.63±1.88; black, 9.98±1.99; women: white, 8.84±1.64; brown, 9.02±1.68; black, 9.34±1.91; P<0.05). However, this difference disappeared after adjustments for age, mean arterial pressure, heart rate, waist circumference, fasting glucose, and glomerular filtration rate (men: white, 9.68±1.54; brown, 9.68±1.50; black, 9.73±1.52; women: white, 8.93±1.32; brown, 8.98±1.29; black, 9.02±1.32; P>0.05). The association between race and arterial stiffness was significant for brown and black women in the highest cf-PWV quartile, even after controlling for covariates. There were no differences in the age-related increase in cf-PWV among the racial groups after adjustment, confirming the strong effect of age and mean arterial pressure on cf-PWV revealed by the multiple linear regression. CONCLUSIONS Racial differences in cf-PWV were mainly attributed to differences in mean arterial pressure and age, although they cannot fully explain the association between race and cf-PWV in women in the highest cf-PWV values. This suggests that therapeutic approaches to overcome the effects of aging on the vascular system should focus on blood pressure control, especially in the black population.