Black patients show organ damage at lower blood pressures, study finds
A major clinical trial reveals that Black patients develop heart and kidney damage at blood pressure levels considered safe for white patients—even when home monitoring is used. The finding suggests existing treatment guidelines may inadequately protect Black Americans and could reshape how doctors assess cardiovascular risk across racial groups.
Originaltitel: Home blood pressure telemonitoring reveals race-specific patterns of target organ damage.
Hemblodtrycksmätning avslöjar rasberoende skador på målorganen — resultatet ändrar hur kliniker bör prioritera behandling. I UPRIGHT-HTM-studien, som omfattade 287 svarta och 154 vita högrisikpatienter under medicinsk telemonitorering, visade svarta patienter främst njurskador medan vita utvecklade hjärtförändringar vid motsvarande blodtrycksnivåer. Studien analyserade 252 215 hemblodtrycksmätningar (median 127/77 mmHg) med ekokardiografi och njurfunktion enligt 2024 KDIGO-riktlinjer. Svarta patienter erhöll mindre ofta statiner och kombinerad antihypertensiv terapi trots högre njurskadegrader oberoende av hemblodtryck. För inköpschefer innebär denna stratifiering behov av målgruppsanpassad övervakningsstrategi och förskrivningsmönster. Regulatoriska specialister måste beakta rasberoende effektskillnader vid riskklassificering. Marknadens efterfrågan på differentierad telemonitorering ökar därmed.
BACKGROUND: Racial differences in cardiac and renal target organ damage (TOD) may persist at comparable blood pressure levels. This study compared TOD in high-risk, non-African-American Black and White patients in relation to the home blood pressure (HBP). METHODS: UPRIGHT-HTM (NCT04299529) is an ongoing international trial comparing risk stratification strategies in asymptomatic patients, aged 55-75 years, with ≥5 risk factors. Patients engage in HBP telemonitoring (OMRON HEM 9210-T). After 34.7 months (median), 287 Black and 154 White patients underwent echocardiography. At baseline, their chronic kidney disease (CKD) grade was assessed by cross-classification of the race-free estimated glomerular filtration rate and albuminuria (2024 KDIGO guideline). HBP was stratified by the 2024 ESC thresholds. Linear and logistic regression models, including a race-by-HBP interaction term, were applied to assess associations with the home systolic HBP. RESULTS: The number of HBP readings was 252 215. Median systolic/diastolic HBP was 127/77 mmHg with 142 patients (32.2%) having home hypertension. Fewer Black patients received statins or combination therapy for hypertension or diabetes. Among nonhypertensive White compared to Black patients, left atrial dimensions, mitral annular s', and stroke volume had a steeper slope in relation to systolic HBP. All patients had concentric left ventricular remodeling, but only 4 Black and 13 White patients had an ejection fraction < 50%. CKD grade was worse in Black than White patients without association with HBP. CONCLUSIONS: TOD primarily affects the kidney in Black and the heart in White patients. Intensifying pharmacological treatment in sub-Saharan Africa, including antihypertensives, lipid-lowering agents, antidiabetic medications, and aspirin, should create an opportunity for improved overall cardiovascular and metabolic prevention.