Pulmonary hypertension, or high blood pressure of the arteries in the lungs, is a common condition that affects hundreds of thousands of people. Pulmonary hypertension can be inherited, develop spontaneously, or be associated with another disease such as heart failure. Having pulmonary hypertension leads to more hospitalizations and increased mortality. Therefore, diagnosing and treating this condition is important to improve quality of life for patients and to reduce healthcare costs.
African-Americans have higher rates of heart failure, high blood pressure, and diabetes, all of which are risk factors for pulmonary hypertension. However, few studies have examined racial differences in patients with pulmonary hypertension and no studies have directly compared pulmonary pressures between African-Americans and Caucasians. Therefore, we examined a large group of patients who were referred for direct pulmonary pressure measurements by right heart catheterization. We hypothesized that African-Americans are at higher risk for developing pulmonary hypertension.
We found that the African-Americans in our study were younger than Caucasians by an average of 8 years, but had higher rates of pulmonary hypertension and higher pulmonary pressures, which reflects more severe disease. African-American patients were associated with a 41% increased risk of pulmonary hypertension, after adjusting for other risk factors. The factors that are driving this observation are unclear. Some of our data suggest a genetic predisposition to pulmonary hypertension among African-Americans, whereas another potential answer is socioeconomic status, which plays an important role in cardiovascular diseases. This should be an important topic for future research.
Identifying racial differences in pulmonary hypertension is important for patients and doctors alike. African-American patients with pulmonary hypertension risk factors should be aware of signs and symptoms of this condition, such as shortness of breath especially with exercise, lightheadedness, or leg swelling. For physicians, more aggressive treatment and more frequent surveillance may be considered for African-American patients at high risk.
In summary, race plays an important role in pulmonary hypertension. Future investigations should examine whether socioeconomic and genetic factors contribute to pulmonary hypertension, in hopes of identifying interventions that can prevent hospitalizations and change the disease trajectory.
Evan Brittain, MD, MSc is Assistant Professor of Medicine, Division of Cardiovascular Medicine at Vanderbilt University Medical Center.
Bin Yang, MD is a third year resident at Vanderbilt University Medical Center.
Bin Q. Yang, Tufik R. Assad, Jared M. O’Leary, Meng Xu, Stephen J. Halliday, Reid W. D’Amico, Eric H. Farber-Eger, Quinn S. Wells, Anna R. Hemnes and
Evan L. Brittain
First Published March 14, 2018