CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 159 were excluded in the analytical sample. Level of significance was set at p < 0.05. Results Table 1 shows study participant characteristics by gender (n = 933, 48% male) at the 28-year follow-up visit. Overall, 54% of the cohort had EBP with more men affected (62%) than women (47%) (p < 0.001). For those with EBP at 22 years, 75% had EBP at the 28-year follow up. When compared to males, young females had significantly higher BMI (p < 0.001), higher HIV prevalence (p < 0.001), and increased frequencies of dipstickpositive haematuria (p < 0.001) and leukocyturia (p < 0.001). Of the females who had previously been pregnant, 19% reported a history of gestational hypertension. Kidney function was well preserved with eGFR above 90 ml/ min/1.73 m2 in 96% of all participants. Only two participants had an initial eGFR less than 60 ml/min/1.73 m2 but both normalised (> 90 ml/min/1.73 m2) with repeat testing after a minimum period of three months. More women (6%) than men (2.5%) had albuminuria (uACR > 3 mg/mmol) (p = 0.02) When we investigated gender-specific risk for EBP, we found that increased weight, increased waist-to-hip ratios, higher BMI, the presence of EBP at age 22 years, and hyperuricaemia were associated with EBP in both genders compared to normotensive males and females (Tables 2, 3). A history of gestational hypertension was associated with EBP among females. eGFR did not differ significantly between males and females or have any significant association with blood pressure. When comparing males with EBP to their normotensive counterparts, there was a significant association with albuminuria [0.9 mg/mmol (0.3–1.5) vs 0.3 mg/mmol (0.2–0.3); (p < 0.001), and dipstick-positive haematuria (5.7 vs 0.6%; p = 0.003), respectively]. Neither albuminuria nor haematuria was associated with EBP in the female cohort. Being female was associated with a 10-mmHg lower SBP than being male and a 3-mmHg lower DBP (p < 0.001 and p = 0.001). A unit higher change in BMI contributed to a 0.5-mmHg higher SBP and 0.3-mmHg higher DBP. Albuminuria was associated with a 7.8-mmHg higher SBP (p < 0.001) and 3.9-mmHg higher DBP (p = 0.01). There was no association found between eGFR and BP. Uric acid on its own was associated with both higher SBP and DBP, however the association for SBP was completely Table 1. Sociodemographic and clinical characteristics of young adults (28 years) from the BT20 cohort, stratified by gender Variables Total Male Female p-value Sample size, n (%) 933 450 (48) 483 (52) Age (years) 933 27.9 (0.34) 27.9 (0.98) 0.95 Socio-economic status 933 10 (8–11) 10 (9–11) Weight (kg) 931 66.9 (14.3) 71.9 (18.5) < 0.001 Height (cm) 932 171.6 (6.4) 159.3 (6.1) < 0.001 Waist:hip ratio 933 0.83 (0.1) 0.78 (0.8) < 0.001 BMI (kg/m2) 931 22.7 (4.5) 28.3 (7.0) < 0.001 Average SBP (mmHg) 933 121.3 (12.9) 112.5 (12.6) < 0.001 Average DBP (mmHg) 933 81.1 (9.6) 79.2 (9.3) 0.003 Blood pressure, n (%) Elevated blood pressure 507 (54) 281 (62) 226 (47) < 0.001 Prehypertension 384 (41) 216 (48) 168 (35) < 0.001 Hypertension 124 (13) 65 (14) 59 (12) Women with self-reported gestational hypertension 483 67 (19) HIV status, n (%) HIV negative 612 282 (63) 330 (68) < 0.001 HIV positive 92 21 (5) 71 (15) Refused test 229 147 (33) 82 (17) Laboratory investigations eGFR (ml/min/m2) 933 119.2 (110.3–124.9) 121.4 (114.0–126.3) < 0.001 > 90, n (%) 896 430 (96) 466 (96) 0.77 60–90, n (%) 35 19 (4) 16 (3) < 60, n (%) 2 1 (0.2) 1 (0.2) uACR (mg/mmol) 911 0.2 (0.1–0.3) 0.2 (0.1–0.5) < 0.001 < 3, n (%) 872 436/447 (97.5) 436/464 (94) 0.02 3–30, n (%) 33 10 (2.2) 23 (5) > 30, n (%) 6 1 (0.2) 5 (1) Uric acid, n (%) 933 Normal 819 383 (85) 436 (90) High 114 67 (15) 47(10) 0.016 Urine dipsticks, n (%) Haematuria 914 17 (4) 84 (18) < 0.001 Proteinuria 914 8 (1.8) 9 (1.9) 0.86 Leucocyturia 914 13 (3) 114 (25) < 0.001 Summary statistics presented as mean (SD), median (IQR) or n (%); estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI(creatinine) equation without adjustment for African-American ethnicity and data represent single screen only; urine albumin:creatinine ratio (uACR) data represent single screen only. BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure. Table 2. Gender-specific associated risk factors for EBP in young male adults (28 years) from the BT20 cohort Variables Total Normal BP Elevated BP p-value Sample size, n (%) 450 169 (37.6) 281 (62.4) Age (years) 450 27.9 (0.3) 27.9 (0.3) 0.802 Weight (kg) 450 63.4 (11.1) 68.9 (15.6) < 0.001 Height (cm) 450 171.9 (6.3) 171.5 (6.5) 0.457 Waist:hip ratio 450 0.81 (0.05) 0.84 (0.1) < 0.001 BMI (kg/m2) 450 21.4 (3.5) 23.4 (4.9) < 0.001 Normotensive age 22 years, n (%) 165 117 (70.9) 100 (37.7) < 0.001 EBP age 22 years, n (%) 265 48 (29.1) 165 (62.3) HIV status, n (%) HIV negative 282 108 (63.9) 174 (61.9) 0.476 HIV positive 21 10 (5.9) 11 (3.9) Refused test 147 51 (30.2) 96 (34.2) Laboratory investigations eGFR (ml/min/m2) 450 116.7 (114.8–118.6) 116.2 (114.5–117.8) 0.985 > 90, n (%) 430 165 (97.6) 265 (94.3) 0.179 60–90, n (%) 19 4 (2.4) 15 (5.3) < 60, n (%) 1 0 (0) 1 (0.4) Urine ACR (mg/mmol) 447 0.3 (0.2–0.3) 0.9 (0.3–1.5) < 0.001 < 3, n (%) 436 167 (99.4) 269 (96.4) 0.041 ≥ 3, n (%) 11 1 (0.6) 10 (3.6) Uric acid (mmol/l) 449 0.3 (0.1) 0.3 (0.1) 0.186 < 0.43 mmol/l, n (%) 383 152 (89.9) 231 (82.2) 0.017 ≥ 0,43mmol/l, n (%) 67 17 (10.1) 50 (17.8) Urine dipsticks, n (%) Haematuria 17 1 (0.6) 16 (5.7) 0.003 Proteinuria 8 1 (0.6) 7 (2.5) 0.134 Leucocyturia 13 4 (2.4) 9 (3.2) 0.426 Summary statistics presented as mean (SD), median (IQR) or n (%); estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI(creatinine) equation without adjustment for African-American ethnicity and data represent single screen only; urine albumin:creatinine ratio (uACR) data represent single screen only. BMI, body mass index; EBP, elevated blood pressure.
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