CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 160 AFRICA attenuated when BMI was added to the model. Being HIV positive was found to be associated with lower SBP and DBP by 2.9 and 2.4 mmHg, respectively (Table 4). Regression analyses for SBP were analysed separately for males and females (Tables 5, 6). Adult BMI remained significantly associated with SBP in males and females, however each unit increase in BMI was associated with a relatively greater increase in SBP for males (+0.8 mmHg, p < 0.001) compared to females (+0.4 mmHg, p < 0.001). Similarly, albuminuria was associated with a 9-mmHg higher SBP in males (p = 0.017) and 6-mmHg higher SBP in females (p = 0.013). The effect of the significance of uric acid being eliminated by BMI remained in males but not for females. Each unit increase in uric acid was associated with a 19.7-mmHg higher SBP (p = 0.03) in females. The lower BP associated with HIV-positive status remained significant only in females. Due to the high numbers of females with EBP having given a history of gestational hypertension, female-specific risk factors were analysed separately for SBP (Table 6). Those of significance included a history of gestational hypertension and type of contraceptive use, specifically injectable contraceptives, which were associated with an increase in SBP of +4.6 mmHg compared to those not using contraception. Of the 358 (74%) females with a history of prior pregnancies, those who selfTable 3. Gender-specific associated risk factors for EBP in young female adults (28 years) from the BT20 cohort Variables Total Normal BP Elevated BP p-value Sample size 483 257 (53.2%) 226 (46.8%) Age (years) 483 27.8 (0.3) 27.9 (1.4) 0.072 Weight (kg) 483 68.7 (16.4) 75.7 (20.0) < 0.001 Height (cm) 483 158.9 (6.1) 159.7 (6.1) 0.138 Waist:hip 483 0.78 (0.08) 0.79 (0.09) < 0.025 BMI (kg/m2) 483 27.2 (6.3) 29.7 (7.6) < 0.001 Normotensive age 22 years, n (%) 332 206 (85.8) 126 (61.8) < 0.001 EBP age 22, n (%) 112 34 (14.2) 78 (38.2) HIV status, n (%) 483 HIV negative 330 169 (65.8) 161 (71.2) 0.106 HIV positive 71 46 (17.9) 25 (11.1) Refused test 82 42 (16.3) 40 (17.7) Laboratory investigations eGFR (ml/min/m2) 483 118.9 (117.3 – 120.4) 118.2 (116.5 – 120.0) 0.402 > 90, n (%) 466 247 (96.1) 219 (96.9) 1.000 60–90, n (%) 16 9 (3.5) 7 (3.1) < 60, n (%) 1 1 (0.4) 0 (0.0) Urine ACR (mg/mmol) 464 1.3 (0.4 – 2.1) 1.4 (0.7 – 2.2) 0.761 < 3, n (%) 436 238 (92.6) 198 (87.6) 0.259 ≥ 3, n (%) 28 13 (5.2) 15 (7.0) Uric acid (mmol/l) 483 0.26 (0.25 – 0.27) 0.28 (0.27 – 1.29) < 0.001 < 0.36 mol/l), n (%) 436 239 (93.0%) 197 (87.2%) 0.031 ≥ 0.36 mmol/l), n (%) 47 18 (7.0%) 29 (12.8%) Urine dipsticks, n (%) Haematuria 84 45 (17.9) 39 (18.2) 0.934 Proteinuria 9 3 (1.2) 6 (2.8) 0.313 Leucocyturia 114 66 (26.3) 48 (22.4) 0.334 Risk factors, n (%) Have children 358 189 (73.5) 169 (74.8) 0.835 Gestational hypertension 67 21 (11.1) 46 (27.2) < 0.001 Type of contraception, n (%) Combined oral 47 27 (25.2) 20 (18.4) 0.458 Intrauterine device 23 13 (12.2) 10 (9.2) Injectable progesterone 143 66 (61.7) 77 (70.7) Sterilisation 3 1 (0.9) 2 (1.8) 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. Table 4. Cross-sectional associations with SBP and DBP at age 28 years Models SBP (mmHg) DBP (mmHg) Beta 95% CI p-value Beta 95% CI p-value Model 1 (931) Age (years) 1.5 0.4–2.5 0.01 0.7 –0.1–1.5 0.11 Female (vs male) –10.0 –12.4 to –7.7 < 0.001 –3.0 –4.7 to –1.1 0.001 BMI 0.5 0.4–0.6 < 0.001 0.3 0.2–0.4 < 0.001 Height (cm) 0.1 –0.0–0.2 0.07 0.03 –0.1–0.1 0.58 Model R2 0.159 0.038 Model 1 + urine ACR (909) Urine ACR (mg/mmol) 0.2 0.1–0.3 0.01 0.1 –0.0–0.1 0.22 Model R2 0.165 0.040 Model 1 + eGFR (931) eGFR (ml/min/ 1.73 m2) –0.0 –0.1–0.0 0.51 –0.0 –0.1–0.0 0.50 Model R2 0.159 0.038 Model 1 + uric acid (930) Uric acid (mmol/l) 10.9 –0.4–2.1 0.06 9.6 1.1–18.1 0.03 Model R2 0.162 0.043 Model 1 + HIV status (931) HIV positive (vs negative) –2.9 –5.7 to –0.2 0.04 –2.4 –4.4 to –0.3 0.03 Refused test 0.8 –1.2–2.7 0.44 0.8 –0.6 2.3 0.27 Model R2 0.164 0.046 BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; ACR, albumin:creatinine ratio. Table 5. Cross-sectional associations with SBP at age 28 years in males vs females Models Males (n = 448) Females (n = 483) Beta 95% CI p-value Beta 95% CI p-value Model 1 Age (years) 2.9 –0.5–6.3 0.10 1.3 0.2–2.4 0.02 BMI 0.8 0.6–1.1 < 0.001 0.4 0.2–0.5 < 0.001 Model R2 0.085 0.043 Model 1 + urine ACR n = 445 n = 462 Urine ACR ≥ 3 mg/ mmol (vs < 3 mg/mmol) Haematuria (vs no haematuria) 9.0 8.7 1.6–16.4 2.7–14.6 0.017 0.005 6.1 0.1 1.3–10.8 –2.8–3.1 0.013 0.92 Model R2 0.113 0.049 Model 1 + eGFR (931) n = 448 n = 483 eGFR (ml/min/ 1.73 m2) 0.0 –0.1–0.1 0.78 –0.1 –0.1–0.0 0.21 Model R2 0.089 0.059 Model 1 + uric acid (930) n = 447 n = 483 Uric acid (mmol/l) 1.7 –13.6–17.1 0.83 19.7 2.5–36.9 0.03 Model R2 0.089 0.065 Model 1 + HIV status (931) n = 448 n = 483 HIV positive (vs negative) –2.4 –7.9–3.1 0.39 –3.2 –6.3 to –0.0 0.047 Refused test 0.6 –2.0–3.2 0.63 0.6 –2.4 3.6 0.68 Model R2 0.092 0.065 BMI, body mass index; eGFR, estimated glomerular filtration rate; ACR, albumin:creatinine ratio.
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