Key result
Home blood pressure telemonitoring showed target organ damage primarily affects the kidney in Black patients and the heart in White patients (EF <50% in 4 Black and 13 White patients).
Why the study?
Racial differences in cardiac and renal target organ damage may persist at comparable blood pressure levels, motivating comparison of target organ damage in high-risk Black and White patients relative to home blood pressure.
Do race-specific patterns of target organ damage exist between high-risk asymptomatic Black and White patients in relation to home blood pressure?
RCT (n=441)
Yes
Do race-specific patterns of target organ damage exist between high-risk asymptomatic Black and White patients in relation to home blood pressure?
Target organ damage primarily affects the kidney in Black patients and the heart in White patients, highlighting the need for tailored preventive strategies.
Racial TOD differences at comparable HBP levels may warrant targeted screening; leaves open whether HBP telemonitoring narrows disparities in high-risk patients.
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.
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Zhang et al. (2026) conducted an RCT in Asymptomatic with ≥5 risk factors (n=441). Risk stratification strategies was evaluated on Target organ damage (cardiac and renal). Home blood pressure telemonitoring showed target organ damage primarily affects the kidney in Black patients and the heart in White patients (EF <50% in 4 Black and 13 White patients).
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