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Current Neurology and Neuroscience Reports
Erschienen in: Current Neurology and Neuroscience Reports 11/2022

01.10.2022 | Stroke (B. Ovbiagele, Section Editor)

Promise of Physiological Profiling to Prevent Stroke in People of African Ancestry: Prototyping Ghana

verfasst von: Fred Stephen Sarfo, Bruce Ovbiagele

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 11/2022

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Abstract

Purpose of Review

Worldwide, compared to other racial/ethnic groups, individuals of African ancestry have an excessively higher burden of hypertension-related morbidities, especially stroke. Identifying modifiable biological targets that contribute to these disparities could improve global stroke outcomes. In this scoping review, we discuss how pathological perturbations in the renin–angiotensin–aldosterone pathways could be harnessed via physiological profiling for the purposes of improving blood pressure control for stroke prevention among people of African ancestry.

Recent Findings

Transcontinental comparative data from the USA and Ghana show that the prevalence of treatment-resistant hypertension among stroke survivors is 42.7% among indigenous Africans, 16.1% among African Americans, and 6.9% among non-Hispanic Whites, p < 0.0001. A multicenter clinical trial of patients without stroke in 3 African countries (Nigeria, Kenya, and South Africa) demonstrated that physiological profiling using plasma renin activity and aldosterone to individualize selection of antihypertensive medications compared with usual care resulted in better blood pressure control with fewer medications over 12 months. Among Ghanaian ischemic stroke survivors treated without renin-aldosterone profiling data, an analysis revealed that those with low renin phenotypes did not achieve any meaningful reduction in blood pressure over 12 months on 3–4 antihypertensive medications despite excellent adherence.

Summary

For a polygenic condition such as hypertension, individualized therapy based on plasma renin-aldosterone-guided selection of therapy for uncontrolled BP following precision medicine principles may be a viable strategy for primary and secondary stroke prevention with the potential to reduce disparities in the poor outcomes of stroke disproportionately shared by individuals of African ancestry. A dedicated clinical trial to test this hypothesis is warranted.
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Metadaten
Titel
Promise of Physiological Profiling to Prevent Stroke in People of African Ancestry: Prototyping Ghana
verfasst von
Fred Stephen Sarfo
Bruce Ovbiagele
Publikationsdatum
01.10.2022
Verlag
Springer US
Erschienen in
Current Neurology and Neuroscience Reports / Ausgabe 11/2022
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-022-01239-x

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