Blood pressure patterns differ between South Asian and East Asian adults in UK

Disparities in how high blood pressure and cardiovascular risks may develop among South Asian and East Asian adults in the United Kingdom highlight the need for more tailored screening and treatment focused on Asian populations, according to a new analysis.

Researchers used health data to project that South Asian adults could experience high blood pressure much sooner than East Asian adults on average. The findings were published Wednesday in the American Heart Association journal Hypertension.

"High blood pressure and its management vary widely across racial and ethnic populations, and the frequently used 'Asian' category hides those differences," lead researcher Dr. So Mi Jemma Cho said in a news release. Cho is a postdoctoral fellow at Massachusetts General Hospital in Boston and the Broad Institute of MIT and Harvard in Cambridge. "This is crucial considering that high blood pressure at a young age is a major contributor to premature heart disease risk."

Guidelines from the AHA and the American College of Cardiology define high blood pressure, or hypertension, as a systolic, or top number, that is consistently 130 millimeters of mercury (mmHg) or higher, or a diastolic – the bottom number – that is 80 mmHg or more. High blood pressure is the leading cause of heart attacks and strokes worldwide.

The analysis is based on the health records of 3,453 adults in the UK Biobank who self-identified as South Asian or East Asian. South Asian people – with origins in India, Pakistan, Bangladesh, Bhutan, Maldives, Nepal or Sri Lanka – made up the majority of participants. East Asian participants reported origins in China.

Researchers tracked blood pressure readings, instances of heart attack, stroke and peripheral artery disease and risk factors such as smoking, diet and social drivers of health. They then used that information to estimate blood pressure patterns at five-year increments and predicted how they related to the participants' risk for cardiovascular disease.

Differences became evident at age 30, with South Asian adults showing earlier and faster increases in systolic blood pressure than East Asian adults on average – but still below 130 mmHg. The analysis also found that, on average, South Asian men were projected to reach a systolic blood pressure of at least 130 mmHg at age 36 – 10 years sooner than East Asian men. South Asian women were predicted to reach the threshold at age 45 compared to age 52 for East Asian women.

Higher blood pressure in early adulthood was associated with a higher lifetime risk for cardiovascular disease in South Asian adults. And although East Asian adults were projected to develop hypertension later in life than their South Asian counterparts, each significant rise in systolic blood pressure in middle age was linked to a nearly 2.5 times higher risk for cardiovascular disease caused by blocked arteries and a nearly fourfold greater risk of stroke.

"These findings demonstrate the need to tailor blood pressure screenings and treatment timing for different Asian subpopulations to advance personalized care and prevention strategies for historically understudied communities," senior study author Dr. Pradeep Natarajan said in the news release. Natarajan is an associate professor at Harvard Medical School in Boston. "Distinct age-related blood pressure patterns provide valuable insights to better manage cardiovascular risks and improve care for diverse populations."

The researchers said their findings might not apply to Asian people living outside the U.K., because differences in health care systems, living environments and cultural adaptation could influence the results.

Ultimately, the findings suggest "a complex interplay of social factors and genetics resulting in varying experiences of hypertension in Asian populations," Dr. Nilay S. Shah said in the news release. Shah, who was not involved with the study, led the writing group for a 2024 AHA scientific statement on the social drivers of cardiovascular health among Asian Americans. He is a cardiologist at Northwestern Medicine Bluhm Cardiovascular Institute in Chicago.

"There is much, much more work to be done to understand cardiovascular risk factors and outcomes experienced by Asian populations," he said.