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

  • Stroke (B. Ovbiagele, Section Editor)
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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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Acknowledgements

The editors would like to thank Dr. John Brust for taking the time to review this manuscript.

Funding

FSS and BO are also supported by funding from the National Heart, Lung, and Blood Institute (R01HL152188) and NINDS (R21 NS103752-01).

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Authors and Affiliations

  1. Department of Medicine, Kwame Nkrumah University of Science & Technology, Private Mail Bag, Kumasi, Ghana

    Fred Stephen Sarfo

  2. Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Fred Stephen Sarfo

  3. Department of Neurology, University of California, San Francisco, USA

    Bruce Ovbiagele

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Correspondence to Fred Stephen Sarfo.

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Sarfo, F.S., Ovbiagele, B. Promise of Physiological Profiling to Prevent Stroke in People of African Ancestry: Prototyping Ghana. Curr Neurol Neurosci Rep 22, 735–743 (2022). https://doi.org/10.1007/s11910-022-01239-x

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