The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT)

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Cardiovascular disease (CVD) is the number one cause of death world-wide. But Africa is known for its tremendous burden of infectious diseases. With the introduction of antiretroviral therapy, the scene is starting to change with indicators pointing that dramatic increases in the incidence of hypertension and subsequent CVD, will overtake infectious diseases in the near future. Economic progress in African countries, come at a significant cost to the health burden. Although antihypertensive medication is highly cost-effective, the weak health systems in Africa fail to ensure awareness, treatment and control. The status quo can thus not be maintained in Africa concerning current practices to manage hypertension. It may have significantly greater impact if tailored population- and individual targeted prevention strategies are employed in the whole population, but especially in young individuals to early detect, prevent or delay hypertension onset. Such strategies should be based on (a) a clear understanding of the pathophysiological development of hypertension over time in young black populations; (b) coupled with objectively measured health behaviours. The African-PREDICT study was designed to address both aspects by longitudinally tracking and monitoring hypertension development in 1200 healthy black and white individuals (aged 20-30 years). We include apparently healthy men and women of African and European descent from low/mid/high levels of socio-economic status; with brachial blood pressure (BP) < 140 and 90 mmHg; HIV uninfected; no previous diagnosis or medication for chronic disease; and not pregnant or breastfeeding. Within a Hypertension Clinic at the North-West University in South Africa, we perform a wide range of basic and advanced measurements at each visit. We obtain: (1) Questionnaire data including medical history, social status, traditional risk factors (age, sex, smoking, alcohol intake) and dietary intake (24 hour dietary recall on 3 days within a week), personality, psychological distress and psychosocial profile; (2) Biological samples for biomarker analyses (blood, spot & 24hr urine) are preserved at -80°C. The study was designed to assess a wide range of traditional and novel biomarkers, including (i) the RAS Fingerprint™ covering 10 peptides from the renin-angiotensin system; (ii) pro-inflammatory multiplex biomarker analyses and urinary proteomic profiles; (iii) urinary metabolomics, with targeted genomics to be performed at a later stage; (3) Anthropometric measurements, bio-electrical impedance – body fat% and lean mass, and 7-day accelerometric physical activity monitoring; (4) Blood Pressure: 24-hour BP, central BP, and cardiovascular stress reactivity tests; and (5) Assessments of early target organ damage include albuminuria, carotid wall thickness and distensibility, ECG, echocardiography, pulse wave velocity, and retinal microvasculature. Since the study sample comprises participants in their twenties, we anticipate few hard end points (e.g. stroke) in the 10 years of follow-up. The focus will be on ‘soft’ surrogate end points, including changes in biomarker profiles and early target organ damage. By employing also in Africa the latest cutting-edge research on biomarkers and polyomics proven to predict hypertension and cardiovascular outcome, precision medicine may have the potential to lead to novel strategies in preventing and treating hypertension in Africa.