Soluble Receptor for Advanced Glycation End Products and Incident Hypertension in REGARDS.

Background: Black US adults experience a greater hypertension burden and have lower levels of soluble receptors for advanced glycation end products (sRAGE). sRAGE may reduce inflammation, which is itself a hypertension risk factor. We hypothesized that higher sRAGE levels are associated with a lower risk of incident hypertension in a cohort of Black and White adults.

Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) enrolled 30,239 Black and White adults from the contiguous United States in 2003-2007; a second visit occurred in 2013-2016. sRAGE was measured at baseline by ELISA in 4,400 participants attending both visits. Hypertension was defined as BP > 140/90 mm Hg or use of antihypertensive medications. Participants with baseline hypertension were excluded. Poisson regression estimated incident hypertension risk ratios (RR) by sRAGE levels, adjusting for confounders.

Results: Among 1,799 participants without baseline hypertension (mean [SD] age 62 [8] years, 55% females, 25% Black), 46% of Black participants and 31% of White participants developed hypertension. Median sRAGE was lower in Black than White persons (P < 0.0001). Relative to quartile 1, White participants in quartile 4 of sRAGE had a 24% lower risk of incident hypertension (RR 0.76; 95% CI 0.59, 0.96) in a minimally adjusted model, but no differences in a fully adjusted model (0.81; 0.63 to 1.05). There was no association of sRAGE with hypertension in Black participants.

Conclusions: Higher baseline sRAGE levels were not associated with lower risk of incident hypertension after adjusting for known confounders. Low sRAGE might represent adverse inflammation that drives hypertension rather than being a primary driver of hypertension development itself.