Elford J, Phillips A, Thomson A G, Shaper A G
Department of Clinical Epidemiology and General Practice, Royal Free Hospital School of Medicine, London.
BMJ. 1990 Feb 3;300(6720):291-5. doi: 10.1136/bmj.300.6720.291.
To evaluate the relative contributions of factors acting at different stages in life to regional differences in adult blood pressure.
Prospective cohort study (British regional heart study).
One general practice in each of 24 towns in Britain.
7735 Men aged 40-59 years when screened in 1978-80 whose geographic zone of birth and zone of examination were classified as south of England, midlands and Wales, north of England, and Scotland. Non-migrants (n = 3144) were born in the town where they were examined; internal migrants (n = 4147) were born in Great Britain but not in the town where they were examined; and international migrants (n = 422) were born outside Great Britain.
Systolic and diastolic blood pressures and height.
Regardless of where they were born, men living in the south of England had lower mean blood pressures than men living in Scotland (142.5/80.1 v 148.1/85.2 mm Hg). The effects of the place of birth and place of examination on adult blood pressure were examined in a multiple regression model. For internal migrants the modelled increase in mean systolic blood pressure across adjacent zones of examination was 2.1 mm Hg (95% confidence interval 1.3 to 2.9); for adjacent zones of birth the corresponding increase was 0.1 mm Hg (-0.7 to 0.7). The place of examination seemed to be a far more important determinant of mean adult blood pressure than the place of birth. Height is an accepted marker of genetic and early life influences. Regional differences in height were therefore analysed to test whether the multiple regression model could correctly distinguish between the influence of place of birth and place of examination. As expected, men born in Scotland were shorter on average than men born in the south of England irrespective of where they lived in Britain (172.6 cm v 175.1 cm for internal migrants).
Regional variations in blood pressure were strongly influenced by where the men had lived for most of their adult lives rather than by where they were born and brought up. Among middle aged men, factors acting in adult life seemed to be more important determinants of regional differences in blood pressure than those acting early in life such as genetic inheritance, intrauterine environment, and childhood experience.
评估在生命不同阶段起作用的因素对成人血压区域差异的相对贡献。
前瞻性队列研究（英国地区心脏研究）。
英国24个城镇中的每个城镇的一家普通诊所。
1978 - 1980年筛查时年龄在40 - 59岁的7735名男性，其出生地理区域和检查区域分为英格兰南部、中部和威尔士、英格兰北部以及苏格兰。非移民（n = 3144）在其接受检查的城镇出生；国内移民（n = 4147）出生在英国但不在其接受检查的城镇；国际移民（n = 422）出生在英国境外。
收缩压、舒张压和身高。
无论出生在哪里，生活在英格兰南部的男性平均血压低于生活在苏格兰的男性（142.5/80.1对148.1/85.2 mmHg）。在多元回归模型中研究了出生地点和检查地点对成人血压的影响。对于国内移民，跨相邻检查区域平均收缩压的模型增加量为2.1 mmHg（95%置信区间1.3至2.9）；对于相邻出生区域，相应增加量为0.1 mmHg（-0.7至0.7）。检查地点似乎是成人平均血压比出生地点更重要的决定因素。身高是遗传和早期生活影响的公认标志。因此分析了身高的区域差异，以检验多元回归模型是否能正确区分出生地点和检查地点的影响。正如预期的那样，无论生活在英国何处，出生在苏格兰的男性平均比出生在英格兰南部的男性矮（国内移民为172.6 cm对175.1 cm）。
血压的区域差异受男性成年后大部分时间居住地点的强烈影响，而非出生和成长地点。在中年男性中，成年期起作用的因素似乎比遗传、子宫内环境和童年经历等生命早期起作用的因素更能决定血压的区域差异。
