Department of Pediatrics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Hypertension. 2013 Jan;61(1):35-41. doi: 10.1161/HYPERTENSIONAHA.111.00106. Epub 2012 Nov 5.
Much remains to be understood about the socioeconomic inequalities in hypertension that continue to exist. We investigated the association of socioeconomic status with blood pressure and prehypertension in childhood. In a prospective cohort, 3024 five- to six-year-old children had blood pressure measurements and available information on potential explanatory factors, namely birth weight, gestational age, smoking during pregnancy, pregnancy-induced hypertension, familial hypertension, maternal body mass index, breastfeeding duration, domestic tobacco exposure, and body mass index. The systolic and diastolic blood pressures of children from mid-educated women were 1.0-mm Hg higher (95% CI, 0.4-1.7) and 0.9-mm Hg higher (95% CI, 0.3-1.4), and the blood pressures of children with low-educated women were 2.2-mm Hg higher (95% CI, 1.4-3.0) and 1.7-mm Hg higher (95% CI, 1.1-2.4) compared with children with high-educated women. Children with mid- (odds ratio, 1.50; 95% CI, 1.18-1.92) or low-educated mothers (odds ratio, 1.80; 95% CI, 1.35-2.42) were more likely to have prehypertension compared with children with high-educated mothers. Using path analyses, birth weight, breastfeeding duration, and body mass index were determined as having a role in the association of maternal education with offspring blood pressure and prehypertension. The socioeconomic gradient in hypertension appears to emerge from childhood as the results show a higher blood pressure and more prehypertension in children from lower socioeconomic status families. Socioeconomic disparities could be reduced by improving 3 factors in particular, namely birth weight, breastfeeding duration, and body mass index, but other factors might also play a role.
关于仍然存在的高血压与社会经济不平等之间的关系，我们还有很多需要了解。我们研究了社会经济地位与儿童时期血压和高血压前期之间的关系。在一项前瞻性队列研究中，3024 名 5 至 6 岁的儿童进行了血压测量，并获得了可能的解释因素的信息，即出生体重、胎龄、孕期吸烟、妊娠高血压、家族性高血压、母亲的身体质量指数、母乳喂养时间、家庭吸烟暴露和体重指数。受过中等教育的女性的孩子的收缩压和舒张压分别高出 1.0mmHg（95%CI，0.4-1.7）和 0.9mmHg（95%CI，0.3-1.4），而受教育程度较低的女性的孩子的收缩压和舒张压分别高出 2.2mmHg（95%CI，1.4-3.0）和 1.7mmHg（95%CI，1.1-2.4）。与母亲受过高等教育的孩子相比，母亲受过中等教育（比值比，1.50；95%CI，1.18-1.92）或低等教育（比值比，1.80；95%CI，1.35-2.42）的孩子更有可能患有高血压前期。通过路径分析，发现出生体重、母乳喂养时间和体重指数在母亲教育与子女血压和高血压前期之间的关系中起着作用。高血压的社会经济梯度似乎从儿童时期就出现了，因为研究结果显示，来自社会经济地位较低家庭的儿童血压较高，高血压前期的比例也较高。通过改善出生体重、母乳喂养时间和体重指数等 3 个因素，可以减少社会经济差距，但其他因素也可能发挥作用。
