Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia.
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
J Hum Hypertens. 2021 Dec;35(12):1118-1128. doi: 10.1038/s41371-020-00473-5. Epub 2021 Jan 18.
Using a case-control design, we determined risk factors associated with hypertension in a disadvantaged rural population in southern India. Three hundred adults with hypertension and 300 age- and sex-matched controls were extensively phenotyped. Underweight (29%, body mass index < 18.0 kg m), chronic kidney disease (25%, estimated glomerular filtration rate <60 ml min 1.73 m) and anemia (82%) were highly prevalent. The ratio of sodium to potassium excretion was high (8.2). In multivariable conditional logistic regression of continuous variables dichotomized by their median value, hypertension was independently associated with greater abdominal adiposity as assessed by waist-hip ratio [odds ratio (95% confidence interval), 1.89 (1.21-2.97)], lesser protein intake as assessed by 24 h urea excretion [0.39 (0.24-0.65)], and lesser plasma renin activity [0.54 (0.35-0.84)]. Hypertension tended to be independently associated with lesser serum potassium concentration [0.66 (0.44-1.01), P = 0.06]. Furthermore, those with hypertension reported less frequent intake of vegetables and urinary sodium-potassium ratio correlated positively with serum sodium-potassium ratio (r = 0.18). Hypertension was also independently associated with lesser blood hemoglobin concentration [0.48 (0.26-0.88)]. Blood hemoglobin concentration was positively associated with serum iron (r = 0.41) and ferritin (r = 0.25) concentration and negatively associated with total iron binding capacity (r = -0.17), reflecting iron-deficiency anemia. Our findings indicate potential roles for deficient intake of potassium and protein, and iron-deficiency anemia, in the pathophysiology of hypertension in a setting of disadvantage in rural India. Imbalanced intake of potassium and sodium may be driven partly by deficient intake of vegetables or fruit.
采用病例对照设计，我们确定了印度南部一个贫困农村人群中与高血压相关的危险因素。对 300 名高血压成年人和 300 名年龄和性别匹配的对照者进行了广泛的表型分析。体重不足（29%，体重指数<18.0kg/m）、慢性肾脏病（25%，估计肾小球滤过率<60ml/min·1.73m）和贫血（82%）的患病率很高。钠排泄与钾排泄的比值较高（8.2）。在多变量条件逻辑回归中，将连续变量按中位数二分后进行分析，高血压与腹部肥胖程度较高（用腰臀比评估，比值比[95%置信区间]，1.89[1.21-2.97]）、24 小时尿尿素排泄量较少的蛋白质摄入[0.39（0.24-0.65）]和血浆肾素活性较低[0.54（0.35-0.84）]有关。高血压与血清钾浓度较低也有独立相关性[0.66（0.44-1.01），P=0.06]。此外，高血压患者蔬菜摄入量较低，且血清钠钾比值与尿钠钾比值呈正相关（r=0.18）。高血压还与血红蛋白浓度较低独立相关[0.48（0.26-0.88）]。血红蛋白浓度与血清铁（r=0.41）和铁蛋白（r=0.25）浓度呈正相关，与总铁结合能力（r=-0.17）呈负相关，反映出缺铁性贫血。我们的研究结果表明，在印度农村贫困地区，钾和蛋白质摄入不足以及缺铁性贫血可能在高血压的病理生理学中发挥作用。钾和钠的摄入不平衡可能部分是由于蔬菜或水果摄入不足所致。
