Bruce N G, Wannamethee G, Shaper A G
Department of Public Health, University of Liverpool, UK.
J Hum Hypertens. 1993 Jun;7(3):229-38.
The importance of various factors in explaining geographical BP variations in the UK has been examined among 2,596 men and women living in nine British towns. Associations between BP and potential explanatory variables have been examined first for individual subjects (within-population), and second for towns (between-populations). The factors showing associations with BP that were consistent within-population and between-towns were BMI, urine sodium/potassium ratio (Na/K), alcohol and anxiety at examination for men, and BMI, Na/K and anxiety at examination for women. After adjustment for these factors and age, the male BP differences between the nine towns were reduced from 10.1 mmHg systolic in men (P = 0.001) to 7.1 mmHg (P = 0.04), and from 5.9 mmHg diastolic (P = < 0.0001) to 5.5 mmHg (P < 0.0001). For women, adjustment only marginally reduced the between-town systolic differences from 5.6 mmHg (P = 0.05) to 5.5 mmHg (P = 0.3) and increased the diastolic differences from 3.7 mmHg diastolic (P = 0.03) to 5.0 mmHg (P < 0.0001). It is concluded that BMI, alcohol consumption and the Na/K ratio play an important part in the pattern of male SBP variations in the UK. The factors associated with female geographical differences in BP were less clear, but BMI and Na/K ratio appear to be important. This study has been unable to identify factors associated with geographical differences in DBP, with the possible exception of BMI in men. However, as systolic pressure is recognised to be more strongly associated with cardiovascular outcome than diastolic pressure, it can be recommended that primary prevention strategies aimed at reducing the population mean level of BP should involve efforts to reduce overweight, alcohol consumption and the Na/K ratio.
在居住于英国九个城镇的2596名男性和女性中，研究了各种因素在解释英国地理区域血压差异方面的重要性。首先针对个体受试者（人群内部），其次针对城镇（人群之间），研究了血压与潜在解释变量之间的关联。在人群内部和城镇之间与血压呈现一致关联的因素，对于男性而言是体重指数（BMI）、尿钠/钾比值（Na/K）、饮酒量以及检查时的焦虑程度；对于女性而言是BMI、Na/K以及检查时的焦虑程度。在对这些因素和年龄进行调整之后，九个城镇男性的收缩压差异从10.1 mmHg（P = 0.001）降至7.1 mmHg（P = 0.04），舒张压差异从5.9 mmHg（P < 0.0001）降至5.5 mmHg（P < 0.0001）。对于女性，调整仅略微降低了城镇间收缩压差异，从5.6 mmHg（P = 0.05）降至5.5 mmHg（P = 0.3），并使舒张压差异从3.7 mmHg（P = 0.03）增至5.0 mmHg（P < 0.0001）。研究得出结论，BMI、饮酒量和Na/K比值在英国男性收缩压变化模式中起重要作用。与女性血压地理差异相关的因素尚不太明确，但BMI和Na/K比值似乎很重要。本研究未能确定与舒张压地理差异相关的因素，男性的BMI可能是个例外。然而，由于收缩压被认为比舒张压与心血管结局的关联更强，因此建议旨在降低人群平均血压水平的一级预防策略应包括努力减轻超重、减少饮酒量以及降低Na/K比值。
