Colhoun H M, Hemingway H, Poulter N R
Department of Epidemiology and Public Health, University College London Medical School, UK.
J Hum Hypertens. 1998 Feb;12(2):91-110. doi: 10.1038/sj.jhh.1000558.
Mortality rates from hypertension related diseases such as coronary heart disease, hypertensive heart disease, stroke and end stage renal disease show an inverse association with socio-economic status (SES).
To review the published literature in order to assess whether (i) there is an association between SES and blood pressure (BP), and if so whether this is explained by (ii) SES differences in treatment rates, or (iii) SES differences in established risk factors for hypertension, or (iv) psycho-social factors associated with SES.
A narrative systematic review of published articles identified from a MEDLINE search from 1966-1996 and manual searching of the retrieved articles' bibliographies.
Lower SES was associated with higher mean BPs in almost all studies in developed countries. This inverse gradient was both stronger and more consistently found in women than in men. The magnitude of the association varied but generally was quite small, with age adjusted mean systolic BP differences of about 2-3 mm Hg between the highest and lowest SES groups. The finding of an SES gradient in BP, despite adjusting for treatment in some studies and the lack of consistent SES differences in hypertension treatment rates, makes differential treatment an unlikely explanation for the SES gradient in BP. A substantial part of the SES gradient was accounted for by the SES gradient in body mass index. Alcohol consumption across SES groups accounted for part of the association in men though few studies examined this issue specifically. In contrast, in undeveloped or developing countries a direct association between SES and BP has often been found which may reflect a higher prevalence of obesity, and higher salt and alcohol intakes among those of higher SES. The SES differences in BP were not detectable in most studies in children. There is little evidence that adverse psycho-social factors associated with low SES cause chronic elevations in BP.
A major challenge in reducing the SES gradient in BP is to understand and prevent the SES differences in obesity, which are particularly large in women. Future research should be directed to this question.
冠心病、高血压性心脏病、中风和终末期肾病等高血压相关疾病的死亡率与社会经济地位（SES）呈负相关。
回顾已发表的文献，以评估（i）SES与血压（BP）之间是否存在关联，如果存在关联，那么这种关联是否可以由以下因素解释：（ii）治疗率的SES差异，或（iii）高血压既定危险因素的SES差异，或（iv）与SES相关的心理社会因素。
对1966年至1996年MEDLINE搜索中识别出的已发表文章进行叙述性系统综述，并对检索文章的参考文献进行手工检索。
在发达国家的几乎所有研究中，较低的SES与较高的平均血压相关。这种反向梯度在女性中比在男性中更强烈且更一致地被发现。关联的程度各不相同，但通常相当小，最高和最低SES组之间年龄调整后的平均收缩压差异约为2 - 3毫米汞柱。尽管在一些研究中对治疗进行了调整，且高血压治疗率缺乏一致的SES差异，但在血压中发现了SES梯度，这使得差异治疗不太可能是血压SES梯度的解释。SES梯度的很大一部分是由体重指数的SES梯度所解释的。SES组间的酒精消费占男性关联的一部分，尽管很少有研究专门研究这个问题。相比之下，在不发达或发展中国家，SES与血压之间经常发现直接关联，这可能反映了较高SES人群中肥胖患病率较高，以及盐和酒精摄入量较高。在大多数儿童研究中未检测到血压的SES差异。几乎没有证据表明与低SES相关的不良心理社会因素会导致血压长期升高。
降低血压SES梯度的一个主要挑战是理解并预防肥胖方面的SES差异，这在女性中尤为明显。未来的研究应针对这个问题。
