Kumanyika S K, Landis J R, Matthews-Cook Y L, Almy S L, Boehmer S J
Center for Biostatistics and Epidemiology, The Pennsylvania State University College of Medicine, Hershey, USA.
Am J Epidemiol. 1998 Sep 15;148(6):528-38. doi: 10.1093/oxfordjournals.aje.a009678.
Recent blood pressure trends reflect progress in hypertension control, but prevalent drug therapy precludes direct estimation of the component due to primary prevention. In data gathered on persons aged 35-74 years in three successive US health examination surveys (1960-1980), systolic blood pressure levels assuming no drug therapy were imputed by reassigning blood pressure to the upper end of the distribution for respondents reporting use of antihypertensive medication. Blood pressure was partitioned into four ordinal categories based on weighted percentiles of the 1960-1962 distributions for 35- to 44-year-old males and females who reported no use of antihypertensive medication. Cumulative logit models (alpha = 0.01) were used to estimate age- and sex-specific trends for blacks and whites within two strata (<25 or > or =25) of body mass index (BMI) (weight (kg)/height (m)2). Before imputation, systolic blood pressure decreased between 1960 and 1980; after imputation, significant decreases remained only in 35- to 44-year-olds. Strong associations of black race and BMI > or =25 with higher blood pressures were present in models with and without drug therapy. Thus, according to the models, there has been little progress in decreasing racial or BMI-related blood pressure differentials. Above the age of 44 years, blood pressure trends were largely attributable to medication use. In contrast, data for 35- to 44-year-olds suggest progress in primary prevention.
近期的血压趋势反映了高血压控制方面的进展，但由于普遍采用药物治疗，无法直接估算一级预防对血压的影响。在美国连续三次健康检查调查（1960 - 1980年）收集的35 - 74岁人群的数据中，对于报告使用抗高血压药物的受访者，通过将血压重新分配到分布的上限来估算假设未进行药物治疗时的收缩压水平。根据1960 - 1962年未使用抗高血压药物的35 - 44岁男性和女性分布的加权百分位数，将血压分为四个有序类别。使用累积logit模型（α = 0.01）来估计体重指数（BMI）[体重（kg）/身高（m）²]两个分层（<25或≥25）内黑人和白人的年龄和性别特异性趋势。在估算之前，1960年至1980年期间收缩压有所下降；估算之后，仅在35 - 44岁人群中仍有显著下降。在有或没有药物治疗的模型中，均存在黑人种族以及BMI≥25与较高血压之间的强烈关联。因此，根据模型，在减少种族或BMI相关的血压差异方面进展甚微。44岁以上人群的血压趋势在很大程度上归因于药物使用。相比之下，35 - 44岁人群的数据表明在一级预防方面取得了进展。
