J Korean Soc Hypertens.  2014 Jun;20(2):31-41. 10.5646/jksh.2014.20.2.31.

Blood Pressure Change and the Associated Factors in a Middle-Aged Korean Rural Population: Atherosclerosis Risk of a Rural Area Korean General Population (ARIRANG) Study

• Lee JW
• Yoo BS
• Lee JH
• Youn YJ
• Ahn SG
• Ahn MS
• Kim JY
• Lee SH
• Yoon JH
• Choi EH

• KMID: 2196748
• DOI: http://doi.org/10.5646/jksh.2014.20.2.31

Abstract

BACKGROUND
Elevation of blood pressure (BP) and the increasing incidence of hypertension have been known to be associated with time course, especially age. But there is still lack of evidence of BP change and the association with biochemical markers or markers for subclinical organ damage in Korean general population. Thus, the purpose of this study is to investigate BP change and the related factors in established Korean mid-aged rural cohort.
METHODS
This study was performed by using data from ARIRANG cohort (Atherosclerosis Risk of a Rural Area Korean General Population) in Gangwon rural area. Data were collected from baseline survey (Nov 2005-Jan 2008) and follow-up survey (Apr 2008-Jan 2011). Among 5,515 participants, 1,863 were analyzed after excluding individuals with hypertension, diabetes mellitus, cerebral infarction, myocardial infarction, missing data for BP, and newly-developed hypertension.
RESULTS
Mean age was 53.4 +/- 8.2 years and men were 718 (38.5%). Mean follow-up period was 2.4 +/- 0.9 years. Baseline systolic and diastolic BP were 123.6 +/- 15.7 mm Hg and 79.2 +/- 10.8 mm Hg. Systolic BP changes were -10.9 +/- 15.3 mm Hg and diastolic BP changes were -7.7 +/- 11.8 mm Hg. In logistic regression analysis, predictors for elevation of systolic BP on follow-up were start regular exercise (odds ratio [OR], 0.765; 95% confidence interval [CI], 0.604 to 0.968; p=0.0257) and fasting glucose (OR, 0.984; 95% CI, 0.972 to 0.996; p=0.0102) and homeostasis assessment-insulin resistance (OR, 0.82; 95% CI, 0.707 to 0.952; p = 0.0086).
CONCLUSIONS
Follow-up systolic and diastolic BP were significantly decreased when compared to baseline BP in mid-aged Korean rural cohort population. Long-term follow-up is needed to discriminate the periodic change of BP and the associated factors.

Keyword

Blood pressure; Cohort study; Hypertension

MeSH Terms

Atherosclerosis*
Biomarkers
Blood Pressure*
Cerebral Infarction
Cohort Studies
Surveys and Questionnaires
Diabetes Mellitus
Fasting
Follow-Up Studies
Gangwon-do
Glucose
Homeostasis
Humans
Hypertension
Incidence
Logistic Models
Male
Myocardial Infarction
Rural Population*
Glucose

Reference

References

1. Franklin SS, Gustin Wt, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997; 96:308–15.

2. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001; 358:1682–6.

3. Lawes CM. Vander Hoorn S, Rodgers A; International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008; 371:1513–8.

4. Kim SG KS, Park WS. Prevalence and management status of hypertension in Korea. Korean Hypertens J. 2006; 12:7–15.

5. Cha KB KS, Kang WK, Park WS. Estimating the burden of diseases due to hypertension in Korea. Korean Hypertens J. 2007; 13:32–40.

6. Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012; 308:875–81.

7. Sutton-Tyrrell K, Newman A, Simonsick EM, Havlik R, Pahor M, Lakatta E, et al. Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging, and body composition. Hypertension. 2001; 38:429–33.

8. Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005; 25:932–43.

9. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006; 27:2588–605.

10. Mitchell GF, Guo CY, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Cross-sectional correlates of increased aortic stiffness in the community: the Framingham Heart Study. Circulation. 2007; 115:2628–36.

11. Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol. 2011; 57:1511–22.

12. Rothwell PM, Howard SC, Dolan E. O’Brien E, Dobson JE, Dahlof B, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010; 375:895–905.

13. Koh SB, Park JK, Yoon JH, Chang SJ, Oh SS, Kim JY, et al. Preliminary report: a serious link between adiponectin levels and metabolic syndrome in a Korean nondiabetic population. Metabolism. 2010; 59:333–7.

14. Yoon JH, Park JK, Oh SS, Lee KH, Kim SK, Cho IJ, et al. The ratio of serum leptin to adiponectin provides adjunctive information to the risk of metabolic syndrome beyond the homeostasis model assessment insulin resistance: the Korean Genomic Rural Cohort Study. Clin Chim Acta. 2011; 412:2199–205.

15. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120:1640–5.

16. Justesen TI, Petersen JL, Ekbom P, Damm P, Mathiesen ER. Albumin-to-creatinine ratio in random urine samples might replace 24-h urine collections in screening for micro- and macroalbuminuria in pregnant woman with type 1 diabetes. Diabetes Care. 2006; 29:924–5.

17. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949; 37:161–86.

18. Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, et al. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985; 6:572–80.

19. Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, et al. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004; 292:2350–6.

20. Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanian A. High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension. 1991; 17:22–7.

21. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007; 25:1105–87.

22. Saad MF, Rewers M, Selby J, Howard G, Jinagouda S, Fahmi S, et al. Insulin resistance and hypertension: the Insulin Resistance Atherosclerosis study. Hypertension. 2004; 43:1324–31.

23. Lima NK, Abbasi F, Lamendola C, Reaven GM. Prevalence of insulin resistance and related risk factors for cardiovascular disease in patients with essential hypertension. Am J Hypertens. 2009; 22:106–11.

24. Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK.

25. Oparil S. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011; 57:160–6.