JKSH Journal of the Korean Society of Hypertension J Korean Soc Hypertens 2233-8136 2233-8454 The Korean Society of Hypertension 10.5646/jksh.2014.20.2.31 jksh-20-31 Original Article 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 LeeJun-WonMD 1 YooByung-SuMD 1 LeeJi HyunMD 1 YounYoung JinMD 1 AhnSung GyunMD 1 AhnMin-SooMD 1 KimJang-YoungMD 1 LeeSeung-HwanMD 1 YoonJung hanMD 1 ChoiEun-HuiMD 2 Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea Correspondence to: Byung-Su Yoo, MD Address: Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea Tel: +82-33-741-0920, Fax: +82-33-741-1219 E-mail: yubs@yonsei.ac.kr 06 2014 13 06 2014 202 31 41 03032014 23032014 27062014 Copyright © 2014 Korean Ophthalmological Society 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

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Anthropometrical, laboratory and metabolic characteristics of study population

Total (n = 1,863) Men (n = 718) Women (n = 1,145) p-value
Age (yr) 53.4 ± 8.2 55.2 ± 8.3 52.3 ± 8.0 <0.0001
Smoking status <0.0001
  Current smoker 292 (15.7) 281 (39.3) 11 (1.0)
  Ex-smoker 204 (11.0) 196 (27.4) 8 (0.7)
  Non-smoker 1360 (73.3) 239 (33.4) 1121 (98.3)
Body mass index (kg/m2) 23.9 ± 2.9 23.9 ± 2.9 23.9 ± 3.0 0.7475
Waist circumference (cm) 81.4 ± 8.6 85.3 ± 7.5 78.9 ± 8.3 <0.0001
Initial systolic BP (mm Hg) 123.6 ± 15.7 125.9 ± 15.7 122.3 ± 15.6 <0.0001
Initial diastolic BP (mm Hg) 79.2 ± 10.8 81.4 ± 10.5 77.8 ± 10.7 <0.0001
Initial heart rate (beats/min) 72.3 ± 23.9 71.0 ± 26.0 73.1 ± 22.5 0.0797
Follow-up systolic BP (mm Hg) 112.7 ± 8.9 113.8 ± 8.6 112.0 ± 9.1 <0.0001
Follow-up diastolic BP (mm Hg) 71.5 ± 7.1 72.4 ± 6.8 70.9 ± 7.2 <0.0001
Follow-up heart rate (beats/min) 65.2 ± 8.0 64.7 ± 8.3 65.5 ± 7.7 0.0687
Δ Systolic BP (mm Hg) -10.9 ± 15.3 -12.0 ± 15.6 -10.2 ± 15.1 0.0141
Δ Diastolic BP (mm Hg) -7.7 ± 11.8 -8.9 ± 11.8 -6.9 ± 11.6 0.0003
Δ Heart rate (beats/min) -8.0 ± 28.2 -7.1 ± 30.0 -8.7 ± 26.9 0.3496
Creatinine (mg/dL) 0.92 ± 0.14 1.05 ± 0.12 0.84 ± 0.09 <0.0001
Fasting glucose (mg/dL) 91.8 ± 12.3 94.2 ± 13.4 90.2 ± 11.4 <0.0001
Hemoglobin A1c (%) 5.4 ± 0.5 5.5 ± 0.6 5.4 ± 0.5 <0.0001
Total cholesterol (mg/dL) 197.8 ± 35.8 194.7 ± 34.0 199.7 ± 36.8 0.0025
HDL cholesterol (mg/dL) 47.0 ± 11.0 45.4 ± 11.5 48.0 ± 10.5 <0.0001
Low density lipoprotein cholesterol (mg/dL) 115.6 ± 30.6 112.4 ± 29.5 117.5 ± 31.1 0.0004
Triglyceride (mg/dL) 131.0 ± 80.6 150.0 ± 93.5 119.1 ± 68.8 <0.0001
Homeostasis assessment-insulin resistance (units) 1.86 ± 1.09 1.79 ± 1.22 1.90 ± 1.00 0.0524
High sensitivity C reactive protein (mg/L) 1.64 ± 4.51 2.03 ± 5.97 1.40 ± 3.25 0.0095
Adiponectin (mg/L) 10.6 ± 5.1 8.4 ± 4.2 12.1 ± 5.1 <0.0001
N-terminal pro B-type natriuretic peptide (pg/mL) 74.1 ± 120.4 64.1 ± 128.6 80.8 ± 114.4 0.0877
Albumin/creatinine ratio 2.55 ± 10.34 2.76 ± 11.24 2.42 ± 9.71 0.5490
  Normal 1434 (97.1) 566 (96.1) 868 (97.8) 0.1788
  High normal 21 (1.4) 11 (1.9) 10 (1.1)
  Microalbuminuria 22 (1.5) 12 (2.0) 10 (1.1)
  Macroalbuminuria 0 (0) 0 (0) 0 (0)
LVH by Cornell 11 (3.0) 2 (1.7) 9 (3.6) 0.5135
LVH by Sokolow-Lyon 11 (3.0) 9 (7.8) 2 (0.8) 0.7268
LVH by echocardiography 72 (12.0) 25 (12.4) 47 (11.8) 0.8316
Metabolic syndrome 461 (24.9) 204 (28.5) 257 (22.5) 0.0037
  High waist circumference 476 (25.7) 208 (29.1) 268 (23.5) 0.0074
  Low HDL cholesterol 940 (50.5) 240 (33.4) 700 (61.1) <0.0001
  High triglyceride 538 (28.9) 271 (37.7) 267 (23.3) <0.0001
  High BP 857 (46.0) 381 (53.1) 476 (41.6) <0.0001
  High fasting glucose 310 (16.6) 173 (24.1) 173 (24.1) <0.0001

Values are presented as mean ± standard deviation, median (interquartile range), or frequency (%). p-value for men vs. women. The diagnosis of metabolic syndrome includes at least 3 of the following criteria: 1) high waist circumference, at least 90 cm for men or at least 80 cm for women; 2) low HDL cholesterol, <40 mg/dL in men and <50 mg/dL in women; 3) high triglyceride, at least 150 mg/dL; 4) high BP, systolic BP at least 130 mm Hg or diastolic BP at least 85 mm Hg; 5) high fasting glucose, at least 100 mg/dL.

BP, blood pressure; HDL, high density lipoprotein; LVH, left ventricular hypertrophy.

Characteristics of study population by quartile of systolic blood pressure change

Variable Q1 Q2 Q3 Q4 p-value
Total 542 (29.1) 468 (25.1) 459 (24.6) 394 (21.1)
  HOMA-IR (units) 2.01 ± 1.13 1.86 ± 0.98 1.83 ± 1.21 1.66 ± 0.96 <0.0001
  Hs-CRP (mg/L) 1.78 ± 4.07 1.36 ± 2.72 1.90 ± 6.88 1.51 ± 3.04 0.2393
  Adiponectin (mg/L) 10.2 ± 5.0 10.6 ± 5.1 10.8 ± 5.3 11.0 ± 4.8 0.1128
  NT-proBNP (pg/mL) 72.8 ± 69.7 79.2 ± 172.5 64.6 ± 66.8 81.0 ± 142.6 0.5895
  Albumin/creatinine ratio 3.52 ± 12.91 2.88 ± 13.94 1.78 ± 3.44 2.00 ± 7.25 0.0774
  LVH by Cornell 5 (3.8) 1 (1.1) 4 (4.4) 1 (1.9) 0.5419
  LVH by Sokolow-Lyon 1 (0.8) 3 (3.2) 4 (4.4) 3 (5.8) 0.1504
  LVH by echocardiography 30 (13.0) 14 (9.1) 17 (12.1) 11 (15.1) 0.5531
Men 228 (31.8) 179 (24.9) 177 (24.7) 134 (18.7)
  HOMA-IR (units) 1.89 ± 1.05 1.69 ± 0.70 1.87 ± 1.72 1.64 ± 1.26 0.1388
  Hs-CRP (mg/L) 2.03 ± 4.51 1.75 ± 3.50 2.69 ± 10.07 1.56 ± 2.50 0.3403
  Adiponectin (mg/L) 8.0 ± 4.1 8.2 ± 4.2 8.5 ± 4.0 9.1 ± 4.5 0.1103
  NT-proBNP (pg/mL) 59.9 ± 49.4 61.9 ± 134.3 55.8 ± 74.8 87.2 ± 232.8 0.5877
  Albumin/creatinine ratio 3.76 ± 15.70 3.10 ± 10.72 1.57 ± 2.80 2.53 ± 11.53 0.3528
  LVH by Cornell 0 1 (3.7) 1 (5.0) 0 0.2565
  LVH by Sokolow-Lyon 0 2 (7.4) 4 (20.0) 3 (14.3) 0.0061
  LVH by echocardiography 8 (8.8) 5 (10.9) 4 (11.8) 8 (26.7) 0.1057
Women 314 (27.4) 289 (25.2) 282 (24.6) 260 (22.7)
  HOMA-IR (units) 2.10 ± 1.18 1.96 ± 1.11 1.81 ± 0.74 1.67 ± 0.76 <0.0001
  Hs-CRP (mg/L) 1.59 ± 3.72 1.12 ± 2.08 1.41 ± 3.61 1.48 ± 3.29 0.3263
  Adiponectin (mg/L) 11.9 ± 4.9 12.1 ± 5.1 12.4 ± 5.6 11.9 ± 4.7 0.6798
  NT-proBNP (pg/mL) 82.3 ± 80.3 92.0 ± 195.6 71.4 ± 59.4 78.3 ± 78.0 0.6562
  Albumin/creatinine ratio 3.34 ± 10.34 2.74 ± 15.79 1.93 ± 3.83 1.73 ± 3.50 0.2730
  LVH by Cornell 5 (6.0) 0 3 (4.2) 1 (3.2) 0.1926
  LVH by Sokolow-Lyon 1 (1.2) 1 (1.5) 0 0 0.8110
  LVH by echocardiography 22 (15.7) 9 (8.3) 13 (12.3) 3 (7.0) 0.2329

Values are presented as mean ± standard deviation or frequency (%).

HOMA-IR, homeostasis assessment-insulin resistance; hs-CRP, high sensitivity C reactive protein; NT-proBNP, N-terminal pro B-type natriuretic peptide; LVH, left ventricular hypertrophy.

Characteristics of study population by quartile of diastolic blood pressure change

Variable Q1 Q2 Q3 Q4 p-value
Total 483 (25.9) 469 (25.2) 487 (26.1) 424 (22.8)
HOMA-IR (units) 1.94 ± 1.34 1.83 ± 0.96 1.87 ± 0.94 1.77 ± 1.09 0.1059
Hs-CRP (mg/L) 1.46 ± 3.10 1.68 ± 3.42 1.82 ± 6.58 1.61 ± 3.83 0.6787
Adiponectin (mg/L) 10.0 ± 4.8 10.4 ± 5.0 10.9 ± 5.1 11.3 ± 5.3 0.0009
NT-proBNP (pg/mL) 78.3 ± 150.9 80.6 ± 137.8 67.3 ± 61.4 67.9 ± 99.7 0.6564
Albumin/creatinine ratio 3.55 ± 12.47 2.46 ± 12.56 1.96 ± 6.22 2.10 ± 7.96 0.1329
LVH by Cornell 2 (3.1) 3 (3.8) 4 (3.0) 2 (2.2) 0.9734
LVH by Sokolow-Lyon 2 (3.1) 2 (3.1) 4 (3.0) 3 (3.3) 1.0000
LVH by echocardiography 13 (12.5) 17 (12.6) 28 (13.7) 14 (9.1) 0.6081
Men 191 (26.6) 184 (25.6) 192 (26.7) 151 (21.0)
HOMA-IR (units) 1.89 ± 1.50 1.79 ± 0.98 1.77 ± 1.02 1.69 ± 1.33 0.4870
Hs-CRP (mg/L) 1.51 ± 2.39 1.80 ± 3.18 2.73 ± 10.04 2.10 ± 4.66 0.2274
Adiponectin (mg/L) 8.0 ± 4.0 8.5 ± 3.9 8.4 ± 4.2 9.0 ± 4.7 0.2304
NT-proBNP (pg/mL) 50.2 ± 37.2 88.0 ± 202.6 50.0 ± 33.7 69.0 ± 154.4 0.2337
Albumin/creatinine ratio 3.90 ± 15.63 1.95 ± 5.63 2.63 ± 9.38 2.38 ± 11.85 0.4446
LVH by Cornell 0 0 2 (4.7) 0 0.5294
LVH by Sokolow-Lyon 1 (4.6) 0 5 (11.6) 3 (10.7) 0.3789
LVH by echocardiography 4 (11.1) 2 (4.7) 11 (15.9) 8 (15.1) 0.3114
Women 292 (25.5) 285 (24.9) 295 (25.8) 273 (23.8)
HOMA-IR (units) 1.96 ± 1.19 1.93 ± 0.93 1.88 ± 0.91 1.82 ± 0.93 0.3424
Hs-CRP (mg/L) 1.38 ± 3.26 1.42 ± 2.91 1.46 ± 3.56 1.34 ± 3.25 0.9780
Adiponectin (mg/L) 11.5 ± 4.8 11.9 ± 5.2 12.3 ± 5.2 12.7 ± 5.1 0.0567
NT-proBNP (pg/mL) 97.1 ± 186.4 74.0 ± 64.9 80.4 ± 74.2 67.3 ± 46.9 0.2673
Albumin/creatinine ratio 3.24 ± 9.57 2.91 ± 15.65 1.39 ± 1.91 1.95 ± 4.55 0.1564
LVH by Cornell 2 (4.4) 4 (6.9) 1 (1.2) 2 (3.2) 0.3342
LVH by Sokolow-Lyon 1 (2.2) 1 (1.7) 0 0 0.2291
LVH by echocardiography 11 (14.5) 16 (17.6) 14 (10.9) 6 (5.9) 0.0762

Values are presented as mean ± standard deviation or frequency (%).

HOMA-IR, homeostasis assessment-insulin resistance; hs-CRP, high sensitivity C reactive protein; NT-proBNP, N-terminal pro B-type natriuretic peptide; LVH, left ventricular hypertrophy.

The correlation between BP change and baseline laboratory tests

Variable ▵ Systolic BP
 ▵ Diastolic BP
r p-value r p-value
Total
  HOMA-IR (units) -0.08953 <0.0001 -0.03769 0.0525
  Hs-CRP (mg/L) 0.01803 0.3538 0.03224 0.0972
  Adiponectin (mg/L) 0.03773 0.0668 0.04552 0.0270
  NT-proBNP (pg/mL) -0.02347 0.4753 -0.03802 0.2476
  Albumin/creatinine ratio -0.01709 0.4345 -0.04549 0.0374
Men
  HOMA-IR (units) -0.07591 0.0129 -0.0498 0.1030
  Hs-CRP (mg/L) 0.01965 0.5202 0.05044 0.0987
  Adiponectin (mg/L) 0.04432 0.1678 0.02324 0.4697
  NT-proBNP (pg/mL) 0.02810 0.5821 0.01912 0.7081
  Albumin/creatinine ratio -0.01107 0.7450 -0.02658 0.4349
Women
  HOMA-IR (units) -0.10559 <0.0001 -0.03112 0.2171
  Hs-CRP (mg/L) 0.02469 0.3274 0.02229 0.3767
  Adiponectin (mg/L) 0.00501 0.8518 0.02257 0.4004
  NT-proBNP (pg/mL) -0.06438 0.1348 -0.08844 0.0397
  Albumin/creatinine ratio -0.02246 0.4316 -0.06413 0.0246

Values are presented as mean ± standard deviation or frequency (%).

BP, blood pressure; HOMA-IR, homeostasis assessment-insulin resistance; hs-CRP, high sensitivity C reactive protein; NT-proBNP, N-terminal pro B-type natriuretic peptide.

Logistic regression analysis for BP elevation on follow-up

Variable Systolic BP
 Diastolic BP
OR 95% CI p-value OR 95% CI p-value
Univariate
  Age 0.985 0.973-0.998 0.0204 0.985 0.974-0.997 0.0153
  Sex 1.150 0.932-1.419 0.1929 1.232 1.006-1.507 0.0432
  Body mass index 0.938 0.905-0.972 0.0004 0.922 0.891-0.954 <0.0001
  Waist circumference 0.974 0.962-0.986 <0.0001 0.964 0.952-0.975 <0.0001
  Start regular exercise 0.787 0.625-0.991 0.0419 0.987 0.796-1.225 0.9078
  Heart rate Δ 1.001 0.996-1.007 0.5896 1.020 1.008-1.032 0.0012
  Fasting glucose 0.973 0.962-0.984 <0.0001 0.977 0.967-0.987 <0.0001
  Total cholesterol 0.997 0.994-1.000 0.0382 0.997 0.994-1.000 0.0319
  High density lipoprotein cholesterol 1.002 0.993-1.012 0.6314 1.003 0.994-1.011 0.5716
  Low density lipoprotein cholesterol 0.998 0.995-1.001 0.2091 0.997 0.994-1.000 0.0869
  Triglyceride 0.998 0.997-1.000 0.0113 0.999 0.997-1.000 0.0308
  HOMA-IR 0.721 0.629-0.826 <0.0001 0.819 0.731-0.919 0.0006
  High sensitivity C reactive protein 1.010 0.989-1.032 0.3470 0.999 0.977-1.021 0.9013
  Adiponectin 1.000 1.000-1.000 0.1875 1.000 1.000-1.000 0.0116
Multivariate
  Age 0.986 0.973-1.000 0.0532 0.981 0.965-0.998 0.0308
  Sex - - - 1.424 0.952-2.129 0.0852
  Body mass index 0.980 0.927-1.036 0.4818 0.984 0.913-1.060 0.6687
  Waist circumference 0.992 0.973-1.011 0.3927 0.992 0.965-1.003 0.5577
  Start regular exercise 0.765 0.604-0.968 0.0257 - - -
  Heart rate Δ - - - 1.022 1.009-1.036 0.0008
  Fasting glucose 0.984 0.972-0.996 0.0102 0.990 0.977-1.004 0.1721
  Total cholesterol 0.999 0.996-1.002 0.6084 1.000 0.996-1.003 0.8399
  Triglyceride 1.000 0.998-1.001 0.5706 1.000 0.999-1.002 0.6490
  HOMA-IR 0.820 0.707-0.952 0.0086 0.885 0.743-1.053 0.1671
  Adiponectin - - - 1.000 1.000-1.000 0.2021

Mutivariate logistic regression analysis adjusted for age and sex.

BP, blood pressure; OR, Odds ratio; CI, confidence interval; HOMA-IR, homeostasis assessment-insulin resistance.