한국 농촌지역 코호트에서 중년 성인의 혈압 변화와 연관 요인
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
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연구배경: 시간의 흐름, 특히 연령의 증가에 따라 혈압이 상승하고 고혈압이 발생하는 것으로 알려져 있다. 하지만 한국인을 대상으로 한 일반 인구집단에서, 시간에따른 혈압의 변화 및 이와 연관된 혈액학적 지표, 무증상장기손상 지표들과의 연관성에 대한 자료는 부족한 실정이다. 따라서 본 연구에서는 코호트 집단에서 혈압의 변화를 분석하고 이와 연관된 요인들을 알아보고자 하였다. 방법: 이 연구는 원주, 평창 농촌지역의 인구집단을 대상으로 한 ARIRANG 코호트(Atherosclerosis Risk of a Rural Area Korean General Population) 자료를 이용하여분석하였다. 2005년 11월부터 2008년 1월까지 기초조사를실시하였고, 2008년 4월부터 2011년 1월까지 재조사를시행받은 대상자들 중 고혈압, 당뇨, 고지혈증, 뇌경색, 심근경색의 과거력이 있거나, 혈압을 측정하지 않은 자, 항고혈압 약물치료에 대한 정보가 부족한 새로 진단된 고혈압환자를 제외한 1,863명을 대상으로 분석을 시행하였다. 결과: 평균 나이는 53.4 ± 8.2세, 남자가 718명(38.5%) 를 차지했다. 평균 추적관찰기간은 2.4 ± 0.9년이었다. 전체집단의 기초조사 수축기혈압은 123.6 ± 15.7 mm Hg이었고, 이완기혈압은 79.2 ± 10.8 mm Hg였다. 재조사 수축기혈압은 전체집단에서 -10.9 ± 15.3 mm Hg, 남자-12.0 ± 15.6 mm Hg, 여자 -10.2 ± 15.1 mm Hg(남자 대여자 p = 0.0141)로 감소했다. 이완기혈압도 -7.7 ± 11.8 mm Hg(전체집단), -8.9 ± 11.8 mm Hg(남자), -6.9 ± 11.6 mm Hg(여자) (남자 대 여자 p = 0.0003)으로 감소했다. 다중 로지스틱회귀분석에서 혈압의 변화(상승)과 연관된의미 있는 예측인자는 운동 시작(odds ratio [OR], 0.765; 95% confidence interval [CI], 0.604 to 0.968; p = 0.0257), 공복혈당(OR, 0.984; 95% CI, 0.972 to 0.996; p = 0.0102), HOMA-IR (OR, 0.820; 95% CI, 0.707 to 0.952; p = 0.0086)이었다. 결론: 중년의 원주 평창 농촌 코호트 집단에서 혈압의변화를 관찰했을 때, 재조사 혈압이 처음보다 유의한 감소를 보였다. 장기적인 추적관찰을 통한 혈압의 변화 및이와 연관된 요인들에 대한 분석이 필요하다.
Abstract
Background: Elevation of blood pressure (BP) and the increasing incidence of hypertension have been known to be associatedwith time course, especially age. But there is still lack of evidence of BP change and the association with biochemical markersor markers for subclinical organ damage in Korean general population. Thus, the purpose of this study is to investigate BPchange and the related factors in established Korean mid-aged rural cohort. Methods: This study was performed by usingdata from ARIRANG cohort (Atherosclerosis Risk of a Rural Area Korean General Population) in Gangwon rural area. Data werecollected 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, myocardialinfarction, missing data for BP, and newly-developed hypertension. Results: Mean age was 53.4 ± 8.2 years and men were718 (38.5%). Mean follow-up period was 2.4 ± 0.9 years. Baseline systolic and diastolic BP were 123.6 ± 15.7 mm Hg and79.2 ± 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. Inlogistic 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 ruralcohort population. Long-term follow-up is needed to discriminate the periodic change of BP and the associated factors.
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