Journal of Preventive Medicine and Public Health

Original Articles

Blood Pressure and the Risk of Death From Non-cardiovascular Diseases: A Population-based Cohort Study of Korean Adults: Jeoungbin Choi, Jieun Jang, Yoonsuk An, Sue K. Park; J Prev Med Public Health. 2018;51(6):298-309. Published online November 14, 2018; DOI: https://doi.org/10.3961/jpmph.18.212

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Abstract Summary PDF Supplementary Material

Objectives
The objective of this study was to assess the relationship between systolic and diastolic blood pressure (SBP, DBP) and the risk of death from specific causes other than cardiovascular diseases.
Methods
We calculated the risk of specific death by SBP and DBP categories for 506 508 health examinees in 2002-2003 using hazard ratios (HRs) and 95% confidence intervals (CIs) in a Cox proportional hazards model.
Results
Compared to normal levels (SBP <120 or DBP <90 mmHg), stage I systolic and diastolic hypertension (SBP 140-159, DBP 85- 89 mmHg, respectively) were associated with an increased risk of death from diabetes mellitus, alcoholic liver disease, and renal failure (HR, 1.83; 95% CI, 1.51 to 2.22; HR, 1.24; 95% CI, 1.06 to 1.46; HR, 2.30; 95% CI, 1.64 to 3.21; HR, 1.67; 95% CI, 1.27 to 2.20; HR, 1.99; 95% CI, 1.41 to 2.81; HR, 1.31; 95% CI, 0.99 to 1.73, respectively), but a decreased risk of death from intestinal pneumonia (HR, 0.64; 95% CI, 0.42 to 0.98; HR, 0.59; 95% CI, 0.39 to 0.91). Only stage II systolic hypertension (SBP ≥160 mmHg) was associated with an increased risk of death from pneumonia, liver cirrhosis, and intestinal ischemia (HR, 1.54; 95% CI, 1.19 to 1.98; HR, 1.46; 95% CI, 1.00 to 2.15; HR, 3.77; 95% CI, 1.24 to 11.40, respectively), and stage I and II diastolic hypertension (SBP 140-159 and ≥160 mmHg) were associated with an increased risk of death from intestinal ischemia (HR, 3.07; 95% CI, 1.27 to 7.38; HR, 4.39; 95% CI, 1.62 to 11.88, respectively).
Conclusions
An increase in blood pressure levels may alter the risk of death from certain causes other than cardiovascular diseases, a well-known outcome of hypertension, although the mechanism of these associations is not well documented.

Summary

Korean summary
2002년 및 2003년 한국 국민건강보험공단 건강검진 수검자 코호트(NHIS-HEALS) 중 506,508명을 대상으로 2013년 말일까지의 통계청 사망자료 기반 심뇌혈관질환을 제외한 기타 사망원인으로의 사망위험을 콕스회귀모형으로 분석한 결과에서 1단계 수축기 고혈압 군과 1단계 이완기 고혈압 군에서 당뇨, 알코올성 간질환, 콩팥부전 사망의 위험도가 통계적으로 유의하게 증가함을 보인 반면, 간질성 폐렴의 사망위험은 유의하게 감소함을 보였다. 2단계 수축기 고혈압 군에서는 폐렴, 간경화 및 허혈성 장질환의 사망위험이 증가하는 것을 보였다. 혈압의 증가가 기존에 알려진 심뇌혈관 질환 이외의 사망위험도에도 연관된 것으로 보이며, 고혈압의 질병부담 연구 및 보건정책 수립시 이 같은 점에 대한 고려가 필요하다.

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Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study: Sang-Wook Yi, Heechoul Ohrr; J Prev Med Public Health. 2015;48(2):105-110. Published online March 11, 2015; DOI: https://doi.org/10.3961/jpmph.15.003

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Abstract PDF

Objectives
Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men.
Methods
From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004.
Results
Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older.
Conclusions
Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older.

Summary

Citations

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Relationship between systolic blood pressure and all-cause mortality: a prospective study in a cohort of Chinese adults
Chunsheng Li, Youren Chen, Qiongbing Zheng, Weiqiang Wu, Zhichao Chen, Lu Song, Shasha An, Zhifang Li, Shuohua Chen, S. L. Wu
BMC Public Health.2018;[Epub] CrossRef
Baseline and longitudinal change in blood pressure and mortality in a Chinese cohort
Jian-Bing Wang, Qiu-Chi Huang, Shu-Chang Hu, Pei-Wen Zheng, Peng Shen, Die Li, Huai-Chu Lu, Xiang Gao, Hong-Bo Lin, Kun Chen
Journal of Epidemiology and Community Health.2018; 72(12): 1083. CrossRef
Low Systolic Blood Pressure and Vascular Mortality Among More Than 1 Million Korean Adults
Sang-Wook Yi, Yejin Mok, Heechoul Ohrr, Jee-Jeon Yi, Young Duk Yun, Jihwan Park, Sun Ha Jee
Circulation.2016; 133(24): 2381. CrossRef

Frequency and Related Factors of Masked Hypertension at a Worksite in Korea: Sang-Kyu Kim, Jun-Ho Bae, Dung-Young Nah, Dong-Wook Lee, Tae-Yoon Hwang, Kyeong-Soo Lee; J Prev Med Public Health. 2011;44(3):131-139. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.131

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Abstract PDF

Objectives

Masked hypertension is associated with metabolic risks and increased risk of cardiovascular disease. The purpose of this study was to identify the frequency of and risk factors of masked hypertension in Korean workers.

Methods

The study was conducted among 121 employees at a hotel in Gyeongju, Korea, from December 2008 to February 2009. We measured blood pressure (BP) both in the clinic and using 24-hour ambulatory BP monitors for all subjects. Hypertension was defined independently by both methods, and subjects were classified into four groups: true normotension, masked hypertension, white coat hypertension, and sustained hypertension.

Results

The frequency of masked hypertension in our study group was 25.6%. Compared with true normotension, the factors related to masked hypertension were male gender (odds ratio [OR], 10.7; 95% confidence interval [CI], 1.41 to 81.09), aging one year (OR, 0.88; 95% CI, 0.78 to 0.99), clinic BP 120-129/80-84 mmHg (OR, 8.42; 95% CI, 1.51 to 46.82), clinic BP 130-139 / 85-89 mmHg (OR, 12.14; 95% CI, 1.80 to 81.85), smoking (OR, 5.51; 95% CI, 1.15 to 26.54), and increase of total cholesterol 1 mg / dL (OR, 1.05; 95% CI, 1.02 to 1.08). In males only, these factors were clinic BP 120-129 / 80-84 mmHg (OR, 15.07; 95% CI, 1.55 to 146.19), clinic BP 130-139 / 85-89 mmHg (OR, 17.16; 95% CI, 1.56 to 189.45), smoking (OR, 11.61; 95% CI, 1.52 to 88.62), and increase of total cholesterol 1 mg/dL (OR, 1.05; 95% CI, 1.01 to 1.09).

Conclusions

The frequency of masked hypertension was high in our study sample. Detection and management of masked hypertension, a known strong predictor of cardiovascular risk, could improve prognosis for at-risk populations.

Summary

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English Abstract

The Prevalence of High Myopia in 19 Year-Old Men in Busan, Ulsan and Gyeongsangnam-Do.: Sang Joon Lee, Sang Hwa Urm, Byeng Chul Yu, Hae Sook Sohn, Young Seoub Hong, Maeng Seok Noh, Yong Hwan Lee; J Prev Med Public Health. 2011;44(1):56-64.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.56

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Abstract PDF

OBJECTIVES
The purpose of this study was to estimate the prevalence and correlated factors of high myopia in 19 year-old men in Southeast Korea. METHODS: This retrospective study was based on the medical checkup data of conscription during 2005. The study subjects were 19 years old men in Busan, Ulsan and Gyeongsangnam-do. The health checkup data of the conscripts consisted of noncycloplegic autorefraction test, the biometric data and social factors. To analyze the social and biometric effects, we classified the biometric factors into 4 or 5 groups and the social factors into 3 groups. High myopia was defined as a spherical equivalent of under -6.0 diopter. Data analysis was performed using the chi square test for trends and multiple logistic regression analysis. The SAS(version 9.1) program was used for all the analyses. RESULTS: The prevalence of high myopia was 12.39% (6256 / 50 508). The factors correlated with high myopia were the residence area (OR, 2.07; 95% CI, 1.77 to 2.4 for small city; OR, 2.01; 95% CI, 1.72 to 2.34 for metropolis; the reference group was rural area), academic achievement (OR, 1.43; 95% CI, 1.34 to 1.53 for students of 4-and 6-year-course university; the reference group was high school graduates & under) and blood pressure (OR, 1.54; 95% CI, 1.10 to 2.16 for hypertension; OR, 1.09; 95% CI, 1.02 to 1.17 for prehypertension; OR, 1.10; 95% CI, 1.01 to 1.20 for hypotension; the reference group was normal blood pressure). CONCLUSIONS: More than one tenth of the young men were high myopia as one of the risk factor for visual loss. Further studies on high myopia and its complications are needed to improve eye health in Southeast Korea.

Summary

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Original Articles

Cohort Study for the Effect of Chronic Noise Exposure on Blood Pressure among Male Workers.: Ji Ho Lee, Tae Joon Cha, Jang Rak Kim, Weechang Kang, Seung Rim Yaang, Choong Ryeol Lee, Cheol In Yoo; Korean J Prev Med. 2002;35(3):205-213.

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Abstract PDF: OBJECTIVE
Whether exposure to chronic noise induces an increase in blood pressure, or the development of hypertension, has not been established. A cohort study was performed to identify the effects of chronic noise exposure on blood pressure. METHODS: 530 males working at a metal manufacturing factory in Busan, Korea were enrolled for the study. They were monitored for 9 consecutive years, from 1991 to 1999, with an annual health check-up. The subjects were divided into 4 groups, which were determines by noise level categories(NLC) according to noise intensity ; NLC-I: office workers, exposed to noise a level below 60dB(A); NLC-II: field technical supporters or supervisors, frequently exposed to workplace noise, wearing no hearing protection device; NLC-III: workers, exposed to workplace noise below 85 dB(A), wearing ear plugs or muffs; NLC-IV: workers, exposed to workplace noise over 85 dB(A), wearing both ear plugs and muffs. RESULTS: After controlling possible confoundens, such as baseline age, smoking, alcohol intake, exercise, family history of hypertension, systolic(SBP) or diastolic blood pressure(DBP) and changes in BMI (body mass index), the pooled mean for the systolic blood pressures, over the duration of the study period, were 3.8mmHg, 2.0mmHg and 1.7mmHg higher in NLC-IV, NLC-III NLC-II groups, respectively, than in the NLC-I group. There were no significant differences in the diastolic blood pressures between the groups. CONCLUSION: This study suggests that chronic noise exposure increases systolic blood pressure independently, among male workers.; Summary

Association of Blood Pressure with the Social Support of Some Rural Residents.: So Yeon Ryu, Chul Gab Lee, Jong Park, Ki Soon Kim; Korean J Prev Med. 2001;34(4):437-443.

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Abstract PDF: OBJECTIVES
This study was performed to assess the association between the social support and blood pressure(BP) in a rural community. METHODS: A cross-sectional survey, comprising a health examination including BP, height and weight and a questionnaire-based interview which investigated social support, demographic factors, smoking, drinking, and etc. was performed between February 10th and March 5th, 1998. The survey included 318 persons who were over than 30-year-old in the rural community of Kwangju, Republic of Korea. We excluded persons who taking antihypertensive medications or who provided incomplete information; we subsequently analyzed the data from 284 persons. In order to test the hypothesis of an association between BP and social support controlling confounders such as age, educational level, working time, body mass index, smoking and drinking, the data was analyzed using multiple linear regression analysis. RESULTS: The subjects were composed of 109(38.4%) males and 175(61.6%) females with mean ages of 62.0 years and 61.1 years, respectively. The hypertension prevalence was 41.3% among males and 45.1% among females. In the correlation analysis, higher total social support scores correlated significantly with lower systolic BP in both males and females. The hypertension prevalence increased significantly with the decreasing of the social support in males. In multiple regression analysis, systolic and diastolic blood pressure showed a negative association with social support in both males and females, although this was not statistically significant. CONCLUSIONS: Larger and broader studies are required in the future in order to identify the association between the social support and BP.; Summary

A Meta-analysis of the Association between Blood Lead and Blood Pressure.: Sang Baek Koh, Chun Bae Kim, Chung Mo Nam, Hong Ryul Choi, Bong Suk Cha, Jong Ku Park, Ho Sung Jee; Korean J Prev Med. 2001;34(3):262-268.

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Abstract PDF: OBJECTIVES
To integrate the results of studies which assess an association between blood lead and blood pressure. METHODS: We surveyed the existing literature using a MEDLINE search with blood lead and blood pressure as key words, including reports published from January 1980 to December 2000. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers exposed to lead, and 2) both blood pressure and blood lead must have been measured and presented with sufficient details so as to estimate or calculate the size of the association as a continuous variable. Among the 129 articles retrieved, 13 studies were selected for quantitative meta-analysis. Before the integration of each regression coefficient for the association between blood pressure and blood lead, a homogeneity test was conducted. RESULTS: As the homogeneity of studies was rejected in a fixed effect model, we used the results in a random effect model. Our quantitative meta-analysis yielded weighted regression coefficients of blood lead associated with systolic blood pressure and diastolic blood pressure results of 0.0047 (95% confidence interval [CI]: -0.0061, 0.0155) and 0.0004 (95% CI: -0.0031, 0.0039), respectively. CONCLUSIONS: The published evidence suggested that there may be a weak positive association between blood lead and blood pressure, but the association is not significant.; Summary

Separate and Combined Effect of Cadmium and Nickel on Blood Pressure in Rats.: Seung Jun Wang, Bong Suk Cha; Korean J Prev Med. 2001;34(2):127-130.

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Abstract PDF: OBJECTIVE
To verify the separate and combined effects of cadmium and nickel on blood pressure in rats. METHODS: Following the daily administration of cadmium chloride(CdCl2) and nickel chloride(NiCl2) to rats both individually and in combination with intraperitoneal injection method for one week, systolic blood pressure of the tail was measured at 1 day and 5, 10, 20, 30 days after administration. Each substance was injected into the rats with 0.1 mg/kg bw and 1.0 mg/kg bw concentration. RESULTS: After 0.1 mg/kg bw CdCl2 was injected, a statistically significant difference was found as compared with the control group(only saline) after 1, 5 and 10 days. After 0.1 mg/kg bw NiCl2 was injected, a statistically significant difference was not found compared with the control group. After 0.1 mg/kg bw CdCl2 and 0.1 mg/kg bw NiCl2 were injected simultaneously, a statistically significant difference was found as compared with the control group after 1, 5 and 10 days and compared with 0.1 mg/kg bw CdCl2 group after 5 days and as compared with 0.1 mg/kg bw NiCl2 group after 5 and 10 days. After 1.0 mg/kg bw CdCl2 was injected, a statistically significant difference was found as compared with the control group after 1, 5, 10 and 20 days. After 1.0 mg/kg bw NiCl2 was injected, a statistically significant difference was found as compared with the control group after 1 day and 5 days. After 1.0 mg/kg bw CdCl2 and 1.0 mg/kg bw NiCl2 were injected in combination, a statistically significant difference was found after 1, 5, 10, 20 and 30 days as compared with 1.0 mg/kg bw CdCl2 after 10, 20 and 30 days and as compared with 1.0 mg/kg bw NiCl2 after 5, 10, 20 and 30 days. CONCLUSION: It was found that the effect of CdCl2 on blood pressure was much more than NiCl2 and a high concentration CdCl2 and NiCl2 in combination delayed the recovery of blood pressure.; Summary

A Meta-analysis on the Association between Chronic Noise Exposure and Blood Pressure.: Chun Bae Kim, Sang Baek Koh, Jai Young Kim, Bong Suk Cha, Hong Ryul Choi, Jong Tae Lee, Chung Mo Nam, Sang Yun Lee, Seung jun Wang, Keeho Park, Dae Youl Kim; Korean J Prev Med. 2000;33(3):343-348.

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Abstract PDF: OBJECTIVES
This study was conducted to integrate the results of studies assessing the association between chronic noise exposure and blood pressure. METHODS: Using a MEDLINE search with noise exposure, blood pressure and hypertension as key words, we retrieved articles from the literature that were published from 1980 to December 1999. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers employed at a high noise level area 2) The paper should use average and cumulative noise exposure as method for exposure evaluation. 3) Blood pressure in each article should be reported in a continuous scale Among the 77 retrieved articles, six studies were selected for quantitative meta-analysis. Before the integration of the regression coefficients for the association between blood pressure and noise level, homogeneity tests were conducted. RESULTS: All studies were a cross-sectional design and the study subjects were industrial workers. Five papers used a time-weighted average for noise exposure and only one paper calculated the cumulative noise exposure level. The measurement of blood pressure in the majority of studies were accomplished in a resting state, and used an average of two or more readings. The homogeneity of studies was rejected in a fixed effect model, so we used the results in a random effect model. The results of the quantitative meta-analysis, the weighted regression coefficient of noise associated with systolic blood pressure and diastolic blood pressure were 0.05 (95% confidence interval [CI]: -0.03, 0.13) and 0.06 (95% CI: -0.01, 0.13), respectively. CONCLUSIONS: Our results suggested that chronic exposure to industrial noise does not cause elevated blood pressure.; Summary

Relationship between Blood Pressure and Impairment of Cognitive Function In Some Rural Residents Aged 60-64.: Choong Won Lee, Moo Sik Lee, Jong Chan Chun; Korean J Prev Med. 2000;33(2):208-214.

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Abstract PDF: OBJECTIVES
Face-to-face interviews were conducted to investigate the relationship between blood pressure and the impairment of cognitive function in rural elderly (N=932) aged 60-64 in Dalsung County, April to September in 1996 METHODS: Impairment of cognitive function was defined as a score of less than 23 by the Korean version of the Mini-Mental State Examination (MMSEK). Blood pressure was measured once in each subject using a portable automatic sphygmomanometer. RESULTS: By univariate logistic regression on males, no category of systolic blood pressure bore statistical significance. Groups with diastolic blood pressures of, less than 80 mmHg, 90-94 mmHg, and more than 95mmHg had odds ratios of more than one compared with the reference group (80-89 mmHg). This was most significant in the group with blood pressures lower than 80 mmHg, which had a statistically significant odds ratio of 1.68 (95 % confidence interval Cl; 1.02-2.75). No category of blood pressure was statistically significant in females. Multivariate logistic regression for males, with adjustment for age, educational attainment, smoking, alcoholic drinking, body mass index, atherosclerotic disease, and antihypertensive medication use, did not alter the odds ratios significantly in terms of systolic blood pressure. However, the group with diastolic blood pressure of less than 80 mmHg had an increased odds ratio of 2.01 (95 % Cl; 1.15-3.52) compared with the reference group. In females, systolic blood pressure did not alter the odds ratio, but the group with a diastolic blood pressure of less than 80 mmHg had a statistically significant odds ratio of 0.57 (95% Cl; 0.37-0.89). CONCLUSIONS: These results suggest that the relationship between blood pressure and cognitive function status is stronger diastolic than systolic blood pressure and that there is a complex relationship between blood pressure and cognitive function by sex.; Summary

A Nested Case-Control Study on the High Normal Blood Pressure as a Risk Factor of Hypertension in Korean Middle-aged Men.: Jong Myon Bae, Yoon Ok Ahn; Korean J Prev Med. 1999;32(4):513-525.

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Abstract PDF: OBJECTIVES
'High-normal blood pressure' is a factor influencing decision to initiate targeted intensive intervention strategy in westernized populations. JNC-VI offered the vigorous lifestyle modification for persons with 'high-normal blood pressure', who could be early detected. As a hypertension seems to be the result of multiple genetic factors operating in concert with associated environmental factors, it will be necessary to identify the high-normal blood pressure as a risk factor of hypertension for applying primary prevention strategy in Korean people. METHODS: Although cohort study design might be adequate to recruit incidence cases, to keep time sequence of events, and to prevent information bias, nested case-control study was chosen for avoiding measurement errors because hypertension is a benign disease. Source population was the 'Seoul Cohort' participants and follow-up was done by using Korea Medical Insurance Corporation's database on the utilization of health services from 1Jan93 to 30Jun97. Incidence cases were ascertained through the chart review, telephone contacts, and direct blood pressure measurements. Controls included the pairing of 4 individuals to each case on the basis of age. RESULTS: As 75 % of 247 incident cases had high-normal blood pressure, the crude odds ratio for hypertension was 2.04 (95% CI 1.47-2.83). Another statistically significant risk factors of hypertension were body mass index, dietary fiber, alcohol consumption, weekly activity and history of quitting smoking. The multivariate odds ratio of high-normal blood pressure adjusted for all risk factors was 1.84 (95 % CI 1.31-2.56). Among high-normal blood pressure group, body mass index, weekly ethanol amounts, weekly physical activity, and dietary fiber except history of quitting smoking were still risk factors of hypertension. CONCLUSION: 'High-normal blood pressure' is a risk factor for hypertension in Korean middle-aged men, which represents that the vigorous lifestyle modification for persons with 'high-normal blood pressure' is need.; Summary

Effects of Change in Obestiy and Life Style Factors on Blood Pressure and Serum Cholesterol - 3-year Follow-up among Workers in a Steel Manufacturing Industry -.: Myung Hwa Ha, Duk Hee Lee, Song Kwon Lee; Korean J Prev Med. 1999;32(3):415-420.

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Abstract PDF: OBJECTIVES
We investigated the effects of changes in obesity and life style factors, such as cigarette smoking, alcohol drinking, and exercise, on the changes in blood pressure and serum cholesterol among Korean men. METHODS: This study included 7,205 healthy male employees in the steel manufacturing industry. Each subject underwent health examination in 1994 and was re-examined in 1997. The study subjects were classified into four categories, according to changes in body mass index (BMI) (loss; stable; mild gain; severe gain), cigarette smoking (quitter; non-smoker; smoker continued; smoker started), alcohol drinking (quitter; non-drinker; drinker continued; drinker started) and exercise (more exercise; continuous regular exercise; continuous irregular or no exercise; less exercise), respectively. We evaluated the relationship between the categories of change in those independent variables and the changes in blood pressure and serum cholesterol, adjusted for BMI in 1994 and age by analysis of variance. RESULTS: The change in systolic blood pressure was positively associated with the changes in BMI (p<0.001) and drinking (p=0.001), but negatively with smoking (p=0.004), compared to the first category of each independent variables. The systolic blood pressure was significantly less increased in the continuous smoking group than quitter or non-smoker. The changes in diastolic blood pressure and serum cholesterol appeared to have statistically significant linear relationships only with the change in BMI. The change in exercise showed a marginal significance with diastolic blood pressure (p=0.088). CONCLUSIONS: These prospective data emphasize the importance of obesity as a determinant of the changes in blood pressure and serum cholesterol. In addition, the changes in smoking and drinking habits can affect systolic blood pressure.; Summary

A Distribution of Waist-hip Ratio Associated with the Blood Pressure in Middle-aged Men.: Jong Myon Bae, Dae Sung Kim, Jaiyong Kim, Yoon Ok Ahn; Korean J Prev Med. 1999;32(3):395-399.

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Abstract PDF: BACKGROUND
Excess abdominal fat, expressed as an increased ratio of waist to hip circumferences (WHR), is independently associated with higher levels of blood pressure. Although a WHR greater than 1.0 in men has been shown to predict complications from obesity, the WHR has not been evaluated in all ethnic groups. METHODS: In order to ascertain the association between WHR and classification of blood pressure and to investigate the critical value of WHR as a predictive factor of hypertension in Korean middle-aged men, we compared the mean of WHRs according to the classification of blood pressure in Seoul Cohort participants. RESULTS: Through a survey of direct measurement of waist and hip girth, 452 subjects were recruited from the cohort. The mean of WHR was 0.88 and its standard deviation was 0.04. The mean of WHRs was higher in the systolic blood pressure group (above 140 mmHg), diastolic blood pressure group (above 90 mmHg), and hypertension group than in the systolic blood pressure group (below 140 mmHg), diastolic blood pressure group (below 90 mmHg), and normotensive group, respectively. And WHR of above 0.89 was associated with hypertension (z-value =6.66). CONCLUSIONS: It is necessary for Korean males with WHR greater than 0.89 to recommend the primary prevention and early detection of hypertension.; Summary

The effect of sodium and potassium intake on blood pressure change in Korean adolescents.: Il Suh, Chung Mo Nam, Kang Hee Lee, Sun Ha Jee, Suk Il Kim, Gyu Sang Kim, Chun Bae Kim; Korean J Prev Med. 1998;31(3):384-394.

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Abstract PDF: In order to investigate the effect of the urinary excretion of sodium and potassium on the change on blood pressure over 3 years, 668 adolescents aged 13 years living in Kangwha area were investigated in a longitudinal follow-up study. Two measurements were taken on each blood pressure (diastolic, systolic) and the average of the two readings was used in the analysis. Sodium and potassium intake were estimated by the determination of those electrolytes in 24hr urine. The mixed model regression analysis was used to identify the effect of urinary sodium and potassium on the change of blood pressure after controlling for BMI of each age. On simple bivariate analysis no relationship was found between urinary sodium excretion and systolic or diastolic blood pressure among both male and female, however, a significant positive association between urinary potassium excretion and systolic blood pressure among male. The results of mixed regression analysis showed that the body mass index (BMI) were more influential that urinary electrolytes among this study subjects. It suggested that risk factors observed from the adults, may not be identical with that of the growing aged population. After control of the BMI and age, significant association between sodium and diastolic BP among male, and association between potassium and systolic BP among female, were found. In summary, the results indicate that growth has been more influential than dietary factor on blood pressure for growing aged population.; Summary

Association of Lifestyle with Blood Pressure.: Ree Joo, Jong Hak Chung; Korean J Prev Med. 1997;30(3):497-507.

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Abstract PDF: This study was conducted to evaluate the association of various lifestyle with blood pressure. The data were obtained from the individuals who got routine health examination in Department of Occupational Medicine, Yeungnam University Hospital from June to September, 1996. Among these people, we selected 130 cases of hypertensives(97 males, 33 females) and 150 normotensives(70 males, 80 females) and study was conducted. The authors collected the information of the risk factors related to hypertension such as age, family history of hypertension, fasting blood sugar, serum total cholesterol, alcohol consumption(g/week), smoking history, relative amount of salt intake(low, moderate, high), the frequency of weekly meat consumption, BMI, daily coffee consumption(cups/day) and the frequency of regular exercise(frequency/week) through questionnaire and laboratory test. By simple analysis, BMI was significantly associated with hypertension in male(p<0.05), and the frequency of weekly meat consumption was significantly associated with hypertension in female(p<0.05). Using logistic regression model, elevated odds ratio was noted for fasting blood sugar, serum total cholesterol, family history of hypertension, alcohol consumption, salt intake and BMI, and reduced odds ratio was noted for coffee consumption and exercise in male but fasting blood sugar(odds ratio=1.022, 95% CI=1.000-1.044), family history in both of parents(odds ratio=3.301, 95% CI=1.864-4.738), salt intake(odds ratio=1.690, 95% CI=1.082-2.298) and BMI(odds ratio=1.204, 95% CI=1.065-1.343) were statistically significant(p<0.05). In female, elevated odds ratio was noted in serum total cholesterol, family history of hypertension, BMI and meat consumption. Of all these variables, the family history of hypertension in either of parents(odds ratio=4.981, 95% CI=3.650-6.312), family history in both of parents(odds ratio=16.864, 95% CI=14.577-19.151), BMI(odds ratio=1.167, 95% CI=1.016-1.318) and meat consumption(odds ratio=2.048, 95% CI=1.133-2.963) showed statistically significant association with hypertension in female(p<0.05).; Summary

The effects of aircraft noise on the hearing loss, blood pressure and response to psychological stress.: Sang Hwan Han, Soo Hun Cho, Kyungshim Koh, Ho Jang Kwon, Mina Ha, Yeong Su Ju, Myung Hee Shin; Korean J Prev Med. 1997;30(2):356-368.

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Abstract PDF: In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group; Summary

An Analytic Study on the Effect of Carbon Disulfide on the Blood Pressure.: Jong Tae Park, Hae Joon Kim, Yong Tae Yum, Do Myung Paek; Korean J Prev Med. 1994;27(3):581-596.

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Abstract PDF: To investigate the effect of carbon disulfide on blood pressure, the BP measurements in the periodic health examination results and the medical records of factory clinic were reviewed The study subjects were composed of 1336 male and 544 female workers, who were categorized into three groups by the exposure status-highly exposed, moderately exposed and non-exposed group. The results of the study were as follows; 1. The age-adjusted mean systolic and diastolic BP of male workers were 122.35 mmHg/79.11mmHg in highly exposed, 121.57mmHg/79.05mmHg in moderately exposed and 122.67mmHg/82.27mmHg in non-exposed group. For female workers, BP were 115.13mmHg/74.49mmHg in moderately exposed and 113.48mmHg/74.30mmHg in non-exposed group. 2. In multiple regression analysis of maximum BP against Age and tenure, the slope coefficients of age and tenure on the systolic BP were 0.379, 0.667 respectively and those on the diastolic BP were 0.331, 0.405 respectively in highly exposed male workers. Tenure was a significant variable in this study. For female workers, however, the slope coefficients of tenure on BP were significant only for systolic BP of moderately- expected group. 3. In multiple regression analysis of Bp against age, cumulative exposure index(CEI), cholesterol, all the variables showed significant slope coefficients in male, but age and CEl on systolic BP were significant for female workers (P<0.05). 4. In the multiple analysis of the amount of Bp change and the velocity of Bp change among male workers, the slope coefficients of tenure tended to increase as exposure level increased. Among female workers, the slope coefficients of tenure were significant on the amount of Bp change and the velocity of Bp change in moderately exposed group.; Summary

The Effect of Coffee Consumption on Serum Total Cholesterol Level in Healthy Middle-Aged Men.: Myung Hee Shin, Dong Hyun Kim, Jong Myun Bae, Hyung Ki Lee, Moo Song Lee, Joon Yang Noh, Yoon Ok Ahn; Korean J Prev Med. 1994;27(2):200-216.

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Abstract PDF: In present study, the authors investigated the possible effect of coffee consumption on serum cholesterol level in 1017 men between the ages of 40 and 59 years, who were randomly selected from the members of Seoul Cohort Study. Serum total cholesterol data was collected with other serologic indices(e.g. systolic blood pressure, diastolic blood pressure, hight, weight, etc.)through the program of biennial health check-up offered by Korean Medical Insurance Corporation(KMIC). The amount of coffee consumption was assessed by a self-administered questionnaire through mailing. Other confounding factors, such as age, body mass index, cigarette smoking, alcohol consumption, physical activity, and other dietary intake pattern were also determined by the questionnaire. The differences in means of serum total cholesterol in compared to non consumers were -0.4+/-3.56mg/dl for those drinking less than 1 cup a day, -0.6+/-3.60mg/dl for those drinking 1 cup a day, and 7.1+/-3.41mg/dl for those drinking more than 2 cups a day. Since smoking interacted the relationship between coffee consumption and serum total cholesterol, we re-analyzed those relationship in smokers and non-smokers separately. Other atherogenic behaviors were well correlated with total cholesterol, so we adjusted the mean values of serum total cholesterol through multivariate model selection with age(r=0.12), total cigarette index(cigarette-years; r=0.10), Quetelet's index(kg/m2, r=0.16), daily calory expenditure(kcal/day, r=0.06), weekly meat and poultry consumption(g/week, r=0.05), weekly fish consumption(g/week, r=0.08), other caffeinated beverage intake(cups/week), and the amount of sugar and prim added to the coffee. Among those variables only age, Quetelet's index, fish consumption, and total cigarette index(in smokers)were remained in the models. After adjustment, the corresponding differences of total cholesterol in smokers were changed to 0.4+/-5.24mg/dl, -0.5+/-4.97mg/dl, and 8.9+/-4.78mg/dl, which were significantly different among themselves(P=0.011). In non-smokers, however, the differences were not statistically significant(P=0.76). Adjusted mean values of systolic blood pressure and diastolic blood pressure were also determined to evaluate the direct effect of coffee to cardiovascular system, but their means were not significantly different by coffee consumption(p=0.18 for SBP, P=0.48 for DBP). Assuming instant coffee on the most popular type of coffee in Korea, the association observed in our study between coffee and serum total cholesterol, especially in smokers , is very interesting finding for the connection between coffee and serum total cholesterol, because only 'boiled coffee' tend to show significant lipid raising effect rather than to other types of coffee, like filtered or espresso, in most of the western countries. We concluded that people who drink coffee more than 2 cups a day have significantly higher serum total cholesterol level than those who never drink coffee, especially in smokers.; Summary

The blood pressure level and sexual maturity in the children at puberty.: Kyoo Sang Kim, Soon Young Lee, Ill Suh, Chung Mo Nam, Sun Hwa Jee; Korean J Prev Med. 1993;26(3):347-358.

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Abstract PDF: The purpose of this study is to analyze the relationship between the blood pressure level and their sexual maturity and physical growth in the children at puberty. For this purpose, we estimated the blood pressure, physical growth and sexual maturity of the boys of 335 and girls of 373 who are in the middle schools which are located in Kang-wha County, KyungKi-Do. Both systolic and diastolic pressure were measured twice. Such physical growth as height, body weight, skin fold thickness, waist circumference, hip circumference and arm circumference were measured. The sexual maturity was estimated according to the classification of Tanner's 5-phase-sexual-maturity; in boys, their pubic hair development phase; in girls, their pubic hair and breast development phase and the menstrual experience. In the phase of the pubic hair development, the boy's sexual maturity was distributed into this; the 1 st 56.4%, the 2nd 29.3%, the 3rd 9.9%, the 4th 4.1% and the 5th 0.3%. While the girls sexual maturity was distributed into this : the 1 st 20.5%, the 2nd 34.9%, the 3rd 30.6% the 4th 12.6% and the 5th 1.3% in the phase of the pubic hair development, and the 1 st 0.8%, the 2nd 13.7%, the 3rd 36.2%, the 4th 18.8% and the 5th 30.5% in the phase of the breast development. This indicated that the girls sexual maturity was higher than those of the boys. The girls menstrual experience rate accounted to the 58.2%. In order to see the relationship between the children's sexual maturity and blood pressure level, we regress blood pressure level on physical growth(i.e., height, BMI) and sexual maturity. Sexual maturity in treats as dummy variables. As the result of this analysis, the boys' sexual maturity has nothing to do with the blood pressure either systolic or diastolic. But the girl's systolic pressure was statistically significant; the 9% of the physical growth, the 5% of the pubic hair development and the 4% of the breast development in sexual maturity was explained. In the girls' diastolic pressure, only their pubic hair development was statistically significant; the 7% of the physical growth and the 7% of the pubic hair development in the diastolic was explained and the 5% of the physical growth in the diastolic Korotokoff phase was explained, especially, the girls experienced menstruation, their systolic and diastolic pressure were significantly high(P<0.01). Conclusively, in the first grade children attending middle schools who are in the early process of the sexual development, the sexual maturity was not related to blood pressure level, on the other hand, the blood pressure level of the girls who are more sexual development than those of the boys' have something to do with sexual maturity and physical growth.; Summary

Leisure time physical activity and its relationship to coronary risk factors in male workers.: Yun Kyeong Rho, Mi Hae Yeh, Sung Kook Lee, Byung Yeol Chun; Korean J Prev Med. 1993;26(3):332-346.

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Abstract PDF: This study was attempted to observe leisure time physical activity pattern and its relationship to coronary risk factors(BMI, systolic blood pressure, diastolic blood pressure, serum total cholesterol, triglycerides, fasting blood sugar). Subjects participated in this study were 277 adult male workers of an industry in Kyungpook province, Korea. Energy expenditure were measured using modified Physical Activity History questionnaire of CARDIA study by interviewing. Serum total cholesterol, triglycerides and blood sugar level were tested with 5 ml fasting blood and height, weight and blood pressure were measured. Data on smoking and drinking habits and others were obtained. Geometric mean of leisure time physical energy expenditure were estimated as 212.80 kcal per week for study subjects and only 22.4% of them expended 2,000 kcal or more per week in leisure time physical activity. Taking walks or hikes and jogging or running were more frequent leisure time physical activities in study subjects. Statistically significant mean differences in total weekly leisure time physical activity for all coronary risk factors were not found among three groups. Because energy expenditure of leisure time was generally low in this subjects and most of them were healthy men, we did not found that leisure time physical activity was significantly associated with coronary risk factors.; Summary

Tracking of blood pressure during childhood.: Soon Young Lee, Il Seo, Jeung Mo Nam; Korean J Prev Med. 1991;24(2):161-170.

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Abstract PDF: The purpose of this study is to find the tracking blood pressure in primary school-age children. A follow-up study was conducted from 1986 to 1990 on 330 first grade children attending primary schools in Kangwha County, Kyungki-Do. Basically we employed a linear regression model with random coefficients to figure out the relation between blood pressure changes and initial blood pressure. We obtained the following results; 1. The mean blood pressures were increased grade went up in both sexs and were generally higher in female than male except for the systolic blood pressure at first grade. The size of difference was about 0.8 mmHg in mean systolic blood pressure and 1.5 mmHg in mean diastolic blood pressure. 2. The average annual increasing rates of systolic blood pressure were 2.5 mmHg in male and 3.1 mmHg in female respectively. For the diastolic blood pressure IV the average annual increasing rates were observed to be 3.0 mmHg in male and 2.9 mmHg in female respectively. Increasing rate of systolic blood pressure was significantly higher in female than male. 3. The adjusted regression coefficient of systolic blood pressure change on initial value was -0.11 in male and -0.13 in female and that coefficient of diastolic blood pressure change on initial value was -0.01 in male and -0.11 in female. This result shows that children with higher initial blood pressure do not pick up their blood pressure faster than others with lower initial blood pressure. There is no evidence of tracking of blood pressure in children. It is essential to find the earliest age having the tracking of blood pressure and we leave it for the further study.; Summary

The Relationship of Psychosocial Factors to Blood Pressure.: Choong Won Lee, Sung Kwan Lee; Korean J Prev Med. 1988;21(1):99-112.

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Abstract PDF: Questionnaires and blood pressure measurements were administered to 279 medical school undergraduates in 1987 to investigate the relationship between psychosocial factors and blood pressure as well as reliability and validity of the Framingham Type A Behavior Scale(FTA). The reliability coefficients of SCL-90-R and FTA measured by Spearman-Brown haves split test were 0.57-0.91, The factors of FTA extracted by principal component analysis were hard-driving competitiveness factor and impatience factor(2-factor solution). The total score of FTA was positively correlated with relative weight and place raised but the correlations were insignificant, and had significantly positive but weak correlations with depression, anxiety hostility, paranoid, and psychoticism subscales of SCL-90-R. In the univariate analysis of blood pressures, relative weight and family history were significant in systolic pressure in males and economic status was significant in blood pressures in both sexes. For diastolic pressure, relative weight and frequency of alcohol intake were significant in males and relative weight was in females. After controlling relative weight, the frequency of alcohol intake for diastolic pressure and economic status for systolic pressure were significant in males. The important variables selected by stepwise regression analysis were relative weight and economic status for systolic pressure of males and relative weight and the frequency of alcohol to the model, changing coefficient of determination 0.206 to 0.217. In females, economic status and relative weight were selected for systolic pressure and for diastolic pressure body mass index alone, but the model of blood pressure for females was considered to be unstable due to small sample size(56). FTA was unrelated to the blood pressures in both sexes.; Summary

English Abstract

Heavy Metal as Risk Factor of Cardiovascular Disease : An Analysis of Blood Lead and Urinary Mercury.: Dae Seon Kim, Eun Hee Lee, Seung Do Yu, Jung Hoon Cha, Seung Chul Ahn; J Prev Med Public Health. 2005;38(4):401-407.

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Abstract PDF: OBJECTIVES
We wanted to investigate the relationship between heavy metal, especially lead and mercury, to the blood pressure and cholesterol level in children. METHODS: This study was undertaken in three primary schools and the study subjects were a total of 274 children. The lead in the blood and the urine mercury were analyzed by performing atomic absorption spectroscopy. RESULTS: All of participants' blood lead levels and urine mercury concentrations were below the suggested level of concern according to the criteria of the CDC and ATSDR. We found no significant correlation between lead, mercury and the blood pressure. The blood lead level did not show any relationship with the blood pressure and cholesterol. However, the urine mercury levels were associated with the serum cholesterol. CONCLUSION: Our study suggests that mercury can induce an increase of cholesterol as a risk factor of myocardial infraction and coronary/cardiovascular disease.; Summary

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