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1 S odium (N a ) P ot as s iu m (K ) 1, 1, 1, 2, 1, 1, 3 1, 2, 3 = Ab stract = T h e effe ct of s odium and pot as s ium int ak e on blood pre s s ure ch an g e in K ore an adole s c ent s Il Suh 1, Chung M o Nam 1, Kan g Hee Lee 1, Sun Ha Jee 2, Suk Il Kim 1, Hyu Sang Kim 1, Chun Bae Kim 3 Dept. of Prev entiv e M edicine an d Public Health, Yon sei Univ er sity Colleg e of M edicin e 1, Gradu ate Sch ool of H ealth Scien ce and M an ag em ent, Yon sei Univ er sity 2, Dept. of Prev entiv e M edicine, Yon sei Univ er sity W onju College of M edicin e 1 In or der to inv estigat e the effect of the urinary ex cr etion of sodium an d potassium on the ch ang e on blood pres sure ov er 3 y ear s, 668 adolescents ag ed 13 y ear s liv in g in Kan gw h a area w ere inv estigated in a lon gitudin al follow - up study. T w o m ea surem ent s w ere taken on each blood pres sure (diastolic, sy stolic) an d the av erage of the tw o readin g s w a s u sed in th e analy sis. Sodium and potas sium intake w ere estim ated by th e determination of th ose electrolytes in 24hr urine. T he mix ed m odel regression analy sis w as u sed t o identify the effect of urinary sodium and potas sium on the ch ang e of blood pressure after controlling for BMI of each age. On sim ple biv ariat e an aly sis n o r elation ship w as foun d bet w een urin ary sodium ex cretion and sy stolic or diastolic blood pressure am on g both m ale an d fem ale, how ev er, a significant positiv e as sociation b etw een urinary pot assium ex cr etion an d sy st olic blood pressure am on g m ale. T h e results of mix ed regression analy sis show ed th at the b ody m ass index (BMI) w ere m ore influ ential th at urinary eletrolytes am on g this stu dy subject s. It sug gested th at risk fact or s ob serv ed fr om the adult s, m ay n ot be identical w ith th at of the gr ow ing aged population. A ft er control of the BM I and age, significant a ssociation b etw een sodium an d diastolic BP am on g m ale, an d as sociation bet w een

of Prev entiv e M edicine an d Public Health, Yon sei Univ er sity Colleg e of M edicin e 1, Gradu ate Sch ool of H ealth Scien ce and M an ag em ent, Yon sei Univ er sity 2, Dept.

2 potassium and sy stolic BP am on g fem ale, w ere found. In summary, th e result s in dicate that grow th has been m ore influ ential than dietary fact or on blood pr es sure for gr ow ing aged population. Key w ords : blood pressure, sodium, potassium I (cerebrov ascular accident, strok e) (, 1996) %, 12.9% (, 1994)... (Voors, 1977).., (National Heart, Lung, and Blood In stitute, 1987) (Stocks, 1924)., (Szklo, 1979; Kotchen, 1989).. 20 (W HO, 1985). 20

for gr ow ing aged population. Key w ords : blood pressure, sodium, potassium I.

3 2.0mmHg, 1.0mmHg ,,,,.. (WHO, 1985). (Na) (K) INT SALT Yanom amo Indian Papua New Guinea. (Cutler 1991). K, W helton (1996) 33 K. Na K Na/ K.. Hofm an (1993) 5-6. Geleijn se (1990) K Na/ K. (, 1963;, 1968;, 1989;, 1990) Na Na, K. Na K.

4 II ( 13 ) , ) ,,. Korotkoff phase I, Korotkoff phase IV. (1989) (1993). 2) Na K 24 Na K ,,,,. 1. ion selectiv e Na K.., (creatinine) 0.4ml/ kg/ hour, 0.3ml/ kg/ hour (Ellitson, 1980)., 300ml/ day.,. 3. 1) (20.8% ), 350

2) Na K 24 Na K. 5 5 24,,,,. 1. ion selectiv e Na K.

5 94 (26.9% ). (T able 1). - T able 1. Num ber of student s in cluded in an aly sis Unit : per son Grade Middle High 3- year Sex 2nd 3r d 1st 2n d follow - up cases Male 252(49.6) 241(48.8) 206(46.2) 206(46.7) 194 F em ale 256(50.4) 253(51.2) 240(53.8) 235(53.3) 234 T ot al 508(100.0) 494(100.0) 446(100.0) 441(100.0) 428 2) Na, K, Na/ K. Na K Na Na/ K 75 K 25. t (body m ass index ) Na, K, Na/ K (mix ed m odel).. BP t = + 1(ag e t ) + 2( BM I t ) + 3( N a ) + 4 (K ) + 5( N a ag e t ) + 6 (K ag e t ), BP t, A g e t, B M I t t,, Na 75 1, 0, K 25 1, 0 (indicator function ). (compound symmetric).

8) 206(46.2) 206(46.7) 194 F em ale 256(50.4) 253(51.2) 240(53.8) 235(53.3) 234 T ot al 508(100.0) 494(100.0) 446(100.0) 441(100.0) 428 2) Na, K, Na/ K.

6 III. 1. (T able 2). 2 T able 2. Mean difference of study v ariables betw een included and ex cluded cases Sex Variable Included Ex cluded p- value* Male Sy stolic BP (mmhg ) Diastolic BP (mmhg ) Height (cm ) W eight (kg ) BMI(kg/ m 2 ) Fem ale Sy stolic BP (mmhg ) Diastolic BP (mmhg ) Height (cm ) W eight (kg ) BMI(kg/ m 2 ) BP : blood pressur e; BMI : body mass index * : calculated by independent tw o sample t - t est 2. Na, K, Na/ K Na, K, Na/ K (T able 3). Na 178.6mEq/ 24hr, 170.6mEq/ 24hr, mEq/ 24hr, 270.6mEq/ 24hr. K 31.2mEq/ 24hr, 32.4mEq/ 24hr mEq/ 24hr, 54.6mEq/ 24hr. Na K.

5 116.7 11.4 0.44 Diastolic BP (mmhg ) 76.2 8.0 76.4 7.9 0.89 Height (cm ) 156.1 5.0 154.8 6.3 0.08 W eight (kg ) 49.2 8.8 47.6 8.3 0.13 BMI(kg/ m 2 ) 20.2 3.1 19.8 3.0 0.

7 T able 3. Distribution s of urinary Na, K, an d Na/ K r atio accordin g t o sex Sex Variables Percentiles Male Na (meq/ 24hr ) K (meq/ 24hr ) Na/ K r atio F emale Na (meq/ 24hr ) K (meq/ 24hr ) Na/ K r atio Na, K, Na/ K T able Na, K, Na/ K 3. Na. K K. K 3 2.2mmHg, K 4.7mmHg. Na/ K.

Male Na (meq/ 24hr ) 92.9 125.6 178.6 223.0 302.1 K (meq/ 24hr ) 18.6 24.0 31.2 42.6 51.2 Na/ K r atio 3.1 4.2 5.

8 T able 4. T h e m ean differ ence of sy stolic blood pr es sur e betw een high (or low ) and normal group in urinary Na, K, and Na/ K ratio according to sex and age Middle High Sex Variable Group * 2n d 3rd 1st 2n d Change Male Na High Normal p- v alue K Low Normal p- v alue Na/ K High Normal p- v alue F emale Na High Normal p- v alue K Low Normal p- v alue Na/ K High Normal p- v alue * : cutoff point of Na and Na/ K ratio is 75 percentiles of their distribution and K is 25 percentiles of its distribution : difference of blood pressure betw een 2nd grade in high school and 3r d grade in middle school

1st 2n d Change Male Na High 112.8 117.9 122.3 119.4 6.5 Normal 111.9 115.8 120.1 118.1 6.2 p- v alue 0.64 0.28 0.27 0.52 0.85 K Low 108.8 113.1 118.1 115.3 6.5 Normal 113.3 117.4 121.5 119.5 6.

9 T able 5. T h e m ean differ ence of diastolic blood pres sur e betw een high (or low ) an d normal group in urinary Na, K, and Na/ K ratio according to sex and age Middle High Sex Variable Group * 2n d 3rd 1st 2n d Change Male Na High Normal p- v alue K Low Normal p- v alue Na/ K High Normal p- v alue F emale Na High Normal p- v alue K Low Normal p- v alue Na/ K High Normal p- v alue * : cutoff point of Na and Na/ K ratio is 75 percentiles of their distribution and K is 25 percentiles of its distribution : difference of blood pressure betw een 2nd grade in high school and 3r d grade in middle school Na, K, Na/ K (T able 6, T able 7).,. Na 2 2.4( )mmHg (p< 0.1) 0.78mmHg (p< 0.1). K ( )mmHg (p< 0.1) 0.69mmHg (p< 0.1). Na/ K.

1st 2n d Change Male Na High 66.1 71.7 74.6 74.0 7.9 Normal 67.1 71.8 75.8 73.3 6.2 p- v alue 0.46 0.89 0.41 0.58 0.20 K Low 65.5 69.0 73.5 72.8 7.3 Normal 67.3 72.8 76.2 73.7 6.4 p- v alue 0.13 0.

10 T able 6. T he effect s of urin ary Na, K, an d Na/ K ratio on blood pres sur e in m ale Independent variable Sy stolic BP Diastolic BP Model 1 Model 2 Model 1 Model 2 Age (year ) 1.98 * * * 1.44 * * * 3.15 * * * 2.71 * * * BMI (kg/ m 2) 1.29 * * * 1.27 * * * 0.55 * * * 0.55 * * * Na (1=high, 0=norm al) * - K ((1=low, 0=norm al) Na Age * - K Age Na/ K (1=high, 0=norm al) Na/ K Age BP : blood pressur e, BMI : body m ass index * : p<0.1, ** : p<0.05, *** : p<0.01 T able 7. T he effect s of urin ary Na, K, an d Na/ K ratio on blood pres sur e in fem ale Independent variable Sy stolic BP Model 1 Model 2 Diastolic BP Model 1 Model 2 (Coefficient ) (Coefficient ) (Coefficient ) (Coefficient ) Age (year ) * * * * * * * * * * * * BMI (kg/ m 2) 1.13 * * * 1.17 * * * 0.75 * * * 0.74 * * * Na (1=high, 0=norm al) K ((1=low, 0=norm al) * Na Age K Age 0.69 * Na/ K (1=high, 0=n orm al) Na/ K Age BP : blood pressur e, BMI : body m ass index * : p<0.1, ** : p<0.05, *** : p<0.01

78 * - K Age 0.07-0.42 - Na/ K (1=high, 0=norm al) - 6.53 - - 9.91 Na/ K Age - - 0.48-0.62 BP : blood pressur e, BMI : body m ass index * : p<0.1, ** : p<0.05, *** : p<0.01 T able 7.

11 Na K, Na. K. Na/ K,.,. 24 Na. (Beaton, 1986), Na 98%, 86% (Holbrook, 1984), 24. Caggiula (1985) 6 24 Na (r =0.61), Holbrook (1984) (r =0.76)., 24 Na,. 24, Dahl and Lov er Brookhav en.,, 28,. Na Belgium (Joosen s ). (1314 ), (713 ).,., (JNC VI, 1997), (Simon, 1994).,., 24

61), Holbrook (1984) (r =0.76)., 24 Na,. 24, 4.

12 Sw aye (1972). (Daw ber, 1967), (Grim, 1970), (Langford, 1975). (Sasak,1964; Prior,1968; Freis,1976; Page, 1976).,,,. K (Langford,1983). K (T annen, 1983; Cappuccio, 1991)., K, (W helton, 1997). JNC (1997), mm ol K., K (Zwiauer, 1991; Krishna, 1989). K. Na/ K. Langford and W at son (1975) 6 24 Na/ K. Na/ K, (W alker, 1978). (Cooper, 1980) Na K (r =0.731), K. 24 Na, K, Na/ K.,,..,.. (Ellit son,1980).., (Jacobsen, 1979),

K (T annen, 1983; Cappuccio, 1991)., K, (W helton, 1997). JNC (1997), 50 90 mm ol K.

13 (Cooper, 1980),.,..,..,., (Alex ander,1962)., Na,., Na,., Na. Voor s (1977),. Na K., Na.., Na. Na Na,., 24 Na, (, 1995) Na 24 Na. (Dr. Kestloot,1996: ),., Belgium Na 0.995, K , Na Na..,

14 Na 3, (Cooper,1980). Na.,., (prev alent incidence bias ). 24.,, Na K. JNC (NIH, 1997) 6g, Na 2.4g.,,., (, 1989),.,.

15 ( 668 ) 4 sodium (Na) potassium (K )., Na K 24 Na K. Na K. Na,. K.. Na/ K,. Na, K Na/ K.. Na K. Na K,. :, Na, K

16 ,, ;26 (3): ,,. Sodium, Potas sium. 1995;24 (4): ,, ;11(2):232-45,, ;22(3): ;6: ;11:65-71,,. Sodium, potas sium. 1995;24 (4): ,,.,,. 1990; 33 (7): , A lex an der JK. Obesity and the circulation. M od Con cept s Car diov asc Dis 1962;1:39 Beat on GH ; Chery A. E v alu ation of m ethods u sed t o a sses s dietary intake: simulation analy sis. Can J Phy siol Pharm acol 1986;64: Cag giula AW. T he m ea surem ent of sodium an d potassium intak e. Am J Clin Nutr 1985;42: Cooper R, Soltero I, Liu K, et al. T he a ssociation betw een urin ary sodium extraction an d blood pressur e in children. Cir culation 1980;62(1): Dahl LK ; Lov er RA. Eviden ce for a relation ship betw een sodium intake and hum an es sential hyperten sion. Arch Intern M ed 1954;94:525. Daw ber T R, Kann el W B, Kagan A, et al. Environm ental factor s in hyperten sion. In T he epidemiology of hyperten sion, edited by Stamler J. New York, p 255 Ellit son RC, Sosenko JM, H arper GP, et al. Ob esity, sodium intake, and blood pressure in adolescent s. Hyperten s 1980;2(suppl I):I F reis ED. Salt, v olum e an d the prev ention of hyperten sion. Circulation 1976;53:580 Geleijn se JM, Grobbee DE, Hofman A. Sodium an d potas sium intake an d blood pressure ch ang e in childhood. BMJ 1990;300: Grim CE, M cdonough JR, Dahl LK, et al. Racial differences in Evans Co, Georgia. (abstr ) Circulation 1970:42(suppl III):III- 85. H ofm an A, Valkenburg HA. Determin ant s of chan ge in blood pressure during childhood. Am J Epidemiol 1983;117 (6): H olbrook JT. Sodium and pota ssium intake an d balence in adult s con suming self- selected diet s. Am J Clin Nut s 1984;40: Jacob sen F K. Christen sen CK, M og en sen CE, et al. Pron ounced increa se in serum creatinine concentration after eating cooked m eat. Br M ed J 1979:1:1049

E v alu ation of m ethods u sed t o a sses s dietary intake: simulation analy sis. Can J Phy siol Pharm acol 1986;64:772-780. Cag giula AW. T he m ea surem ent of sodium an d potassium intak e.

17 Joosen s JV ; W illem s J, Claes sen s J, et al. S odium an d hypert en sion. In nutrition an d cardiov ascular diseases, edited by Fidan za F, Rom e, M org agni E dizioni, 1990 Kim JS, Kim SJ, Jones DW, et al. Hyperten sion in Kor ea : A n ation al surv ey. Am J Prev M ed 1994;10(4): Kotchen JM, M ckean HE, Neill M, et al. Blood pres sure tren ds associated w ith chang es in h eight an d w eight fr om early adolescen ce t o y oung adulthood. J Clin Epidemiol 1989;42(8): Krishn a GG, Miller E, Kapoor S. Increased blood pressure during potassium depletion in n orm oten siv e men. N En gl J M ed 1989;320: Lan gford H, W at son RL. Electrolytes and hyperten sion. In Epidemiology and control of hyperten sion, edited by Paul O, N ew York, 1975, pp N ational H eart, Lung an d Blood In stitut e. Report of th e secon d task for ce on blood pres sure control in children Pediatrics 1987;79:1-24 N ational In stitut e of H ealth. T he Sixth Report of T h e Joint Nation al Com m itte on Prev entiv e, Detection, Ev alu ation, and T reatment of High Blood Pres sure. NIH publication N o , Nov ember P age LB, Dam on A, M oellerin g RC. Antecedent s of cardiov ascular disease in six Solomon Islan ds societies. Circulation 1974;49:1132 Prior IA M, Grimley - Ev an s J, Harv ey HPB, et al. Sodium intake and blood pressure in tw o Polyn esian population s. N En gl J M ed 1968;279:515 S a sak N. T he r elation ship of salt intake to hypert en sion in the Japanese. Geriatrics 1964;19:735 Sim on JA, Obarzan ek E, Daniels, et al. Dietary cation intake and blood pressure in black girls and w hite girls. Am J E pidem iol 1994;139: Stock s P. Blood pres sure in early life. A statistical stu dy. Lon don, Cambridg e Univ er sity Pres sure, Sw ay e PS. Dietary salt and essential hyperten sion. Am J Cardiol 1972;29:33-38 Szklo M. Epidemiologic pattern s of blood pressure in children. Epidemiological review 1979;1: V oor s AW, F or ster T A, Frericb s RR, et al. Studies of blood pres sure in children, ages 5-14 y ears, in a total biracial community - T he Boglau sa H eart Stu dy. Circulation 1976;54: V oor s AW, W ebber LS, Frerich s RR, et al. Body h eight an d body m ass as determinant s of basal blood pr essur e in childr en - th e Bogalu sa Heart Study. Am J Epidem iol 1977;106:101 W alker G, Ru s sell P, W helton P, et al. Relation betw een blood pressure, plasma renin activity, aldosteron e, urin ary sodium and potassium in 574 ambulatory subject s (ab str ). Cir cularion 1978;58 (suppl II):II W helton PK, H e J, Cutler JA, et al. Effect s of oral pota ssium on blood pres sure: m eta - analy sis of ran domized controlled clinical trials. JAMA 1997;277: W HO. Blood pressure studies in children. T echnical Report Series. N o. 715, Gen ev a,

Am J Prev M ed 1994;10(4):200-4. Kotchen JM, M ckean HE, Neill M, et al. Blood pres sure tren ds associated w ith chang es in h eight an d w eight fr om early adolescen ce t o y oung adulthood.

18 W H O Zw iau er K, Eberlein, W idhalm K. Inv er se relation ship b etw een diastolic blood pres sure an d urin ary ex cretion of potassium in girls ag ed 8 to 9 y ears - a prelimin ary communication. W ien Klin W ochen schr 1991;103 (17):

d urin ary ex cretion of potassium in girls ag ed 8 to 9 y

a16.PDF

a16.PDF ,,,, A B S T RA CT A S t u dy on S erv ic e Ch ara ct eri s t ic s of D ire c t ors of H e alt h Cen t ers in K ore a T his stu dy h as attempted to show general characteristics of health centre director