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
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. 1980 (cerebrov ascular accident, strok e) (, 1996).. 1990 12.9%, 12.9% (, 1994)... (Voors, 1977).., (National Heart, Lung, and Blood In stitute, 1987)... 1900 (Stocks, 1924)., (Szklo, 1979; Kotchen, 1989).. 20 (W HO, 1985). 20
2.0mmHg, 1.0mmHg. 10 14....,,,,.. (WHO, 1985). (Na) (K).. 32 52 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) 5-17 233 K Na/ K. (, 1963;, 1968;, 1989;, 1990) Na Na, K. Na K.
II. 1. 1993 8 2 ( 13 ) 24 318, 350. 2. 1) 1993 1996,,. Korotkoff phase I, Korotkoff phase IV. (1989) (1993). 2) Na K 24 Na K. 5 5 24,,,,. 1. ion selectiv e Na K.., (creatinine) 0.4ml/ kg/ hour, 0.3ml/ kg/ hour (Ellitson, 1980)., 300ml/ day.,. 3. 1) 24 318 66 (20.8% ), 350
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 - 3. 2 2. 3. (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).
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 ) 111.9 11.2 112.0 10.2 0.98 Diastolic BP (mmhg ) 66.6 7.8 66.8 8.2 0.83 Height (cm ) 160.3 8.0 160.5 8.2 0.87 W eight (kg ) 49.5 10.2 51.1 10.0 0.32 BMI(kg/ m 2 ) 19.1 2.7 19.7 3.6 0.26 Fem ale Sy stolic BP (mmhg ) 117.7 11.5 116.7 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 0.39 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, 90 302.1mEq/ 24hr, 270.6mEq/ 24hr. K 31.2mEq/ 24hr, 32.4mEq/ 24hr 90 51.2mEq/ 24hr, 54.6mEq/ 24hr. Na K.
T able 3. Distribution s of urinary Na, K, an d Na/ K r atio accordin g t o sex Sex Variables Percentiles 10 25 50 75 90 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 5.6 7.5 9.5 F emale Na (meq/ 24hr ) 101.3 129.2 170.6 219.1 270.6 K (meq/ 24hr ) 18.7 23.8 32.4 42.5 54.6 Na/ K r atio 3.2 4.1 5.3 6.8 8.3 3. Na, K, Na/ K T able 4 5 2 Na, K, Na/ K 3. Na. K K. K 3 2.2mmHg, K 4.7mmHg. Na/ K.
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 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 6.2 p- v alue 0.02 0.02 0.08 0.03 0.87 Na/ K High 113.0 117.1 121.1 117.4 4.4 Normal 111.9 116.1 120.5 118.8 6.9 p- v alue 0.56 0.60 0.75 0.47 0.15 F emale Na High 119.5 118.5 116.5 115.1-4.4 Normal 117.4 117.4 114.5 113.4-4.0 p- v alue 0.23 0.50 0.27 0.31 0.76 K Low 114.2 115.2 113.1 112.0-2.2 Normal 119.1 118.5 115.7 114.4-4.7 p- v alue 0.00 0.04 0.15 0.16 0.04 Na/ K High 116.3 116.6 113.4 111.8-4.6 Normal 118.4 118.0 115.5 114.4-4.0 p- v alue 0.24 0.40 0.24 0.08 0.63 * : 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
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 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 0.00 0.06 0.50 0.51 Na/ K High 65.6 70.5 74.7 73.2 7.6 Normal 67.2 72.2 75.8 73.5 6.3 p- v alue 0.23 0.22 0.45 0.79 0.35 F emale Na High 76.7 75.5 75.0 72.5-4.2 Normal 76.3 75.3 73.8 71.7-4.6 p- v alue 0.74 0.87 0.39 0.48 0.72 K Low 76.4 73.9 73.7 72.1-4.3 Normal 76.4 75.8 74.3 71.8-4.5 p- v alue 1.00 0.11 0.64 0.82 0.82 Na/ K High 75.5 74.1 72.8 71.0-4.47 Normal 76.7 75.8 74.5 72.2-4.48 p- v alue 0.33 0.15 0.19 0.32 1.00 * : 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(- 12.54+0.78 13)mmHg (p< 0.1) 0.78mmHg (p< 0.1). K 2 2.27(- 11.27+0.69 13)mmHg (p< 0.1) 0.69mmHg (p< 0.1). Na/ K.
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) - 4.49 - - 12.54 * - K ((1=low, 0=norm al) - 3.93 - - 7.62 - Na Age 0.17-0.78 * - 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. 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 ) - 1.20 * * * - 2.20 * * * - 1.14 * * * - 1.73 * * * BMI (kg/ m 2) 1.13 * * * 1.17 * * * 0.75 * * * 0.74 * * * Na (1=high, 0=norm al) - 2.38 - - 5.32 - K ((1=low, 0=norm al) - 11.27 * - - 5.05 - Na Age 0.17-0.35 - K Age 0.69 * - 0.37 - Na/ K (1=high, 0=n orm al) - 5.25-0.29 Na/ K Age - - 0.44-0.07 BP : blood pressur e, BMI : body m ass index * : p<0.1, ** : p<0.05, *** : p<0.01
Na K, Na. K. Na/ K,.,. 24 Na. (Beaton, 1986), 3 1 24. Na 98%, 86% (Holbrook, 1984), 24. Caggiula (1985) 6 24 Na (r =0.61), Holbrook (1984) (r =0.76)., 24 Na,. 24, 4. 1954 Dahl and Lov er Brookhav en.,, 28,. Na Belgium (Joosen s ). (1314 ), (713 ).,., (JNC VI, 1997), (Simon, 1994).,., 24
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), 50 90 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),
(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 0.987.., Na Na..,
Na 3, (Cooper,1980). Na.,., (prev alent incidence bias ). 24.,, Na K. JNC (NIH, 1997) 6g, Na 2.4g.,,., (, 1989),.,.
1993 2 318 350 ( 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
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