Relationship between traditional risk factors for hypertension and systolic blood pressure in the Tohoku Medical Megabank Community-based Cohort Study

Abstract

Risk factors for hypertension have been emphasized in the Japanese Society of Hypertension Guidelines for the Management of Hypertension. However, large-scale studies on the association of smoking, potassium excretion, and gamma-glutamyl transferase level with BP in the Japanese population are limited. We conducted a cross-sectional study to examine the association between hypertension risk factors and systolic blood pressure in the Tohoku Medical Megabank Community-based Cohort Study (23,446 men and 38,921 women aged ≥20 years). A model adjusted for age, body mass index, smoking status, drinking status, estimated daily salt intake, potassium excretion, (or urinary sodium-to-potassium ratio), gamma-glutamyl transferase, physical activity, education level, status of damage to homes during the Great East Japan Earthquake, and residential areas was used. The average age and systolic blood pressure were 62.5 (10.3) years for men and 59.6 (11.3) years for women, 128.9 (16.7) mmHg for men and 124.7 (17.5) mmHg for women, respectively. Body mass index estimated daily salt intake, urinary sodium-to-potassium ratio and gamma-glutamyl transferase levels were positively associated with systolic blood pressure. Compared with never-drinkers, current drinkers who consumed 23-45 g/day and ≥46.0 g/day had significantly increased systolic blood pressure. Conversely, current smokers (1-10 cigarettes/day and 11-20 cigarettes/day) were inversely associated with systolic blood pressure compared to never-smokers. Overall, systolic blood pressure was associated with gamma-glutamyl transferase and hypertension risk factors, including body mass index, alcohol consumption, estimated daily salt intake, urinary sodium-to-potassium ratio, and potassium excretion. Our findings support the notion that lifestyle modifications should be attempted to prevent hypertension.

Keywords: Blood pressure; Epidemiology; Gamma-glutamyl transferase; Hypertension; Risk factor.

Fig. 1

Association between estimated daily salt intake and SBP (in the model adjusted for age, BMI, GGT, drinking status, smoking status, estimated 24-h potassium excretion, physical activity, education status, damage to the home during the GEJE, and residential area). p for difference was derived from Dunnett’s test using estimated daily salt intake <6.0 g/day as the reference. Bars represent 95% confidence intervals. p for difference is shown as follows: *p < 0.05, **p < 0.01, and ***p < 0.001. p for trend was calculated by scoring the estimated daily salt intake categories and entering the number as a continuous term in the regression model. BMI body mass index, GGT gamma-glutamyl transferase, GEJE Great East Japan Earthquake, SBP systolic blood pressure

Fig. 2

Association between GGT levels and SBP (in the model adjusted for age, BMI, estimated daily salt intake, drinking status, smoking status, estimated 24-h potassium excretion, physical activity, education status, damage to the home during the GEJE, and residential area). p for difference was derived from Dunnett’s test using GGT < 25.0 IU/L as the reference. Bars represent 95% confidence intervals. p for difference is shown as follows: *p < 0.05, **p < 0.01, and ***p < 0.001. p for trend was calculated by scoring the GGT categories and entering the number as a continuous term in the regression model. BMI body mass index, GGT gamma-glutamyl transferase, GEJE Great East Japan Earthquake, SBP systolic blood pressure

Fig. 3

Association between drinking status and SBP (in the model adjusted for age, BMI, estimated daily salt intake, GGT, smoking status, estimated 24-h potassium excretion, physical activity, education status, damage to the home during the GEJE, and residential area). p for difference was derived from Dunnett’s test using never drinker as the reference. Bars represent 95% confidence intervals. p for difference is shown as follows: *p < 0.05, **p < 0.01, and ***p < 0.001. BMI body mass index, GGT gamma-glutamyl transferase, GEJE Great East Japan Earthquake, SBP systolic blood pressure

Fig. 4

Association between smoking status and SBP (in the model adjusted for age, BMI, estimated daily salt intake, GGT, drinking status, estimated 24-h potassium excretion, physical activity, education status, damage to the home during the GEJE, and residential area). p for difference was derived from Dunnett’s test using never smoke as the reference. Bars represent 95% confidence intervals. p for difference is shown as follows: *p < 0.05, **p < 0.01, and ***p < 0.001. BMI body mass index, GGT gamma-glutamyl transferase, GEJE Great East Japan Earthquake, SBP systolic blood pressure

Fig. 5

Association between estimated 24-h potassium excretion and SBP (in the model adjusted for age, BMI, estimated daily salt intake, GGT, drinking status, smoking status, physical activity, education status, damage to the home during the GEJE, and residential area). p for difference was derived from Dunnett’s test using estimated 24-h potassium excretion <25.0 mEq/day as the reference. Bars represent 95% confidence intervals. p for difference is shown as follows: *p < 0.05, **p < 0.01, and ***p < 0.001. p for trend was calculated by scoring the estimated 24-h potassium excretion categories and entering the number as a continuous term in the regression model. BMI body mass index, GGT gamma-glutamyl transferase, GEJE Great East Japan Earthquake, SBP systolic blood pressure

Fig. 6

Association between urinary Na/K ratio and SBP (in the model adjusted for age, BMI, GGT, drinking status, smoking status, physical activity, education status, damage to the home during the GEJE, and residential area). p for difference was derived from Dunnett’s test using urinary Na/K ratio <3.0 as the reference. Bars represent 95% confidence intervals. p for difference is shown as follows: *p < 0.05, **p < 0.01, and ***p < 0.001. p for trend was calculated by scoring the urinary Na/K categories and entering the number as a continuous term in the regression model. BMI body mass index, GGT gamma-glutamyl transferase, GEJE Great East Japan Earthquake, Na/K ratio sodium to potassium ratio, SBP systolic blood pressure