(Circulation. 1997;96:1071-1073.)
© 1997 American Heart Association, Inc.
Articles |
Regional Variations of Blood Pressure
Environment or Genes?
From the Departments of Medicine and Epidemiology, Medical College of Wisconsin, Milwaukee.
Correspondence to Theodore A. Kotchen, MD, Professor and Chairman, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226.
Key Words: Editorials • blood pressure • diet • genetics • hypertension
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Introduction |
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According to data obtained from cross-sectional surveys, only minor and inconsistent regional differences in hypertension prevalence have been observed in the United States. A recent report from the CARDIA study, however, documents impressive regional differences in changes of blood pressure in a cohort at each of four sites followed periodically over 7 years.1 Compared with Chicago, Minneapolis, and Oakland, although there were no regional differences at baseline, the highest incidence and prevalence of elevated blood pressure at 7 years was observed in Birmingham. These regional differences in blood pressure and in change of blood pressure over time suggest hypotheses about environmental contributions to elevated blood pressure.
The potential significance of the relatively high blood pressures
in Birmingham is highlighted by an increased relative risk of stroke
mortality that has persisted in the southeastern United States for more
than five decades, despite the overall nationwide decline in stroke
mortality.2 Although the specific geographic boundaries
may be changing somewhat, the southeastern region of the United States
has been referred to as the Stroke Belt. Factors that account for the
existence of the Stroke Belt have not been clearly defined, and it has
been suggested that geographic variation in hypertension prevalence
does not account for the large geographic variation of stroke
occurrence or stroke mortality.3 However, the percentage
of hypertensive individuals with diastolic pressures
115 mm Hg is higher in the Southeast than in any other region
of the United States, and increased rates of hypertensive heart disease
have also been observed in
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