Rise of blood pressure with age. New evidence of population differences

Epstein and Eckoff in 1967 devised a scheme to summarize population differences in the rise of mean values of systolic blood pressure by age in accordance with their slopes and levels. For the first time, the validity of this scheme can be examined with data from a single study, INTERSALT. This study included 52 populations in 32 countries. On the basis of these data, collected in an exceptionally well-standardized mode under a common protocol, the diversity of populations in the slopes of age differences in median values of systolic blood pressure has been strongly reconfirmed. Populations with no increase in median systolic blood pressure were again observed and remained exceptional. The analyses of these data also indicate a positive relation between the slope of rising systolic blood pressure with age and urinary sodium, urinary sodium-potassium ratio, and reported alcohol consumption as well as a negative association between urinary potassium excretion and blood pressure slope. The present analyses therefore add to the previous knowledge and results published by the INTERSALT investigators in the following three respects: (1) they relate INTERSALT results to the postulated biological gradient of variation among populations as presented by Epstein and Eckoff, including explanatory variables; (2) they demonstrate strong correlation between ranks of median blood pressure at 40 to 49 years and values at 20 to 29 years; and (3) they therefore support the original Epstein and Eckoff concept of population variation, link this with blood pressure risk factors, and call attention to the large degree of population differences already evident among populations at 20 to 29 years of age.