EPIDEMIC HYPERTENSION IN NIGERIAN WORKERS

我们对尼日利亚工人流行性高血压的研究成功地 在贝宁招募了501名男性和303名女性公务员，年龄在20-64岁之间 城市，一个与美国黑人遗传相关的人口。该人群 似乎正处于从高血压低患病率向高血压低患病率过渡的时期。 高血压患病率高。在社会经济地位较高的人中， (SES)男性（高级工作人员），我们发现， 高血压比低SES男性（初级工作人员）。较小 在女性中，工作人员的地位存在差异。平均体重 男性的体重指数（BMI）很低（高中22.9，初中21.4 女性比例较低（高级工作人员为25.0，初级工作人员为23.8）。 高血压与较高的体重指数，腰围， 空腹胰岛素和减少体力活动。高血压的差异 SES组之间的发生率不能归因于钠的差异 或钾排泄、大量营养素摄入、酒精摄入， 心血管反应性或测量的应激源。很高 基于ECG电压标准的左心室肥大患病率 （ECG-LVH），在高级和初级工作人员中，男性和女性， 与高血压有关，但在血压正常者中并不少见。 在男性中，体重指数对血液中的 体重指数中位数21.5左右。进一步的分析表明， 高于BMI阈值，成人体重增加是一个更强的决定因素， 血压比成年前的体重高。成人体重增加似乎是 主要是中央体重增加。然而，只有纵向数据可以 支持这样的结论。我们假设黑人的血压 对中枢体重增加和相关的胰岛素变化非常敏感。 黑人的最佳体重似乎远低于这个数字 在美国被视为正常 我们建议对这一队列进行纵向研究，以确定 体重增加和体重相关因素的重要性，以及可能的 其他因素的相互作用，例如社会心理、电解质 反应性，大量营养素摄入，血压变化。因素 与体重增加有关的疾病。ECG-LVH的高患病率 将根据超声心动图测量（ECHO-LVH）进行验证，我们 将确定ECG-LVH变化的预测因素，以及 微量白蛋白尿在第2年（队列第4年），我们将重新研究一半的 心脏超声心动图、心血管反应性和新发 心理社会措施。在第4年（队列第6年），除了 心血管反应性，我们将重复基线测量， 队列，包括多种血压测量，身高，体重， 腰部、臀部、ECG、体力活动、两次24小时饮食回忆、酒精 摄入量、绝经状态、心理社会指标、24小时尿钠， 钾，肌酐，微量白蛋白尿，空腹血清脂质，胰岛素， 葡萄糖和肌酸酐。这种动态的人口提供了一个宝贵的 有机会获得有关病因学的重要信息 高血压，这将是更难以获得从美国黑人 因为体重和血压的增加已经 在美国人口中根深蒂固、一成不变。

Our study of Epidemic Hypertension in Nigerian Workers has successfully recruited 501 male and 303 female civil servants, ages 20-64, in Benin City, a population of genetic relevance to U.S. blacks. This population appears to be in transition from a low prevalence of hypertension to a high prevalence of hypertension. Among the higher socioeconomic status (SES) males (Senior staff), we found a twofold higher prevalence of hypertension than in the lower SES males (Junior staff). Smaller differences were observed by staff status in females. Mean body mass index (BMI) was very low in the males (22.9 in Senior and 21.4 in Junior staff) and low in females (25.0 in Senior and 23.8 in Junior staff). Hypertension was associated with higher body mass index, waist girth, fasting insulin, and lower physical activity. Differences in hypertension rates between SES groups could not be attributed to differences in sodium or potassium excretion, macronutrient intake, alcohol intake, cardiovascular reactivity, or measured stressors. There was a high prevalence of left ventricular hypertrophy, based on ECG voltage criteria (ECG-LVH), in both Senior and Junior staff, males and females, which was related to hypertension, but was not uncommon in normotensives. Among males, there appeared to be a threshold effect for BMI on blood pressure around the median BMI, 21.5. Further analyses suggested that, above the BMI threshold, adult weight gain is a stronger determinant of blood pressure than pre-adult weight. Adult weight gain appeared to be predominantly central weight gain. However, only longitudinal data can support such a conclusion. We hypothesize that blood pressure in blacks is very sensitive to central weight gain and related changes in insulin. It seems likely that optimal weight for blacks is far lower than that considered normal in the U.S. We propose a longitudinal study of this cohort to determine the importance of weight gain and weight-related factors, and the possible interaction of other factors, e.g. psychosocial, electrolytes, reactivity, macronutrient intake, to change in blood pressure. Factors related to weight gain will be identified. The high prevalence of ECG-LVH will be validated against echocardiographic measures (ECHO-LVH), and we will identify the predictors of change in ECG-LVH, and the correlates of microalbuminuria. In Year 2 (Cohort Year 4) we will restudy half of the population with echocardiography, cardiovascular reactivity, and new psychosocial measures. In Year 4 (Cohort Year 6), with the exception of cardiovascular reactivity, we will repeat baseline measures in the full cohort, including multiple blood pressure measures, height, weight, waist, hips, ECG, physical activity, two 24 hour dietary recalls, alcohol intake, menopausal status, psychosocial measures, 24 hour urine for Na, K, creatinine, micro-albuminuria, and fasting serum for lipids, insulin, glucose, and creatinine. This dynamic population provides a valuable opportunity to gain important information about the etiology of hypertension which would be much more difficult to gain from a U.S. black population because higher weight and blood pressure are already entrenched and static in the U.S. population.