Changes in blood pressure among students attending Glasgow University between 1948 and 1968: analyses of cross sectional surveys  Commentary: Changing population blood pressure levels

doi:10.1136/bmj.322.7291.885

BMJ 2001;322:885-889 ( 14 April )

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Changes in blood pressure among students attending Glasgow University between 1948 and 1968: analyses of cross sectional surveys

Peter McCarron, lecturer in epidemiology and public health medicine, ^a Mona Okasha, PhD student, ^a James McEwen, professor of public health medicine, ^b George Davey Smith, professor of clinical epidemiology. ^a

^a Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^b Department of Public Health, University of Glasgow, Glasgow G12 8RZ

Correspondence to: Peter McCarron, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, Executive Plaza North, Suite 4097, Bethesda, MD 20892-7350, USA mccarrop{at}mail.nih.gov

Objectives: To examine the changes in blood pressure overtime in a cohort of young adults attending university between1948 and1968.
Design: Cross sectionalstudy.
Setting: GlasgowUniversity.
Participants: 12 414 students aged 16-25 years $---$ 9248 men(mean age 19.9 years) and 3164 women (19.2 years) $---$ who participatedin health screening on entering university between 1948 and1968.
Main outcome measures: Systolic and diastolic bloodpressure.
Results: In male students mean systolic blood pressureadjusted for age decreased from 134.5 (95% confidence interval133.8 to 135.2) mm Hg in those born before 1929 to 125.7 (125.0to 126.3) mm Hg in those born after 1945, and diastolic bloodpressure dropped from 80.3 (79.8 to 80.8) mm Hg to 74.7 (74.2to 75.1) mm Hg. For female students the corresponding declineswere from 129.0 (127.5 to 130.5) mm Hg to 120.6 (119.8 to 121.4)mm Hg and from 79.7 (78.7 to 80.6) mm Hg to 77.0 (76.5 to 77.5)mm Hg. Adjustment for potential confounding factors made littledifference to these findings. The proportion of students withhypertension declined substantially in bothsexes.
Conclusions: Substantial declines in systolic and diastolicblood pressure over time were occurring up to 50 years ago inyoung adults who were not taking antihypertensive medication.Since blood pressure tracks into adult life, the results of thecross sectional comparisons suggest that factors acting in earlylife may be important in determining population risk of cardiovasculardisease. Changes in such factors may have made important contributionsto the decline in rates of cardiovascular diseases, particularlystroke, seen in developed countries during the pastcentury.

What is already known on this topic
Mortality from stroke in developed countries decreased throughout the 20th century; declines in mortality from coronary heart disease occurred more recently

Explanations may include favourable trends in risk factors, including blood pressure

Since blood pressure tracks into adulthood, description of the trends occurring in blood pressure in young adults may help to elucidate the critical periods involved in influencing trends in blood pressure

What this study adds
Declines in blood pressure over time were taking place up to 50 years ago in young adults

These changes did not result from use of antihypertensive medications and point to the importance of factors in early life in determining blood pressure and risk of subsequent cardiovascular disease

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