The Effect of the Sodium to Potassium Ratio on Hypertension Prevalence: A Propensity Score Matching Approach
Abstract
:1. Introduction
2. Data and Methods
2.1. Study Population
2.2. Study Measures
2.3. Statistical Analyses
3. Results
3.1. General Characteristics of the Study Population
3.2. The Effect of the Sodium to Potassium Ratio on Hypertension Prevalence
3.3. The Effect of the Sodium to Potassium Ratio on Blood Pressure
4. Discussion and Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Variables | Definitions | Mean a (n = 9424) |
---|---|---|
Sodium intake | The quantity of sodium intake per day (mg/day) | 4533.17 ± 30.24 |
Potassium intake | The quantity of potassium intake per day (mg/day) | 3104.64 ± 15.97 |
Sodium to potassium ratio | The quantity of sodium intake divided by the quantity of potassium intake (Na/K) | 1.54 ± 0.01 |
Hypertension (%) | 1 if systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or currently taking hypertension medications, 0 otherwise. | 19.56 |
Body mass index | The body weight divided by the square of height (kg/m2) | 22.87 ± 0.03 |
Walking exercise | Time spent walking per day (hours/day) | 0.67 ± 0.01 |
Smoking status (%) | 1 if a subject is currently smoking, 0 otherwise | 14.51 |
Drinking status (%) | 1 if a subject drinks a glass or more/month for the last 1 year, 0 otherwise | 53.28 |
Daily stress level (%) | 1 if a subject reports “high” or “very high” levels of usual stress, 0 otherwise | 24.49 |
Use of nutrition label (%) | 1 if a subject reads the nutrition label, 0 otherwise | 30.19 |
Family history of hypertension (%) | 1 if a subject’s father, mother, or siblings have ever been diagnosed with hypertension, 0 otherwise | 37.37 |
Female (%) | 1 if sex is female, 0 otherwise | 68.19 |
Age | Age (years) | 46.12 ± 0.16 |
Marital status (%) | 1 if unmarried, 0 otherwise | 15.86 |
Manual worker (%) | 1 if a subject has a manual job, 0 otherwise | 22.50 |
Household Income | Monthly household income (million won/month) | 446.57 ± 8.05 |
Education | Schooling year: elementary school graduation = 6, middle school graduation = 9, high school graduation = 12, university = 16 | 12.30 ± 0.04 |
Variables | Q1 | Q2 | Q3 | Q4 | p-Difference | p-Trend a |
---|---|---|---|---|---|---|
n | 2356 | 2356 | 2356 | 2356 | ||
(Sodium and potassium variables) | ||||||
Sodium intake (mg/day) | 2578.22 | 3783.20 | 4770.62 | 7000.64 | 0.000 b | (+) 0.000 |
Potassium intake (mg/day) | 3638.99 | 3113.01 | 2919.98 | 2746.57 | 0.000 b | (−) 0.000 |
Sodium to potassium ratio (Na/K) | 0.74 | 1.22 | 1.64 | 2.57 | 0.000 b | (+) 0.000 |
(Health-related variables) | ||||||
Hypertension (%) | 19.27 | 18.00 | 19.44 | 21.52 | 0.023 | (+) 0.025 |
Body mass index (kg/m2) | 22.88 | 22.78 | 22.87 | 22.93 | 0.438 | (+) 0.668 |
Walking exercise | 0.71 | 0.65 | 0.67 | 0.67 | 0.270 | (−) 0.001 |
Smoking status (%) | 9.00 | 13.92 | 16.72 | 18.38 | 0.000 | (+) 0.000 |
Drinking status (%) | 44.57 | 54.07 | 57.60 | 56.88 | 0.000 | (+) 0.000 |
Daily stress level (%) | 22.71 | 23.64 | 25.47 | 26.15 | 0.022 | (+) 0.002 |
Use of nutrition label (%) | 31.96 | 30.35 | 31.62 | 26.83 | 0.000 | (−) 0.001 |
Family history of hypertension (%) | 39.26 | 37.61 | 38.37 | 34.25 | 0.002 | (−) 0.001 |
(Socio-demographic variables) | ||||||
Female (%) | 77.42 | 68.42 | 64.52 | 62.39 | 0.000 | (−) 0.000 |
Age (year) | 48.17 | 45.62 | 44.70 | 45.99 | 0.000 | (−) 0.000 |
Marital status (%) | 13.88 | 15.15 | 17.83 | 16.60 | 0.001 | (+) 0.001 |
Manual worker (%) | 18.97 | 21.86 | 23.09 | 26.06 | 0.000 | (+) 0.000 |
Household income (million won/month) | 4.53 | 4.52 | 4.54 | 4.27 | 0.588 | (−) 0.000 |
Education (year) | 12.15 | 12.39 | 12.49 | 12.15 | 0.001 | (+) 0.757 |
(Other dietary variables) | ||||||
Energy intake (kcal/day) | 1886.51 | 1992.44 | 2025.98 | 2016.89 | 0.000 | (+) 0.000 |
Protein intake (g/day) | 64.76 | 71.97 | 74.26 | 73.96 | 0.000 | (+) 0.000 |
Fat intake (g/day) | 36.54 | 43.45 | 45.81 | 45.01 | 0.000 | (+) 0.000 |
Carbohydrate intake (g/day) | 321.50 | 316.61 | 310.31 | 309.18 | 0.001 | (−) 0.007 |
Fiber intake (g/day) | 9.43 | 7.17 | 6.86 | 7.12 | 0.000 | (−) 0.000 |
Cereals and cereal products (kcal/day) | 891.22 | 1008.12 | 1029.62 | 1083.04 | 0.000 | (+) 0.000 |
Potatoes and starches (kcal/day) | 86.91 | 41.56 | 32.34 | 19.73 | 0.000 | (−) 0.000 |
Vegetables (kcal/day) | 83.87 | 87.56 | 88.01 | 91.44 | 0.001 | (+) 0.000 |
Fruits (kcal/day) | 174.04 | 103.45 | 75.99 | 57.96 | 0.000 | (−) 0.000 |
Meat and meat products (kcal/day) | 133.22 | 189.94 | 208.58 | 199.43 | 0.000 | (+) 0.000 |
Variables | Q1 vs. Q2 | Q1 vs. Q3 | Q1 vs. Q4 | Q2 vs. Q3 | Q2 vs. Q4 | Q3 vs. Q4 | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Control | Treatment | Control | Treatment | Control | Treatment | Control | Treatment | Control | Treatment | Control | Treatment | |
n | 1970 | 1970 | 1897 | 1897 | 1859 | 1859 | 2188 | 2188 | 2103 | 2103 | 2183 | 2183 |
Hypertension prevalence (%) | 17.56 | 18.58 | 17.13 | 19.87 | 18.77 | 22.22 | 17.64 | 20.11 | 18.12 | 21.07 | 20.43 | 19.65 |
ATT (% point) | 1.02 | 2.74 | 3.44 | 2.47 | 2.95 | −0.78 | ||||||
p-value a | 0.204 | 0.015 | 0.005 | 0.019 | 0.008 | 0.260 | ||||||
Change in hypertension prevalence per unit change of sodium to potassium ratio (% points) | 2.16 | 3.08 | 1.89 | 5.88 | 2.18 | −0.84 | ||||||
Sodium to potassium ratio (Na/K) | 0.74 | 1.21 | 0.74 | 1.64 | 0.74 | 2.56 | 1.22 | 1.63 | 1.22 | 2.57 | 1.64 | 2.56 |
Sodium intake (mg/day) | 2588.94 | 3692.91 | 2610.23 | 4628.49 | 2594.76 | 6737.10 | 3813.46 | 4725.11 | 3799.56 | 6932.19 | 4762.82 | 7023.80 |
Potassium intake (mg/day) | 3641.10 | 3050.27 | 3641.29 | 2833.01 | 3629.11 | 2652.12 | 3139.32 | 2893.91 | 3126.56 | 2721.18 | 2914.06 | 2768.39 |
Variables | Q1 vs. Q2 | Q1 vs. Q3 | Q1 vs. Q4 | |||||||||
% Bias | p-Value a | % Bias | p-Value | % Bias | p-Value | |||||||
Before | After | Before | After | Before | After | Before | After | Before | After | Before | After | |
Body mass index | −3.0 | −1.6 | 0.295 | 0.625 | −0.3 | −0.7 | 0.905 | 0.824 | 1.8 | 0.3 | 0.544 | 0.938 |
Walking exercise | −5.5 | 0.4 | 0.058 | 0.891 | −3.7 | 0.6 | 0.202 | 0.850 | −4.1 | 0.1 | 0.164 | 0.971 |
Smoking status | 15.5 | −0.6 | 0.000 | 0.834 | 23.2 | −2.5 | 0.000 | 0.395 | 27.5 | −2.7 | 0.000 | 0.369 |
Drinking status | 18.2 | −3.4 | 0.000 | 0.293 | 26.3 | −1.9 | 0.000 | 0.559 | 24.8 | 2.1 | 0.000 | 0.533 |
Daily stress level | 2.2 | −0.8 | 0.448 | 0.791 | 6.5 | 1.4 | 0.027 | 0.676 | 8.0 | 0.3 | 0.006 | 0.940 |
Use of nutrition label | −3.5 | 3.5 | 0.232 | 0.274 | −0.7 | 0.3 | 0.802 | 0.918 | −11.3 | 1.9 | 0.000 | 0.565 |
Family history of hypertension | −3.4 | 0.8 | 0.243 | 0.793 | −1.8 | 1.4 | 0.530 | 0.665 | −10.4 | 1.6 | 0.000 | 0.634 |
Female | −20.3 | 4.6 | 0.000 | 0.141 | −28.7 | 2.5 | 0.000 | 0.435 | −33.2 | 3.1 | 0.000 | 0.334 |
Age | −17.2 | 0.2 | 0.000 | 0.945 | −23.4 | 1.7 | 0.000 | 0.598 | −14.3 | −1.6 | 0.000 | 0.627 |
Marital status | 3.6 | −0.3 | 0.215 | 0.928 | 10.8 | −2.0 | 0.000 | 0.532 | 7.6 | 0.6 | 0.009 | 0.853 |
Manual worker | 7.2 | −0.4 | 0.014 | 0.904 | 10.1 | 0.1 | 0.001 | 0.968 | 17.0 | −2.7 | 0.000 | 0.398 |
Household Income | −0.2 | 1.2 | 0.952 | 0.708 | 0.1 | −1.0 | 0.982 | 0.766 | −3.7 | 3.1 | 0.205 | 0.303 |
Education | 6.7 | −1.3 | 0.021 | 0.691 | 9.3 | −1.1 | 0.001 | 0.725 | −0.0 | 1.7 | 0.997 | 0.613 |
Pseudo R2 | p > LRb (χ2) | Pseudo R2 | p > LR (χ2) | Pseudo R2 | p > LR (χ2) | |||||||
Over-all balance tests | 0.022 | 0.001 | 0.000 | 0.979 | 0.037 | 0.000 | 0.000 | 1.000 | 0.041 | 0.001 | 0.000 | 0.993 |
Variables | Q2 vs. Q3 | Q2 vs. Q4 | Q3 vs. Q4 | |||||||||
% Bias | p-Value a | % Bias | p-Value | % Bias | p-Value | |||||||
Before | After | Before | After | Before | After | Before | After | Before | After | Before | After | |
Body mass index | 2.7 | −0.6 | 0.362 | 0.837 | 4.7 | −2.2 | 0.107 | 0.469 | 2.1 | −0.5 | 0.475 | 0.856 |
Walking exercise | 1.8 | −0.6 | 0.541 | 0.841 | 1.3 | 1.4 | 0.655 | 0.643 | −0.4 | 1.6 | 0.884 | 0.602 |
Smoking status | 7.8 | −3.0 | 0.008 | 0.301 | 12.1 | −7.4 | 0.000 | 0.011 | 4.4 | −2.0 | 0.135 | 0.495 |
Drinking status | 7.1 | −3.5 | 0.015 | 0.247 | 5.6 | −0.5 | 0.053 | 0.877 | −1.5 | 2.8 | 0.617 | 0.358 |
Daily stress level | 4.2 | −2.8 | 0.146 | 0.358 | 5.8 | 0.7 | 0.047 | 0.830 | 1.6 | −1.6 | 0.594 | 0.603 |
Use of nutrition label | 2.8 | −1.2 | 0.345 | 0.696 | −7.8 | 0.3 | 0.007 | 0.919 | −10.6 | 0.4 | 0.000 | 0.894 |
Family history of hypertension | 1.6 | −1.3 | 0.589 | 0.663 | −7.0 | −2.5 | 0.016 | 0.424 | −8.6 | 1.0 | 0.003 | 0.754 |
Female | −8.3 | 3.7 | 0.005 | 0.221 | −12.7 | 4.7 | 0.000 | 0.123 | −4.4 | 0.5 | 0.130 | 0.875 |
Age | −6.3 | 3.2 | 0.031 | 0.284 | 2.5 | 1.5 | 0.400 | 0.638 | 8.5 | −5.0 | 0.003 | 0.091 |
Marital status | 7.2 | −5.2 | 0.013 | 0.078 | 3.9 | −0.8 | 0.175 | 0.799 | −3.3 | 1.3 | 0.263 | 0.662 |
Manual worker | 2.9 | −0.7 | 0.312 | 0.828 | 9.9 | −3.3 | 0.001 | 0.272 | 6.9 | −5.0 | 0.018 | 0.092 |
Household Income | 0.2 | 0.2 | 0.941 | 0.945 | −3.1 | 0.0 | 0.287 | 1.000 | −3.4 | 2.2 | 0.248 | 0.425 |
Education | 2.7 | −0.5 | 0.347 | 0.881 | −6.8 | 0.4 | 0.020 | 0.896 | −9.4 | 5.7 | 0.001 | 0.055 |
Pseudo R2 | p > LR (χ2) | Pseudo R2 | p > LR (χ2) | Pseudo R2 | p > LR (χ2) | |||||||
Over-all balance tests | 0.004 | 0.001 | 0.036 | 0.900 | 0.007 | 0.002 | 0.000 | 0.638 | 0.004 | 0.001 | 0.008 | 0.790 |
Models | Blood Pressure (mm Hg) | ATT (mm Hg) (Standard Error) | p-Value a | |
---|---|---|---|---|
Control | Treated | |||
Systolic blood pressure | ||||
Q1 vs. Q2 | 111.34 | 112.43 | 1.09 (0.51) | 0.017 |
Q1 vs. Q3 | 111.05 | 111.93 | 0.88 (0.52) | 0.046 |
Q1 vs. Q4 | 111.28 | 112.70 | 1.41 (0.54) | 0.005 |
Q2 vs. Q3 | 112.14 | 112.31 | 0.17 (0.49) | 0.362 |
Q2 vs. Q4 | 112.48 | 112.76 | 0.28 (0.50) | 0.292 |
Q3 vs. Q4 | 112.93 | 112.60 | −0.33 (0.49) | 0.255 |
Diastolic blood pressure | ||||
Q1 vs. Q2 | 72.51 | 73.34 | 0.83 (0.32) | 0.005 |
Q1 vs. Q3 | 72.44 | 72.63 | 0.19 (0.33) | 0.284 |
Q1 vs. Q4 | 72.55 | 73.46 | 0.92 (0.34) | 0.004 |
Q2 vs. Q3 | 73.44 | 73.11 | −0.33 (0.31) | 0.141 |
Q2 vs. Q4 | 73.58 | 73.64 | 0.06 (0.32) | 0.426 |
Q3 vs. Q4 | 73.44 | 73.74 | 0.30 (0.32) | 0.173 |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
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Park, J.; Kwock, C.K.; Yang, Y.J. The Effect of the Sodium to Potassium Ratio on Hypertension Prevalence: A Propensity Score Matching Approach. Nutrients 2016, 8, 482. https://doi.org/10.3390/nu8080482
Park J, Kwock CK, Yang YJ. The Effect of the Sodium to Potassium Ratio on Hypertension Prevalence: A Propensity Score Matching Approach. Nutrients. 2016; 8(8):482. https://doi.org/10.3390/nu8080482
Chicago/Turabian StylePark, Junhyung, Chang Keun Kwock, and Yoon Jung Yang. 2016. "The Effect of the Sodium to Potassium Ratio on Hypertension Prevalence: A Propensity Score Matching Approach" Nutrients 8, no. 8: 482. https://doi.org/10.3390/nu8080482