Higher blood pressure in adults with less education: Some explanations from INTERSALT

Rose Stamler, Martin Shipley, Paul Elliott, Alan Dyer, Susana Sans, Jeremiah Stamler*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


An inverse association between social class and disease has frequently been reported; education, an indicator of social class, was negatively related to blood pressure in several studies. Reasons are not clear. INTERSALT, an international study on electrolytes and blood pressure, obtained data on years of education for 10,079 adults in 52 centers in 32 countries. Data presented here are for 47 centers, omitting five where the population in the sample had no education or no differences in educational level. Regression coefficients were calculated for the education-blood pressure association in each center. An inverse association was found for men in 28 centers and for women in 38. Center coefficients were combined to give a studywide estimate of that association. When adjusted only for age, systolic pressure in men was 1.3 mm Hg higher for 10 fewer years of education (p<0.05) and for women 4.5 mm Hg higher (p<0.001). However, when adjusted also for five lifestyle factors (24-hour sodium and potassium excretion, body mass index, alcohol intake, and smoking), these estimates were reduced by about one half, and the inverse association was no longer significant for men. Similar findings were obtained for diastolic pressure. Those with less education had on average higher sodium excretion, lower potassium excretion, greater body mass, and higher alcohol intake, all factors tending to increase blood pressure. Improvement of these factors, which help explain the differences in blood pressure related to years of education, has the potential to reduce the blood pressure disadvantage associated with lower socioeconomic status.

Original languageEnglish (US)
Pages (from-to)237-241
Number of pages5
Issue number3
StatePublished - Mar 1992


  • Blood pressure
  • Educational status
  • Population studies
  • Socioeconomic status

ASJC Scopus subject areas

  • Internal Medicine


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