血压是国家体质健康监测中身体机能的必测指标，反映个体心肺功能和心血管系统健康状况，无论是在运动风险评估，还是慢性疾病防治方面，对于儿童青少年、大学生、老年人等多种群体均有借鉴价值。而学生作为国家社会主义的接班人、建设国家的主力军，其健康的体质是实现人生价值的基础，他们的体质健康水平间接代表着一个国家未来的国民体质健康水平，因此学生的体质健康尤为关键，而改革开放以来，学生的体质健康水平有所提高但依然不容乐观，如学生耐力素质下降、超重肥胖率升高等，血压水平异常成为影响心肺功能水平、心血管疾病及慢性疾病的潜在风险，且成为儿童青少年血压偏高延续至成年期的预警指标，因此探讨血压水平变化，在减少运动风险和降低心血管患病风险具有重要作用。

本研究以1979-2014年7-22岁城镇男生、城镇女生、乡村男生、乡村女生为研究对象，采用文献资料法、数理统计法、逻辑分析法对学生的血压与体质健康指标进行全面分析和探讨，以期得到学生血压的发展趋势、空间分布特征与相关影响因素，为提升学生体质健康水平、规避运动风险和预防成年期慢性疾病提供依据。

研究目的：

（1）了解我国不同年代、城乡、性别、年龄的学生血压变化特征，探讨纵向时间流变特点及影响；

（2）了解我国不同年代、城乡、性别、年龄的学生血压在全国地理分区的分布特点，探讨空间分布特征及影响；

（3）了解我国不同年代、城乡、性别、年龄的学生血压与各个体质指标的相关性，探讨各指标之间的相互影响性。

研究方法：

（1）学生血压的时间流变趋势研究：采用环比类推法和描述性统计，分析我国学生血压发展水平的纵向发展趋势。

（2）学生血压的空间分布特征研究：通过采用百分位数法，分别采取P10、P25、P75、P90为节点，使用SPSS26.0进行阈值计算并填充地图图层，按照国家六大行政地理分区直观了解血压的地理分布特征。

（3）采用方差组间比较和皮尔逊相关分析，探讨血压和体质指标之间的相关系数。

（4）采用SEM结构方程模型，分析血压和不同体质指标的标准化回归系数，匹配拟合标准进行影响因子分析。

研究结果：

1. 学生血压发展水平的时间流变趋势：

我国自1979-2014年学生血压在年代变迁方面，总体上呈现上升趋势。

（1）收缩压增长数据为：

①城镇男生收缩压2005-2010年（增长值1.51mmHg），2010-2014年（增长值0.76mmHg）；

②乡村男生收缩压2005-2010年（增长值1.87mmHg），2010-2014年（增长值0.92mmHg）；

③城镇女生收缩压2005-2010年（增长值1.21mmHg），2010-2014年（增长值0.68mmHg）；

④乡村女生收缩压2005-2010年（增长值1.36mmHg），2010-2014年（增长值0.80mmHg）。

（2）舒张压增长数据为：

①城镇男生舒张压：1991-2000年上升幅度较大，增长值2.77mmHg；2005-2014年舒张压在整体年份中处于较高水平，2005-2010年（增长值0.81mmHg），2010-2014年（增长值0.52mmHg）；

②乡村男生舒张压：1995-2014年舒张压增长值较城镇男生高，具体为1995-2000年（增长值0.87mmHg）、2000-2005年（增长值1.05mmHg）、2005-2010年（增长值1.02mmHg）、2010-2014年（增长值0.81mmHg）；

③城镇女生舒张压：1995-2000年（增长值2.63mmHg），2005-2010年（增长值0.83mmHg），2010-2014年（增长值0.57mmHg），总体上升幅度明显；

④乡村女生舒张压：呈现以2000-2005年为分界点，除此年份其余年份舒张压水平均呈上升趋势，具体增长数据为1985-1991年（增长值7.69mmHg），1991-1995年（增长值0.12mmHg），1995-2000年（增长值2.35mmHg），2005-2010年（增长值0.85mmHg），2010-2014年（增长值0.75mmHg）。

综上所述，从收缩压发展水平来看，城镇男生高于乡村男生，城镇女生高于乡村女生；从舒张压发展水平来看，乡村男生略高于城镇男生，城镇女生略高于乡村女生。

2. 学生血压发展水平的地域分布特征：

①城镇男生收缩压：1979年呈现出区域分布较分散的特点，1985-2000年，分布规律不均，出现分化特点，以东北地区、华北地区、中南地区的部分省份为主要分布，2005-2014年主要分布于东北地区、华北地区、华东地区的部分省份；

城镇男生舒张压：20世纪90年代后，由零散逐渐趋向集中，总体上呈现：东部高，西部低；北方高，南方低；沿海城市高，内陆城市低，从东北向中部递减的特点，且多分布于地势较高的第二、三阶梯交界线的位置。

②城镇女生收缩压：1979-1991年间分布分散，规律不明显，1995-2014年，城镇女生收缩压分布特征与男生相似，主要集中于北方地区，且北高南低，东北地区高，西北地区低，沿海城市高内陆城市低；

城镇女生舒张压：区域分布特点与收缩压的分布相像，北高南低，舒张压均值处于P75-P90、＞P90百分位的省份主要分布在华北北部、东北地区、和华东个别省份。

③乡村男生收缩压：1985-2014年处于P75-P90、＞P90的省份主要呈现先分散后集中再分散的特征，且由沿海地区向内陆地区递减，到2014年转移到东北地区和华北北部以及部分中南地区省份；

乡村男生舒张压：20世纪80年代、90年代分布较为分散，到21世纪，分布区域较为集中。从地理位置上来看，呈现了我国长江以北地区大部分省份较高、长江以南的省份舒张压较低的状况，且逐渐呈现出以华北北部省份和东北地区省份为主要分布。

④乡村女生收缩压：1985-2014年主要集中于我国北部，从时间变化来看，1991年-2000年分布较为分散，且处于渤海地区的省份收缩压水平较高，这与我国乡村男生血压分布相似；随年代发展，2005年后，收缩压水平较高的省份转向于长三角、珠三角地区，与城镇女生相比，多分布于南方省份。

乡村女生舒张压：从年代发展变化来看，1991-2000年主要集中于西北、华北地区，2005年-2014年主要分布于华北北部省份和中南地区部分省份，在总体上与城镇学生的分布特点相似。

综上所述，我国学生血压在全国六大地理分区主要集中于华北、西北、东北地区，并呈现沿海高、内陆低，北方高、南方低的特点；从时间变化来看，随年代发展，不断由分散分布，规律不明显走向为分布集中，逐渐突出的特点；从性别差异来看，男女生差异性较小，总体分布特征一致；从地理环境来看，于环渤海经济圈、长江下游地区、东三省、西北高原地区相对集中。

3. 学生血压与体质指标的相关关系：

（1）身体形态指标

①身高：自1979-2014年，身高与血压的相关性逐渐加强；从城乡分组来看，城镇学生高于乡村学生；从性别分组来看，男生相关性高于女生；从年龄分组来看，呈现随着年龄增大相关性逐渐增强的趋势，数据符合方差正态分布检验，且P<0.05，统计学具有显著差异。

②体重：女生组的体重与收缩压的相关性较强，且随年代变迁而升高；从性别分组来看，男生组＞女生组；从年龄分组来看，收缩压与体重表现出明显的增龄特点，舒张压与体重的相关性，男生组的相关系数随年龄增加，女生组具有年龄段的分化特征，9-18岁相关系数较强，数据符合方差正态分布检验，且P<0.05，统计学具有显著差异。

③BMI：从年代变迁来看，男女生BMI与血压的相关性具有随年代发展而升高的趋势；从城乡分组来看，乡村学生的BMI与血压的相关性高于城镇女生；从性别分组来看，男生组＞女生组；从BMI分组来看，男生超重组高于女生超重组。

（2）身体机能指标

①心率：从城乡分组来看，城镇学生的血压与心率指标的相关性高于乡村学生；从性别分组来看，男女生组的相关性呈非常显著性差异（P<0.01），且男生高于女生；从年龄分组来看，心率指标与血压的相关性具有比较明显的年龄差异，特别是在20-22岁大学生阶段，且男生＞女生。

②肺活量：从年代发展来看，我国7-22岁男生呈现肺活量与血压相关系数随年代逐渐下降的趋势；从城乡分组来看，城镇学生肺活量与血压的相关系数高于乡村学生；从性别分组来看，男生组较女生组高。

（3）身体素质指标

①耐力素质：从年代发展来看，耐力素质与血压的相关系数较小，这与我国学生耐力素质呈下降趋势关系密切^[115]，从不同年龄段来看，小学阶段的男生和女生在耐力素质与血压的相关性较强（P<0.05）。

②力量素质：从性别分组来看，女生的力量素质与血压的相关关系较强，从年份变化上来看，女生组的力量素质与收缩压相关性随年份而变化的特征不太明显，但统计学意义显著（P<0.01），男生组变化性较小；从年龄分组来看，男女生力量素质与血压的相关性均集中在小学阶段。

③速度素质：从年份变化来看，女生组较男生明显，女生的速度素质在多个年份（1979、1985、2010、2014）具有非常显著性差异（P<0.01）；从城乡分组来看，城镇男生高于乡村男生，女生城乡差异较小；从性别分组来看，女生组较男生组更为明显（P<0.01）；从年龄分组来看，男生分组分别在7岁、17岁、18岁具有显著相关性；女生组在7-10岁、22岁具有非常显著性差异男生分组分别在7岁、17岁、18岁具有显著相关性；女生组在7-10岁、22岁具有非常显著性差异。

④柔韧素质：男生组在1979年（F=1.255，R=.142，P<0.01）、1991年（F=0.992，R=.078，P<0.05）、2010年（F=0.843，R=-.109，P<0.01），女生组在1979年（F=1.171，R=-.115，P<0.05）、1985年（F=-.115，R=.073，P<0.05）相关性较强；从城乡分组来看，城市男生（F=1.035，R=.062，P<0.01）和城市女生（F=1.077，R=.043，P<0.05）的柔韧素质与收缩压具有显著性差异，乡村学生的相关性较弱。

4. 学生血压结构方程模型拟合结果：

年龄因素对血压的路径系数为-43.092（P<0.01），呈显著正向影响；性别因素对血压的路径系数为22.475（P<0.01），呈显著正向影响；身体形态中，身高因素对血压的路径系数为-0.086，体重因素对血压的路径系数为1.127，BMI因素对血压的路径系数为0（P<0.01）；身体机能中，肺活量因素对于血压的路径系数为0，脉搏因素对血压的路径系数为-12.142（P<0.01）；身体素质中，速度素质因素对血压的路径系数为-74.985（P<0.01），力量素质因素对血压的路径系数为97.592（P<0.01），耐力素质因素对血压的路径系数为-35.233（P<0.01），柔韧素质因素对血压的路径系数为-131.477（P<0.01）。

研究结论：

(1) 我国学生血压水平的时间流变趋势总体上随年代的发展而升高，收缩压上升趋势主要集中在2005-2014年，舒张压上升趋势主要集中在1995-2014年，呈曲折上升特点。

(2) 我国学生血压的地域分布特征主要集中在华北、东北、西北地区，在总体上呈现东部高西部低，北方高南方低，沿海城市高，内陆城市低的特点。

(3) 身体形态、身体机能、身体素质等含有9项体质指标与血压均呈正相关，与身体形态、身体机能相关性最强。

学生血压SEM结构方程模型中年龄因素、性别因素、体重因素、力量因素的标准化回归系数呈显著正相关影响。

Blood pressure is a required indicator of physical function in national physical health monitoring, reflecting individual cardiopulmonary function and cardiovascular system health status. It has reference value for children, teenagers, college students, the elderly and other groups, whether in exercise risk assessment or chronic disease prevention. And students as a replacement for national socialism, the main force of national development, its healthy physique physique is the foundation of the realization of the value of life, their physical health level of indirect represents the future of a country national physical health level, therefore it is important to the students' physical health, but since China's reform and opening up, the students' physical health level has improved but is still not optimistic, Such as students' endurance quality decline, overweight obesity rates rise, abnormal blood pressure level affect the level of cardiopulmonary function, the potential risk of cardiovascular disease and chronic disease, high blood pressure and become children continue to adulthood early warning indicators, therefore, blood pressure change in reducing the risk and reduce the risk of cardiovascular disease plays an important role.

In this study, male and female students aged 7-22 in urban and rural areas from 1979 to 2014 were selected as the research objects. The methods of literature, mathematical statistics and logical analysis were used to comprehensively analyze and discuss the blood pressure and physical health indicators of students, so as to obtain the development trend, spatial distribution characteristics and related influencing factors of blood pressure of students. It provides basis for improving students' physical health, avoiding sports risks and preventing chronic diseases in adulthood.

Objective：

(1) To understand the characteristics of blood pressure changes of students in different years, urban and rural areas, gender and age in China, and to explore the characteristics and causes of longitudinal temporal changes;

(2) To understand the characteristics of blood pressure distribution in different geographical regions of students of different ages, urban and rural areas, gender and age in China, and explore the characteristics and causes of spatial distribution;

(3) The correlation coefficient between blood pressure and body mass index was studied by comparing between groups of variance and Pearson correlation analysis.

Methods

(1) Study on the time change trend of students' blood pressure: the longitudinal development trend of Chinese students' blood pressure development level was analyzed by sequential analogy and descriptive statistics.

(2) Study on the spatial distribution characteristics of students' blood pressure: By adopting percentile method, P10, P25, P75 and P90 were taken as nodes respectively, and SPSS26.0 was used to calculate the threshold value and fill in the map, so as to intuitively understand the geographical distribution of blood pressure according to the six administrative geographical regions of the country.

(3) The correlation coefficient between blood pressure and body mass index was studied by comparing between groups of variance and Pearson correlation analysis.

(4) The SEM structural equation model was used to analyze the standardized regression coefficients of blood pressure and different physical indicators, and the influence factor analysis was conducted by matching and fitting criteria.

Results

1. Time-changing trend of students' blood pressure development level:

From 1979 to 2014, students' blood pressure showed an upward trend in terms of time changes.

(1) Systolic blood pressure growth data:

①The systolic blood pressure of urban male students increased by 1.51mmHg (2005-2010) and 0.76mmHg (2010-2014);

②The systolic blood pressure of rural boys increased by 1.87mmHg from 2005 to 2010 and 0.92mmHg from 2010 to 2014;

③The systolic blood pressure of urban female students from 2005 to 2010 (increased by 1.21mmHg) and from 2010 to 2014 (increased by 0.68mmHg);

④Systolic blood pressure of rural female students from 2005 to 2010 (increase of 1.36mmHg) and from 2010 to 2014 (increase of 0.80mmHg).

(2) Diastolic blood pressure growth data:

①The diastolic blood pressure of urban boys increased significantly from 1991 to 2000, with an increase value of 2.77mmHg. The diastolic blood pressure was at a high level in the whole years from 2005 to 2014, from 2005 to 2010 (0.81mmHg) and from 2010 to 2014 (0.52mmHg);

②The increase of diastolic blood pressure of rural boys from 1995 to 2014 was higher than that of urban boys. Specifically, from 1995 to 2000 (0.87mmHg), from 2000 to 2005 (1.05mmHg), from 2005 to 2010 (1.02mmHg), from 2010 to 2014 (0.81mmHg);

③The diastolic blood pressure of urban girls increased significantly from 1995 to 2000 (2.63mmHg), from 2005 to 2010 (0.83mmHg), and from 2010 to 2014 (0.57mmHg);

④Diastolic blood pressure of rural girls: From 2000 to 2005, the diastolic blood pressure level showed an upward trend in other years, with specific growth data of 1985-1991 (7.69mmHg), 1991-1995 (0.12mmHg), and 1995-2000 (2.35mmHg). 2005-2010 (0.85mmHg) and 2010-2014 (0.75mmHg).

In conclusion, from the perspective of systolic blood pressure development level, urban boys are higher than rural boys, and urban girls are higher than rural girls. In terms of diastolic blood pressure development level, rural boys were slightly higher than urban boys, and urban girls were slightly higher than rural girls.

2. Regional distribution characteristics of students' blood pressure development level:

①The spatial distribution of male systolic blood pressure in urban areas was relatively scattered in 1979, but uneven and differentiated in 1985-2000. The systolic blood pressure was mainly distributed in northeast China, North China and some provinces in central and southern China. From 2005 to 2014, it was mainly distributed in northeast China, North China and some provinces in East China. After the 1990s, the diastolic blood pressure of urban male students in China gradually tended to be concentrated from scattered, and generally presented as follows: higher in the east, lower in the west; High in the north, low in the south; The coastal cities are high, the inland cities are low, and the characteristics of decreasing from northeast to central, and mostly distributed in the higher ground of the second and third ladder boundary position;

②The systolic blood pressure of urban girls was distributed dispersively from 1979 to 1991, and the pattern was not obvious. From 1995 to 2014, the systolic blood pressure of urban girls was similar to that of male students. The systolic blood pressure of urban girls was mainly concentrated in northern China, and it was higher in north China and lower in south China, higher in northeast China and lower in northwest China, and higher in coastal cities and lower in inland cities. The regional distribution characteristics of diastolic blood pressure of urban female students were similar to that of systolic blood pressure, which was higher in the north and lower in the south. The diastolic blood pressure was in the percentile of P75-P90 and > P90, mainly distributed in northern and northeast China and some provinces in east China;

③From 1985 to 2014, the systolic blood pressure levels of male rural students in the provinces of P75-P90 and > P90 showed the characteristics of first dispersion, then concentration and then dispersion, and decreased from coastal areas to inland areas, and then transferred to northeast China, northern North China and some provinces in central and southern China in 2014. The diastolic blood pressure of rural boys was more dispersed in the 1980s and 1990s, and more concentrated in the 21st century. Geographically, the diastolic pressure is higher in most provinces north of the Yangtze River and lower in the provinces south of the Yangtze River, and gradually it is mainly distributed in the northern provinces of North China and the northeastern provinces;

④From 1985 to 2014, the systolic blood pressure of female rural students was mainly concentrated in the north of China. From the perspective of time change, the distribution was relatively scattered from 1991 to 2000, and the systolic blood pressure of provinces located in The Bohai Sea area was higher, which was similar to that of male rural students in China. With the development of The Times, after 2005, provinces with higher systolic blood pressure levels shifted to the Yangtze River Delta and pearl River Delta, and compared with urban girls, they were more distributed in southern provinces.

The regional distribution of diastolic pressure of rural female students in China from 1985 to 2014, from the perspective of chronological development and change, mainly concentrated in northwest and North China from 1991 to 2000, and mainly distributed in the northern provinces of North China and some provinces in central and southern China from 2005 to 2014, generally similar to the distribution characteristics of urban students.

In conclusion, the blood pressure of students in the six geographical regions of China is mainly concentrated in North China, northwest China and northeast China, with the characteristics of high in coastal areas, low in inland areas, high in north China and low in south China. From the perspective of time change, with the development of the years, it has gradually changed from scattered distribution with no obvious law to concentrated distribution and gradually prominent. In terms of gender differences, the differences between male and female students are small, and the overall distribution characteristics are consistent. In terms of geographical environment, it is relatively concentrated in the bohai Economic circle, the lower reaches of the Yangtze River, the three eastern provinces and the northwest Plateau area.

3. Correlation between blood pressure and physical indexes of students:

(1) Body shape index

①Height and blood pressure: The correlation between height and blood pressure increased gradually from 1979 to 2014. In terms of urban and rural groups, urban students are higher than rural students. In terms of gender grouping, the correlation of male students is higher than that of female students. In terms of age group, the correlation gradually increases with the increase of age, and the data conform to the test of variance normal distribution（P<0.05), statistically significant difference.

②Body weight and blood pressure: the correlation between body weight and systolic blood pressure in the female group was strong, and increased with the change of age. In terms of gender group, male group > female group; In terms of age group, systolic blood pressure and body weight showed obvious aging characteristics, and the correlation between diastolic blood pressure and body weight. The correlation coefficient of male group increased with age, and the correlation coefficient of female group was differentiated with age. The correlation coefficient of 9-18 years old was strong, and the data was in accordance with the test of variance normal distribution（P<0.05)， statistically significant difference.

③BMI and blood pressure: From the perspective of age change, the correlation between BMI and blood pressure of male and female students tends to increase with the development of age. The correlation between BMI and blood pressure of rural students was higher than that of urban girls. In terms of gender group, male group > female group; In terms of BMI grouping, the hyperreorganization of boys was higher than that of girls.

(2) Body function index

①Heart rate and blood pressure: the correlation between blood pressure and heart rate of urban students was higher than that of rural students. In terms of gender, the correlation between male and female students was significantly different (P<0.01), and boys were higher than girls; In terms of age groups, the correlation between heart rate index and blood pressure has obvious age difference, especially in 20-22 years old college students, and male students are more than female students.

②Lung capacity and blood pressure: From the perspective of age development, the correlation coefficient between lung capacity and blood pressure of male students aged 7-22 in China gradually decreased with age. The correlation coefficient between vital capacity and blood pressure of urban students was higher than that of rural students. In terms of gender grouping, the male group was taller than the female group.

(3) Physical quality index

①Endurance quality and blood pressure: From the perspective of chronological development, the correlation coefficient between endurance quality and blood pressure is small, which is closely related to the declining trend of endurance quality of Chinese students^[115]. From the perspective of different ages, boys and girls in primary school have a strong correlation between endurance quality and blood pressure (P< 0.05).

②Strength quality and blood pressure: from the perspective of gender group, strength quality and blood pressure of female students are strongly correlated. From the perspective of year change, the correlation between strength quality and systolic blood pressure of female students is not obvious, but statistically significant (P<0.01), there was little change in male group; In terms of age group, the correlation between strength quality and blood pressure of male and female students is concentrated in primary school.

③Speed quality and blood pressure: from the perspective of year change, the female group was more obvious than the male group, and the speed quality of the female group had a very significant difference in many years (1979, 1985, 2010, 2014) (P<0.01); In terms of urban and rural groups, male students in urban areas are higher than male students in rural areas. In terms of gender group, it was more obvious in female group than male group (P<0.01); In terms of age group, boys were significantly correlated at 7, 17 and 18 years old respectively. There was a significant difference between the female group at 7-10 and 22 years old and the male group at 7, 17 and 18 years old. There was a significant difference between 7-10 years old and 22 years old in the female group.

④Flexibility and blood pressure in male subjects in 1979 (F=1.255, R=.142, P< 0.01), 1991 (F=0.992, R=.078, P< 0.05), 2010 (F=0.843, R=-.109, P<0.01), female group in 1979 (F=1.171, R=-.115, P<0.05), 1985 (F=-.115, R=.073, P<0.05) strong correlation; Urban male students (F=1.035, R=.062, P<0.01) and urban girls (F=1.077, R=.043, P<0.05)There was a significant difference between the flexibility quality and systolic blood pressure, and the correlation was weak in rural students.

4. Fitting results of structural equation model of student blood pressure: the path coefficient of age factor on blood pressure was -43.092 (P<0.01), showed a significant positive effect; The path coefficient of gender on blood pressure was 22.475 (P<0.01), showed a significant positive effect; The path coefficients of height, body weight and BMI on blood pressure were -0.086, 1.127 and 0 respectively (P<0.01); In body function, the path coefficient of vital capacity to blood pressure was 0, and the path coefficient of pulse factor to blood pressure was -12.142 (P<0.01); In physical fitness, the path coefficient of speed factors on blood pressure was -74.985 (P<0.01), the path coefficient of strength factors on bp was 97.592 (P<0.01), the path coefficient of endurance factors on bp was -35.233 (P<0.01), the path coefficient of flexibility factors on bp was -131.477 (P<0.01).

Conclusion

(1) On the whole, the time flow trend of Blood pressure level of Chinese students increased with the development of years. The upward trend of systolic blood pressure was mainly concentrated in 2005-2014, and the upward trend of diastolic blood pressure was mainly concentrated in 1995-2014, showing a zigzag upward trend.

(2) The regional distribution characteristics of blood pressure of students in China are mainly concentrated in North China, northeast China and northwest China. On the whole, it is high in the east and low in the west, high in the north and low in the south, high in coastal cities and low in inland cities.

(3) Body shape, body function, body quality and other 9 physical indicators were positively correlated with blood pressure, and the correlation with body shape and body function was the strongest.

The standardized regression coefficients of age factor, gender factor, weight factor and strength factor in the SEM structural equation model of students' blood pressure showed significant positive correlation.