Masked hypertension has been proven to be associated with an increased risk for cardiovascular diseases. The purpose of this study was to examine the direct associations of obesity-related anthropometric indices, including waist circumference, with masked hypertension. Participants in this population-based survey included 395 residents (> or = 35 years) of Ohasama, a rural Japanese community. They measured blood pressure at home (HBP) and underwent an oral glucose-tolerance test. Participants were classified into four groups on the basis of their HBP and casual-screening blood pressure (CBP) values: sustained normotension, white-coat hypertension, masked hypertension or sustained hypertension. The relationships between the obesity-related anthropometric indices and the four blood pressure groups were examined using multivariate analysis adjusted for confounding factors. The mean waist circumference in men was significantly higher in individuals with masked hypertension (87.3 cm) than in those with sustained normotension (81.0 cm) and white-coat hypertension (79.3 cm), whereas the mean waist circumference in women was significantly higher in individuals with sustained hypertension (79.5 cm) than in those with sustained normotension (75.0 cm). In the multivariate analysis, waist circumference, body mass index (BMI) and waist-to-hip ratio were significantly associated with masked hypertension, particularly in individuals with normal CBP. Our results suggest that HBP measurements might be particularly important in abdominally obese people for the early detection of masked hypertension.
We investigated the relationship between peroxisome proliferator-activated receptor (PPAR ) Pro12Alasubstitution and insulin resistance in subjects with normal insulin secretory capacity, since it has been reported that PPAR may affect not only insulin resistance but also insulin secretion. We examined 81 Japanese male patients with untreated essential hypertension using the glucose clamp technique. We found 77 subjects with Pro/Pro and 4 subjects with Pro/Ala genotype, and the glucose disposal rate was not signifi-
Characteristics of glucose metabolism in subjects with white-coat hypertension (WCHT) have not been fully investigated. The purpose of this study was to determine the relationship between glucose metabolism and WCHT on the basis of blood pressure (BP) at home (HBP) in the general population. Participants were from Ohasama, a rural Japanese community, and included 466 residents (mean age, 61.0 years) who had no history of diabetes mellitus. HBP and oral glucose tolerance test values were measured. Participants were classified into four groups on the basis of their HBP and casual-screening BP (CBP) values: normotension (NT) (HBPo135/85 mm Hg, CBPo140/90 mm Hg); WCHT (HBPo135/85 mm Hg, CBPX140/90 mm Hg); masked hypertension (HBPX135/85 mm Hg, CBPo140/90 mm Hg); or sustained hypertension (SHT) (HBPX135/85 mm Hg, CBPX140/90 mm Hg). The relationships between glucose metabolism and BP among the four groups were examined using multivariate analysis adjusted for possible confounding factors. Factors in relation to glucose metabolism, such as fasting glucose level, 2-h postchallenge glucose level and homeostasis model assessment-insulin resistance index, were significantly higher in subjects with WCHT and SHT than in those with NT (all Po0.03). When men and women were analyzed separately, these relationships were more pronounced in women. Our results suggest that dysregulation of glucose metabolism in WCHT might contribute to the increase in the long-term cardiovascular risk among the general population.
Renin-angiotensin system activity has been shown to affect insulin sensitivity. However, the relationship between I/D polymorphism and insulin resistance is controversial. Therefore, we examined the relationship between the ACE genotype and insulin sensitivity in 51 Japanese hypertensive patients using the glucose clamp technique. The ACE genotype distribution in the hypertensive subjects was: 7 subjects with DD, 20 subjects with ID, and 24 subjects with II. Insulin sensitivity in terms of the glucose disposal rate was not significantly different among the three ACE genotypes, although there was a tendency for insulin sensitivity to decrease in the order of II, ID and DD, DD being the lowest. These findings are contrary to previous reports that insulin sensitivity was increased in normotensive subjects with the DD genotype who were Caucasian or African-American. There might be a difference due to race and whether the subjects are hypertensive or obese. We concluded that insulin sensitivity was not different among the ACE genotypes in the Japanese hypertensive subjects, supporting a previous report on the Chinese population. To date, insulin sensitivity has not been found to differ with ACE genotypes in the oriental population.
To assess the validity of the steady-state plasma glucose (SSPG) method using octreotide (Sandostatin), we compared the SSPG method with the euglycemic hyperinsulinemic clamp technique in ten non-obese, insulin-dependent diabetic patients. The SSPG method was performed by intravenous infusion of octreotide (0.5 microgram/min), insulin (2 mU/kg/min) and glucose (9 mg/kg/min) for 180 min. Octreotide suppressed endogenous growth hormone, glucagon and insulin secretion. A steady state condition was reached by 90 min, and the mean value of SSPG at 150 and 180 min was used as the index of insulin sensitivity. The euglycemic hyperinsulinemic clamp technique was performed with an artificial endocrine pancreas (Biostator), and insulin sensitivity was expressed as the glucose disposal rate (GDR) from 150-180 min. There was a significant correlation (r = 0.91, p < 0.001) between the results of the two methods. In conclusion, measurement of SSPG, using octreotide to suppress endogenous insulin secretion, is a reliable method to assess insulin sensitivity in man.
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