Clustering of cardiovascular risk factors in confirmed prehypertensive individuals.

Abstract

Numerous studies have indicated that hypertensive subjects have an atherogenic lipoprotein pattern, hyperinsulinemia, and impaired glucose tolerance relative to normotensive individuals. These abnormalities could be due to adverse effects of certain antihypertensive agents, to pathophyslological concomitants of the hypertensive state itself, or to both. In this report, we describe the cardiovascular risk factor profile of 1,440 subjects who were normotensive and were not taking any antihypertensive medications when first examined and who subsequently participated in the 8-year follow-up of the San Antonio Heart Study. Hypertension developed in 130 subjects during the follow-up period. At baseline these prehypertensive individuals had significantly higher levels of blood pressure, fasting total and low density lipoprotein cholesterol, triglyceride, glucose, and insulin, and 2-hour glucose than those who remained free of hypertension. In addition, they had higher body mass indexes, a less favorable body fat distribution, and lower levels of high density lipoprotein cholesterol. In multiple linear regression analyses, baseline levels of triglyceride and blood pressure remained significantly higher and high density lipoprotein cholesterol remained significantly lower in the subjects who later converted to hypertension than in those who remained normotensive. Although baseline insulin levels were also higher in the prehypertensive subjects, this difference was not statistically significant In nonobese subjects, however, those with high baseline insulin concentrations had nn increased incidence of hypertension compared with those with low insulin concentrations. The present results suggest that the cluster of atherogenic changes associated with hypertension actually precede the development of the hypertensive state. adiposity, alcohol consumption, and glucose intolerance are all related to the incidence of hypertension.1 " 7 Dietary minerals such as increased sodium and decreased potassium intake have also been implicated in the etiology of hypertension.8 " 11 Little is known, however, about possible metabolic precursors of hypertension, especially dyslipidemia and hyperinsulinemia. Previous epidemiologica] studies that report clustering of cardiovascular risk factors in patients with hypertension are limited because, in general, they have been cross-sectional. 12 -16 It is possible, therefore, that this clustering of risk factors could result from compensatory mechanisms that induce secondary metabolic changes (e.g., increased catecholamine concentrations secondary to the hypertensive state). Alternatively, certain antihypertensive agents have been reported to induce dyslipidemia and to increase insulin resistance. 17In metabolic ward studies, insulin resistance as mea- Supported by grants R01 HL-24799 and R37 HL-36820 from the National Heart, Lung, and Blood Institute.Address The significance of the clustering of cardiovascular risk factors in hypertensive patients can be clarified to a considerable degree by exami...

Changes in Metabolic Syndrome Variables Since Childhood in Prehypertensive and Hypertensive Subjects

“…This is consistent with previous studies in adult populations showing clustering of metabolic abnormalities associated with the development of hypertension. [12][13][14][15] The current data, by showing the highest adverse trends in risk variables of metabolic syndrome among the hypertensive group, suggest that metabolic sequelae of obesity might have been well established much earlier in the hypertensive group versus the prehypertensive group.…”

“…9 -11 Further, prospective studies have shown that hypertension is preceded by a prehypertension stage characterized by abnormalities considered as potential metabolic precursors of hypertension. [12][13][14][15] However, in this regard, the course of concurrent development of adverse levels of blood pressure and other risk variables of metabolic syndrome during the period of childhood, adolescence, and young adulthood in persons at risk still needs elucidation. This might be useful not only in assessing future risk but also in prevention and intervention algorithms.…”

A common mutation in methylenetetrahydrofolate reductase gene among the Japanese population

“…Haffner et at. suggested that the cluster of atherogenic findings (atherogenic lipid and lipoprotein profile, glucose intolerance, and hyperinsulinemia) actually precede the development of the hypertensive state (Haffner et al, 1992). MTHFR gene mutation as an atherogenic risk factor may contribute to development of hypertensive state.…”

Arterial hypertension and glycemia in non-diabetic subjects: is there an association independent of obesity?

“…Adjustment for confounding variables, including age and BMI, removed the effect of FPG. Haffner and Ferrannini [23] have also shown that the difference in baseline PLPG between arterial hypertension cases and normotensive subjects disappeared after adding BMI and an index of body fat distribution to the model, a ®nding that was not con®rmed by Selby [24].…”