Hypertension in Patients with Insulin Resistance: Etiopathogenesis and Management in Children

Tagi, Veronica Maria; Mainieri, Francesca; Chiarelli, Francesco

doi:10.3390/ijms23105814

Cited by 17 publications

(11 citation statements)

References 101 publications

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“…Several studies demonstrated an association between arterial hypertension and insulin resistance and this is also a problem for pediatric patients [ 21 ]. Insulin resistance is involved in the development of hypertension through various mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population

et al. 2023

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Excess weight and high waist circumference (WC) are associated with increased blood pressure (BP), starting from the pediatric age. Insulin resistance is associated with elevated BP in childhood. The aim of the study was to assess the role of insulin resistance in mediating the relationship between body mass index (BMI), WC, and BP values in a pediatric population referred to a cardio-pediatric center for the presence of one or more cardiovascular risk factors. In 419 children (mean age 10.7 [standard deviation, SD 2.5] years), the following parameters were collected both in basal conditions and after 18.6 (SD 9.3) months of follow-up during which a treatment based on lifestyle and dietary modifications was given: systolic and diastolic BP (SBP and DBP), WC, plasma glucose, and insulin values. The HOMA (Homeostasis Model Assessment)-index was considered as an expression of insulin resistance. At baseline there was a significant correlation between HOMA-index and SBP z-score (β = 0.081, p = 0.003), and insulin resistance was a mediator of the relationship between BMI and SBP z-score (p = 0.015), and between waist circumference to height (WtHr) and SBP z-score (p = 0.008). The effect of BMI z-score modifications on SBP z-score changes from baseline to follow-up was totally mediated by HOMA-index changes (p = 0.008), while HOMA-index only partially mediated the effect of WtHr modifications on SBP z-score changes (p = 0.060). Our study strongly suggests that, in a pediatric population at cardiovascular risk, the HOMA-index is an important mediator of the relationship between BMI, WC and SBP.

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Section: Discussionmentioning

confidence: 99%

Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population

et al. 2023

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“…Excess adipose tissue can increase IR by promoting inflammation through increased levels of resistin or tumour necrosis factor-α. Adipose tissue macrophages activate inflammatory signalling pathways within neighbouring insulin-targeting cells (adipocytes), releasing inflammatory factors directly involved in the development of IR ( 45 ).IR increases the sympathetic nervous system by enhancing angiotensin II (AngII) and aldosterone activity, and oxidative stress leads to elevated blood pressure ( 46 ). Therefore, it is advisable to eat a light diet, reduce the intake of high-fat diets, control body weight and blood glucose, enhance exercise, and regularly monitor fat content, blood glucose, and lipid levels to prevent hypertension.…”

Section: Discussionmentioning

confidence: 99%

Association of visceral adiposity index with hypertension (NHANES 2003–2018)

Zhou,

Li,

et al. 2024

Front. Cardiovasc. Med.

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ObjectivesThis study focused on the association between visceral adiposity index (VAI) and the prevalence of hypertension in a nationally representative population of American adults.MethodsThe study obtained data from the National Health and Nutrition Examination Survey (NHANES) database from 2003–2018 for a large-scale study. This study incorporated participants ≥18 years of age. Multivariate logistic regression modelling and smoothed curve fitting were applied to investigate the existence of a correlation between VAI and hypertension prevalence. Subgroups were analyzed to confirm the stationarity of the association between VAI and hypertension prevalence. In addition, an interaction test was conducted in this study.ResultsIn completely adapted sequential models, the risk of hypertension prevalence in the overall population increased 0.17-fold with each 1-unit increase in VAI [odds ratio (OR) = 1.17; 95% confidence interval (CI) 1.12–1.22]. In the wholly adapted categorical model, there was a 0.95-fold increased risk of hypertension in the population of VAI quartile 4 (Q4) vs. VAI quartile 1 (Q1) (OR = 1.95; 95% CI 1.62–2.35). These results indicate that VAI was strongly related to the occurrence of hypertension, and smoothed curve-fitting analysis showed nonlinearity. Adjustment for covariates revealed no apparent interactions in the subgroup analyses, and results were stable across subgroups.ConclusionThis cross-sectional study suggests a nonlinear and positive correlation between elevated VAI and the adult risk of developing hypertension in U.S. adults.

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“…Locally produced IGF-1 supports blood vessel reparation and downregulates inflammation-related oxidative stress [ 2 ]. IGF-1 participates in the regulation of regional blood flow and blood pressure via stimulation of endothelial nitric oxide synthase (eNOS) activity and nitric oxide (NO) production in endothelial cells [ 4 ] that results in the induction of vasodilation and increased blood flow [ 5 ]. Genetic IGF-1 deficiency in mouse models leads to elevated blood pressure, supporting the role of IGF-1 in blood flow and pressure regulation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Expression of Insulin-like Growth Factor-1 (IGF-1), IGF-1 Receptor (IGF-1R), and Hypertension-Mediated Organ Damage (HMOD) Parameters in Leukocytes and Plasma of Children/Adolescents with Primary Hypertension

Grzywa-Czuba,

Trojanek,

Michałkiewicz

et al. 2024

JPM

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A decrease in IGF-1 is often linked to inflammation. Low systemic and local IGF-1 production and downregulation of IGF-1R expression may precede and predict PH development in children/adolescents. Leukocyte mRNA expression of IGF-1 and its receptor (IGF-1R) and plasma IGF-1 were measured in a group of 39 PH children/adolescents (29 boys and 10 girls) and 35 age-matched normotensive children (19 boys and 16 girls) using the RT-PCR and ELISA tests. The expression of the IGF-1R protein was assessed by flow cytometry. Plasma IGF-1 concentration was evaluated with ELISA. The expression of IGF-1 and IGF-1R and plasma concentrations of IGF-1 did not differ between groups. However, the PH children had a decreased percentage in IGF-1R-bearing lymphocytes (p = 0.02) and monocytes (p = 0.0003), as well as a low density of IGF-R in monocytes (p = 0.02). The IGF-1 expression was negatively correlated with pulse-wave velocity (PWV) (r = −0.49), systolic blood pressure (SBP) (−0.44), and carotid intima-media thickness (cIMT) (−0.43). The IGF-1R expression was negatively correlated with PWV (r = −0.42) and SBP (r = −0.41). Our results suggest that early subclinical hypertensive arterial injury is associated with lower activity of IGF-1-IGF-1R expression and loss of protective actions.

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Hypertension in Patients with Insulin Resistance: Etiopathogenesis and Management in Children

Cited by 17 publications

References 101 publications

Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population

Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population

Association of visceral adiposity index with hypertension (NHANES 2003–2018)

Association between Expression of Insulin-like Growth Factor-1 (IGF-1), IGF-1 Receptor (IGF-1R), and Hypertension-Mediated Organ Damage (HMOD) Parameters in Leukocytes and Plasma of Children/Adolescents with Primary Hypertension

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