Insulin resistance influences the impact of hypertension on left ventricular diastolic dysfunction in a community sample

Abstract

Background Although obesity‐associated metabolic abnormalities (insulin resistance‐IR) may not play as marked a role in determining left ventricular (LV) diastolic dysfunction (DD) as hypertension, the impact of combinations of these risk factors on DD is unknown. Hypothesis We hypothesized that IR influences the impact of hypertension on DD. Methods In 704 randomly selected participants from a community sample with a high prevalence of hypertension (50.6%) and obesity (46.5%), we determined adiposity indices, IR from the homeostasis model (HOMA‐IR) and LV diastolic function using standard echocardiographic techniques. Results HOMA‐IR was independently associated with lateral wall e' and E/e' ( P < 0.05 to P < 0.005) as well as a diagnosis of DD ( P < 0.02). Importantly, however, an enhanced relationship between HOMA‐IR and E/e' in hypertensives (n = 356, partial r = 0.15, P < 0.005) as compared to normotensives (n = 348, partial r = 0.02 P = 0.75) was noted. Consequently, as compared to normotensives, with adjustments for confounders, hypertension was independently associated with DD only in those with the highest tertile of HOMA‐IR (odds ratio = 2.65, 95% confidence interval = 1.29‐5.42, P < 0.01), while in those with the lowest tertile of HOMA‐IR, hypertension failed to show a higher prevalence of DD ( P = 0.22). Conclusions Insulin resistance enhances the impact of hypertension on LV DD. Thus, DD is more likely to occur with the combination of hypertension and IR.

Relação entre o Tecido Adiposo Epicárdico e Resistência à Insulina em Crianças Obesa

“…The relationship between arterial blood pressure and IR has been shown in many studies 42,43 In our study, we found that systolic blood pressure is an independent predictor of IR. This may be due to increased fat tissue in the body that plays an important role in IR and subclinical inflammation caused by inflammatory cytokines, such as IL-6, IL-1 and TFN-alpha secreted from this adipose tissue.…”

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

“…The inter-rater agreement between manual assessments was less than moderate, and it was poor between automated and manual, which demonstrates substantial variability in how algorithms are applied by clinicians [56]. Moreover, the discussion of methodology in Bamaiyi et al illustrates how difficult it may be to observe guidelines fully, consistently, and accurately (e.g., keeping to the recommended number of diagnostic criteria throughout) [57].…”

Subclinical decrease in cardiac autonomic and diastolic function in patients with metabolic disorders: HSCAA study

“…Of interest, even though HOMA-IR, an insulin resistance index, was not significantly associated with E/A in simple regression analysis, it was significantly and inversely associated with E/A after adjustment for other clinical factors, suggesting that insulin resistance may be a potential predictor of preclinical cardiac diastolic dysfunction. Limited numbers of population based studies suggest insulin resistance may enhance the impact of hypertension on preclinical cardiac diastolic dysfunction [ 35 , 36 ]. Our results clearly show importance of insulin resistance in the pathogenesis of LV diastolic dysfunction in patients with glycemic abnormalities.…”