Racial Differences in the Relation between Blood Pressure and Insulin Resistance

Mf, Saad; Lillioja, Stephen; Nyomba, B. L. Grégoire; Castillo, C; Ferraro, R T; M, De Gregorio; Ravussin, Éric; Wc, Knowler; Ph, Bennett; Bv, Howard

doi:10.1056/nejm199103143241105

Cited by 398 publications

(210 citation statements)

References 37 publications

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“…An association between hyperinsulinaemia and hypertension has also been reported in several studies (7-11). Increased peripheral insulin resistance, independent of the degree of obesity, has also been found in hypertensive subjects using euglycemic insulin clamp technique (12)(13)(14).…”

mentioning

confidence: 99%

The Interrelationships between Fasting Serum Insulin Level, Obesity and Blood Pressure in Women: Results from a Cross-Sectional Population Study of Women in Gothenburg, Sweden.

Kristjansson¹,

Lissner

Bengtsson³

et al. 1993

Hypertens Res

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This study is based on a representative population sample of women in Gothenburg, Sweden. Three hundred and thirty-six 50-year-old nondiabetic women, not taking any antihypertensive medication, were included in the study. They underwent a comprehensive examination programme, where body weight, body height, waist and hip circumferences, systolic and diastolic blood pressures and fasting serum insulin concentration were measured. Fasting serum insulin concentration was significantly correlated with systolic and diastolic blood pressures. After controlling for both body mass index (BMI) and waist to hip circumference ratio (WHR), fasting serum insulin concentration remained independently associated with blood pressure (P = 0.001 for systolic blood pressure, P = 0.06 for diastolic blood pressure). When stratified for BMI or WHR the correlations between fasting serum insulin concentration and blood pressure remained significant only in the upper 50th precentiles of BMI and WHR. When relating pressure to different levels of fasting serum insulin concentration there seems to be a threshold at an insulin concentration corresponding to the upper quartile limit (at approximately 17 uU/ml), above which level the blood pressure rises more obviously. The same phenomenon was seen for systolic and diastolic blood pressures. (Hypertens Res 1993; 16: 197-201)

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mentioning

confidence: 99%

The Interrelationships between Fasting Serum Insulin Level, Obesity and Blood Pressure in Women: Results from a Cross-Sectional Population Study of Women in Gothenburg, Sweden.

Kristjansson¹,

Lissner

Bengtsson³

et al. 1993

Hypertens Res

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“…22 The role of HT as a factor influencing CHD risk in subjects with MS is under debate, particularly in the elderly. 23 Saad et al 24 stated that the higher prevalence of HT observed in European than in African/Asian people is one of the possible reasons influencing higher CHD mortality observed in subjects with MS. Shen et al 25 suggested that HT is related to MS only secondary to other mechanisms activated by insulin resistance and hyperinsulinemia, that is increased renal sodium and water retention, plasma noradrenaline and sympathetic nervous system activity. [26][27][28] Grundy et al 29 believe that HT is 'less metabolic' than other metabolic- Another potential confounder about the role of HT in MS is aging, because both HT and MS increase in prevalence with age.…”

Section: Discussionmentioning

confidence: 99%

Pulse hypertension: a new component of the metabolic syndrome in elderly women?

et al. 2007

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The classification of arterial hypertension (HT) to define metabolic syndrome (MS) is unclear in that different cutoffs of blood pressure (BP) have been proposed. We evaluated the categorization of HT most qualified to define MS in relationship with coronary heart disease (CHD) mortality at a population level. A total of 3257 subjects aged X65 years were followed up for 12 years. MS was defined according to the criteria of the National Education Cholesterol Program using three different categories of HT: MS-1 (systolic blood pressure (SBP) X130 and diastolic blood pressure (DBP) X85 mm Hg), MS-2 (SBP X130 or DBP X85 mm Hg) and MS-3 (pulse pressure (PP) X75 mm Hg in men and X80 mm Hg in women). Gender-specific adjusted hazard ratio (HR) with 95% confidence intervals (CI) for CHD mortality was derived from Cox analysis in the three MS groups, both including and excluding antihypertensive treatment. In women with MS untreated for HT, the risk of CHD mortality was always significantly higher than in those without MS, independent of categorization; the HR of MS was 1.73 (CI 1.12-2.67) using MS-1, 1.75 (CI 1.10-2.83) using MS-2 and 2.39 (CI 3.71-1.31) using MS-3. In women with MS treated for HT, the HR of CHD mortality was significantly increased only in the MS-3 group (1.92, CI 1.1-2.88). MS did not predict CHD in men. In conclusion, MS can predict CHD mortality in elderly women with untreated HT but not in those with treated HT; in the latter, PP is the most predictive BP value.

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“…However, no correlation between high blood pressure (BP) and hyperinsulinemia was found in obese subjects by Grugni et al (9). Saad et al showed the racial differences in the relation between BP and insulin resistance (10). Despite the obvious importance and clinical magnitude of the problem, the nature of the relationship between obesity and hypertension has remained obscure.…”

Section: Introductionmentioning

confidence: 99%

“…Euglycemic insulin clamp procedure Since this method has been previously described in detail (1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14], only the general procedure will be outlined here.…”

Section: Blood Pressurementioning

confidence: 99%

Relationship between Insulin and Blood Pressure in Japanese Obese Subjects.

et al. 1999

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Object: The association of obesity and hypertension is well recognized. However, the nature of the relationship between increased body weight and blood pressure (BP) elevation has remained obscure. Patients and Methods: Weevaluated BP, insulin sensitivity, insulin clearance and fasting plasma insulin concentration in 19 younger (over 40 years) and in 15 older (more than 40 years) obese subjects to determine the relationships between BP and other factors. Insulin sensitivity and clearance were determined with the euglycemic clamp technique. Results: BP was not associated with insulin sensitivity although most of the subjects showed insulin resistance. In the younger obese group, a positive correlation between diastolic BPand body mass index (kg/m2) was found (r=0.740; p=0.043). In the older obese group, systolic and diastolic BPwere correlated with fasting plasma insulin levels (r=0.705; p=0.003; r=0.574; p=0.025, respectively), and systolic BP was inversely correlated with insulin clearance (r=-0.715, p=0.003). Conclusion: These results suggest that insulin is an important factor in BP elevation in older obese subjects, but not in younger obese subjects. (Internal Medicine 38: 467-471, 1999)

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Racial Differences in the Relation between Blood Pressure and Insulin Resistance

Abstract: The relations between insulinemia, insulin resistance, and blood pressure differ among racial groups and may be mediated by mechanisms active in whites, but not in Pima Indians or blacks.

Cited by 398 publications

References 37 publications

The Interrelationships between Fasting Serum Insulin Level, Obesity and Blood Pressure in Women: Results from a Cross-Sectional Population Study of Women in Gothenburg, Sweden.

The Interrelationships between Fasting Serum Insulin Level, Obesity and Blood Pressure in Women: Results from a Cross-Sectional Population Study of Women in Gothenburg, Sweden.

Pulse hypertension: a new component of the metabolic syndrome in elderly women?

Relationship between Insulin and Blood Pressure in Japanese Obese Subjects.

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