(Hypertension. 1997;30:1144-1149.)
© 1997 American Heart Association, Inc.
Articles |
Insulin Resistance, Hyperinsulinemia, and Blood Pressure
Role of Age and Obesity
From the Metabolism Unit, CNR Institute of Clinical Physiology, and the Department of Internal Medicine, University of Pisa, Italy (E.F.); other affiliations are shown in the Appendix.
Correspondence to Dr E. Ferrannini, CNR Institute of Clinical Physiology, Via Savi, 8, I-56126 Pisa, Italy.
Abstract In population surveys, blood pressure and plasma
insulin concentration are related variables, but the association is
confounded by age and obesity. Whether insulin resistance is
independently associated with higher blood pressure in normal subjects
is debated. We analyzed the database of the European Group for
the Study of Insulin Resistance, made up of nondiabetic men and women
from 20 centers, in whom insulin sensitivity was measured by the
euglycemic insulin clamp. After excluding subjects aged
70 years, those with severe obesity (body mass index [BMI] >40
kg · m-2), and those with abnormal blood pressure
values (140/90 mm Hg), 333 cases (ages 18 to 70 years; BMI,
18.4 to 39.8 kg · m-2) were available for
analysis. In univariate analysis, both
systolic and diastolic blood pressures were
inversely related to insulin sensitivity, with r values of
0.18 (P<.005) and 0.34 (P<.0001), respectively.
In a multivariate model simultaneously
accounting for sex, age, BMI, and fasting insulin, systolic and
diastolic blood pressures were still inversely related to
insulin sensitivity (partial r, 0.15 and 0.19;
P<.01 for both). In this model, age was positively related
to blood pressure levels independently of insulin sensitivity, whereas
BMI was not. The predicted impact on blood pressure of a decrease in
insulin sensitivity of 10 µmol · min-1
· kg-1 was +1.4 mm Hg, similar to that associated
with a 10-year difference in age. Although insulin levels and insulin
action were reciprocally interrelated, diastolic blood
pressure varied as a simultaneous function of both. In
normotensive, nondiabetic Europeans, insulin sensitivity and age are
significant, mutually independent correlates of blood pressure, whereas
body mass is not. The relation of blood pressure to both insulin action
and circulating insulin levels is compatible with distinct influences
on blood pressure by insulin resistance and compensatory
hyperinsulinemia.
Key Words: arterial blood pressure • insulin • insulin resistance • insulin action • obesity
This article has been cited by other articles:
 |
|
 |
|
  J. Seo, E. S. Fortuno III, J. M. Suh, D. Stenesen, W. Tang, E. J. Parks, C. M. Adams, T. Townes, and J. M. Graff Atf4 Regulates Obesity, Glucose Homeostasis, and Energy Expenditure Diabetes, November 1, 2009; 58(11): 2565 - 2573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Fishman, R. H. Muzumdar, G. Atzmon, X. Ma, X. Yang, F. H. Einstein, and N. Barzilai Resistance to leptin action is the major determinant of hepatic triglyceride accumulation in vivo FASEB J, January 1, 2007; 21(1): 53 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Pitombo, E. P Araujo, C. T De Souza, J. C Pareja, B. Geloneze, and L. A Velloso Amelioration of diet-induced diabetes mellitus by removal of visceral fat J. Endocrinol., December 1, 2006; 191(3): 699 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Li, E. S. Ford, L. C. McGuire, A. H. Mokdad, R. R. Little, and G. M. Reaven Trends in hyperinsulinemia among nondiabetic adults in the u.s. Diabetes Care, November 1, 2006; 29(11): 2396 - 2402. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Sinaiko, J. Steinberger, A. Moran, C.-P. Hong, R. J. Prineas, and D. R. Jacobs Jr Influence of Insulin Resistance and Body Mass Index at Age 13 on Systolic Blood Pressure, Triglycerides, and High-Density Lipoprotein Cholesterol at Age 19 Hypertension, October 1, 2006; 48(4): 730 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Natali, E. Toschi, S. Baldeweg, D. Ciociaro, S. Favilla, L. Sacca, and E. Ferrannini Clustering of insulin resistance with vascular dysfunction and low-grade inflammation in type 2 diabetes. Diabetes, April 1, 2006; 55(4): 1133 - 1140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ratto, G. Leoncini, F. Viazzi, V. Vaccaro, A. Parodi, V. Falqui, N. Conti, C. Tomolillo, G. Deferrari, and R. Pontremoli Metabolic Syndrome and Cardiovascular Risk in Primary Hypertension. J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S120 - S122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Labrie, V Luu-The, A Belanger, S-X Lin, J Simard, G Pelletier, and C Labrie Is dehydroepiandrosterone a hormone? J. Endocrinol., November 1, 2005; 187(2): 169 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Second World Congress on the Insulin Resistance Syndrome: Hypertension, cardiovascular disease, and treatment approaches Diabetes Care, August 1, 2005; 28(8): 2073 - 2080. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Maggard, L. R. Shugarman, M. Suttorp, M. Maglione, H. J. Sugerman, E. H. Livingston, N. T. Nguyen, Z. Li, W. A. Mojica, L. Hilton, et al. Meta-Analysis: Surgical Treatment of Obesity Ann Intern Med, April 5, 2005; 142(7): 547 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ferrannini Insulin and Blood Pressure: Connected on a Circumference? Hypertension, March 1, 2005; 45(3): 347 - 348. [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Villareal and J. O. Holloszy Effect of DHEA on Abdominal Fat and Insulin Action in Elderly Women and Men: A Randomized Controlled Trial JAMA, November 10, 2004; 292(18): 2243 - 2248. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Punjabi, E. Shahar, S. Redline, D. J. Gottlieb, R. Givelber, and H. E. Resnick Sleep-Disordered Breathing, Glucose Intolerance, and Insulin Resistance: The Sleep Heart Health Study Am. J. Epidemiol., September 15, 2004; 160(6): 521 - 530. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Iwashima, T. Katsuya, K. Ishikawa, N. Ouchi, M. Ohishi, K. Sugimoto, Y. Fu, M. Motone, K. Yamamoto, A. Matsuo, et al. Hypoadiponectinemia Is an Independent Risk Factor for Hypertension Hypertension, June 1, 2004; 43(6): 1318 - 1323. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Saad, M. Rewers, J. Selby, G. Howard, S. Jinagouda, S. Fahmi, D. Zaccaro, R. N. Bergman, P. J. Savage, and S. M. Haffner Insulin Resistance and Hypertension: The Insulin Resistance Atherosclerosis Study Hypertension, June 1, 2004; 43(6): 1324 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Definitions of the Insulin Resistance Syndrome: The 1st World Congress on the Insulin Resistance Syndrome Diabetes Care, March 1, 2004; 27(3): 824 - 830. [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Cruz, M. J. Weigensberg, T. T.-K. Huang, G. Ball, G. Q. Shaibi, and M. I. Goran The Metabolic Syndrome in Overweight Hispanic Youth and the Role of Insulin Sensitivity J. Clin. Endocrinol. Metab., January 1, 2004; 89(1): 108 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Winkler, T. Konrad, S. Fullert, I. Friedrich, R. Destani, M. W. Baumstark, K. Krebs, H. Wieland, and W. Marz Pioglitazone Reduces Atherogenic Dense LDL Particles in Nondiabetic Patients With Arterial Hypertension: A double-blind, placebo-controlled study Diabetes Care, September 1, 2003; 26(9): 2588 - 2594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kanauchi, S. Yamano, K. Kanauchi, and Y. Saito Homeostasis Model Assessment of Insulin Resistance, Quantitative Insulin Sensitivity Check Index, and Oral Glucose Insulin Sensitivity Index in Nonobese, Nondiabetic Subjects with High-Normal Blood Pressure J. Clin. Endocrinol. Metab., July 1, 2003; 88(7): 3444 - 3446. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Time2Take on risk -- making the link between insulin resistance and cardiovascular risk: Report of a GSK symposium from Diabetes UK, Glasgow, March 19th 2003 The British Journal of Diabetes & Vascular Disease, March 1, 2003; 3(2_suppl): S1 - S8. [PDF]
|
|
|
|
|
|
Hypertension, Insulin, and Proinsulin in Participants With Impaired Glucose Tolerance Hypertension, November 1, 2002; 40(5): 679 - 686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Gabriely, X. H. Ma, X. M. Yang, G. Atzmon, M. W. Rajala, A. H. Berg, P. Scherer, L. Rossetti, and N. Barzilai Removal of Visceral Fat Prevents Insulin Resistance and Glucose Intolerance of Aging: An Adipokine-Mediated Process? Diabetes, October 1, 2002; 51(10): 2951 - 2958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Cruz, T. T-K. Huang, M. S. Johnson, B. A. Gower, and M. I. Goran Insulin Sensitivity and Blood Pressure in Black and White Children Hypertension, July 1, 2002; 40(1): 18 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Svensson, J. Fowelin, K. Landin, B.-A. Bengtsson, and J.-O. Johansson Effects of Seven Years of GH-Replacement Therapy on Insulin Sensitivity in GH-Deficient Adults J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2121 - 2127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. de Simone, F. Pasanisi, and F. Contaldo Link of Nonhemodynamic Factors to Hemodynamic Determinants of Left Ventricular Hypertrophy Hypertension, July 1, 2001; 38(1): 13 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Masuo, H. Mikami, T. Ogihara, and M. L. Tuck Weight Gain-Induced Blood Pressure Elevation Hypertension, May 1, 2000; 35(5): 1135 - 1140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ritz and S. R. Orth Nephropathy in Patients with Type 2 Diabetes Mellitus N. Engl. J. Med., October 7, 1999; 341(15): 1127 - 1133. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ferrannini Insulin Resistance versus Insulin Deficiency in Non-Insulin-Dependent Diabetes Mellitus: Problems and Prospects Endocr. Rev., August 1, 1998; 19(4): 477 - 490. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Heise, K. Magnusson, L. Heinemann, and P. T. Sawicki Insulin Resistance and the Effect of Insulin on Blood Pressure in Essential Hypertension Hypertension, August 1, 1998; 32(2): 243 - 248. [Abstract] [Full Text] [PDF]
|
|