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From the Departments of Geriatric Medicine (K.M., T.O.) and of Community
Health Nursing (H.M.), Osaka University Medical School, Suita City, Osaka,
Japan; and the University of California at Los Angeles School of Medicine,
Veterans Administration Medical Center, Sepulveda, Calif (M.L.T.).
Correspondence to Toshio Ogihara, MD, Department of Geriatric Medicine, Osaka University Medical School, 2–2 Yamada-oka, Suita City Osaka, 565-0871, Japan.
Abstract—This study evaluated the
effects of a positive family history of hypertension (FH+) on the
contributions of sympathetic nervous system (SNS) activity and insulin
to blood pressure elevation (BPE). The study design was longitudinal
and evaluated BP, body mass index (BMI), and fasting plasma insulin and
norepinephrine (NE) levels for 10 years in 557 young,
nonobese Japanese men who were normotensive at entry. FH+ was defined
as hypertension in first-degree relatives as verified by historical
records or direct determination. BPE was defined as a
© 1998 American Heart Association, Inc.
Scientific Contributions
Familial Hypertension, Insulin, Sympathetic Activity, and Blood Pressure Elevation
10% rise
in systolic and diastolic BP over entry levels
during the 10-year period. In the total group FH+ was noted in 16%,
and BPE occurred in 18% of normotensive subjects. When evaluated by
FH, the prevalence of BPE was 33% in FH+ compared with 16% in FH-
(P<0.05). BP levels were greater both at entry and at
year 10 in the FH+ group. The absolute increment in plasma NE over 10
years was greater in the BPE group than in those without BPE
(P<0.01). Of note, the rise in plasma NE levels in BPE
individuals was identical in FH+ and FH- subjects. Plasma insulin
increments were also greater in normotensive subjects with BPE than in
normotensive subjects without BPE. However, compared with NE,
development of hyperinsulinemia was more pronounced
in the FH+ subjects. The results indicate that SNS hyperactivity may be
a less genetically determined predictor of hypertension than is
hyperinsulinemia. Because SNS changes in this
initially normotensive population appeared more closely related to the
development of hypertension than to
hyperinsulinemia, environmental rather than genetic
factors may be the main determinant of early BPE in nonobese
normotensive subjects.
Key Words: family history • sympathetic nervous system • insulin • blood pressure
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