Published Online
on May 3, 2004

A more recent version of this article appeared on June 1, 2004

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Submitted on March 15, 2004
Revised on March 16, 2004

Insulin Resistance and Hypertension. The Insulin Resistance Atherosclerosis Study

Mohammed F. Saad^*; Marian Rewers; Joseph Selby; George Howard; Sujata Jinagouda; Salwa Fahmi; Dan Zaccaro; Richard N. Bergman; Peter J. Savage; and Steven M. Haffner

From the Department of Medicine (M.F.S., S.J., S.F.), UCLA School of Medicine, Los Angeles, Calif; the Department of Preventive Medicine and Biometrics (M.R.), University of Colorado, Denver; the Division of Research (J.S.), Kaiser Permanente, Oakland, Calif; the Department of Public Health Sciences (G.H., D.Z.), Wake Forest University Medical School, Winston-Salem, NC; the Department of Physiology and Biophysics (R.N.B.), University of Southern California, Los Angeles; the Division of Epidemiology and Clinical Applications (P.J.S.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md; and the Department of Medicine (S.M.H.), University of Texas at San Antonio.

^* To whom correspondence should be addressed. E-mail: msaad{at}mednet.ucla.edu.

Abstract--The association between insulin resistance and insulinemia and hypertension is controversial. We examined the relation between insulin resistance and hypertension in 564 non-Hispanic whites (NHW), 505 Hispanics (H), and 413 African Americans (AA) who participated in the Insulin Resistance Atherosclerosis Study (IRAS). Insulin sensitivity was measured with a frequently sampled intravenous glucose tolerance test with minimal model analysis. The prevalence of hypertension was 32.5%, 49.4%, and 32.3% in NHW, AA, and H, respectively (P<0.001). When subjects without diabetes in all ethnic groups were combined, age, male sex, race (AA), body mass index (BMI), and insulin resistance, but not fasting insulin, were significantly associated with hypertension. When each ethnic group was analyzed separately, insulin resistance was significantly associated with hypertension in NHW and H, but not AA. After excluding subjects taking antihypertensive medications, male sex, BMI, fasting glucose, and insulin resistance, but not fasting insulin, were significant determinants of blood pressure. When the 3 ethnic groups were analyzed separately, insulin resistance was significantly associated with blood pressure in H, but not NHW, or AA. Neither insulin resistance nor fasting insulin was significantly associated with hypertension or blood pressure in subjects with diabetes of the 3 ethnic groups after adjusting for age, sex, BMI, and waist. In conclusion, insulin resistance, but not insulinemia, was related to hypertension and blood pressure in subjects without diabetes, but ethnic differences in these relations appear to exist. Neither insulin resistance nor insulinemia was related to hypertension or blood pressure in patients with type 2 diabetes in the 3 ethnic groups.

Key words: insulin resistance • insulin • hypertension • blood pressure • diabetes

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