Skip to main content
  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

  • Home
  • About this Journal
    • General Statistics
    • Editorial Board
    • Editors
    • Information for Advertisers
    • Author Reprints
    • Commercial Reprints
    • Customer Service and Ordering Information
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • AHA Guidelines and Statements
    • Acknowledgment of Reviewers
    • Clinical Implications
    • Clinical-Pathological Conferences
    • Controversies in Hypertension
    • Editors' Picks
    • Guidelines Debate
    • Meeting Abstracts
    • Recent Advances in Hypertension
    • SPRINT Trial: the Conversation Continues
  • Resources
    • Instructions to Reviewers
    • Instructions for Authors
    • →Article Types
    • → Submission Guidelines
      • Research Guidelines
        • Minimum Information About Microarray Data Experiments (MIAME)
      • Abstract
      • Acknowledgments
      • Clinical Implications (Only by invitation)
      • Conflict(s) of Interest/Disclosure(s) Statement
      • Figure Legends
      • Figures
      • Novelty and Significance: 1) What Is New, 2) What Is Relevant?
      • References
      • Sources of Funding
      • Tables
      • Text
      • Title Page
      • Online/Data Supplement
    • →Tips for Easier Manuscript Submission
    • → General Instructions for Revised Manuscripts
      • Change of Authorship Form
    • → Costs to Authors
    • → Open Access, Repositories, & Author Rights Q&A
    • Permissions to Reprint Figures and Tables
    • Journal Policies
    • Scientific Councils
    • AHA Journals RSS Feeds
    • International Users
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
  • Facebook
  • Twitter

  • My alerts
  • Sign In
  • Join

  • Advanced search

Header Publisher Menu

  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

Hypertension

  • My alerts
  • Sign In
  • Join

  • Facebook
  • Twitter
  • Home
  • About this Journal
    • General Statistics
    • Editorial Board
    • Editors
    • Information for Advertisers
    • Author Reprints
    • Commercial Reprints
    • Customer Service and Ordering Information
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • AHA Guidelines and Statements
    • Acknowledgment of Reviewers
    • Clinical Implications
    • Clinical-Pathological Conferences
    • Controversies in Hypertension
    • Editors' Picks
    • Guidelines Debate
    • Meeting Abstracts
    • Recent Advances in Hypertension
    • SPRINT Trial: the Conversation Continues
  • Resources
    • Instructions to Reviewers
    • Instructions for Authors
    • →Article Types
    • → Submission Guidelines
    • →Tips for Easier Manuscript Submission
    • → General Instructions for Revised Manuscripts
    • → Costs to Authors
    • → Open Access, Repositories, & Author Rights Q&A
    • Permissions to Reprint Figures and Tables
    • Journal Policies
    • Scientific Councils
    • AHA Journals RSS Feeds
    • International Users
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
Editorial Commentaries

Obesity, Insulin Resistance, and Nocturnal Systolic Blood Pressure

Adam Whaley-Connell, James R. Sowers
Download PDF
https://doi.org/10.1161/HYPERTENSIONAHA.107.100255
Hypertension. 2008;51:620-621
Originally published February 20, 2008
Adam Whaley-Connell
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
James R. Sowers
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Info & Metrics
  • eLetters

Jump to

  • Article
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • eLetters
Loading

An increasing prevalence of obesity is observed in all age and ethnicity groups and is increasingly being recognized as a serious health problem in children and adolescents.1–4 Obesity is associated with a number of metabolic abnormalities, as well as increased risk for cardiovascular disease (CVD).3,4 In this issue of Hypertension, Lurbe et al5 reported a relationship between insulin resistance, determined by the homeostatic model assessment technique, and nocturnal elevations of systolic blood pressure and heart rate in a large cohort of overweight and obese European children and adolescents. This relationship was present even after adjustment for age, sex, and height. Furthermore, waist circumference was strongly associated with insulin resistance, and both waist circumference and insulin resistance were associated with elevated nocturnal, but not daytime, blood pressures. These are important observations despite some limitations as to the methodology that the investigators used. One limitation of this report is the fact that sleep was not well documented, which limited the ability to strongly relate the nocturnal blood pressures and heart rate to circadian rhythmicity. Another potential limitation of this study relates to the fact that the children were recruited from an obesity clinic; therefore, the data may not be representative of the general population of children and adolescents. Finally, the results of this study are limited by the fact that it was a cross-sectional rather than a prospective longitudinal investigation. Nevertheless, the observations in this study are in concert with previous reports of a positive relationship between insulin resistance and hypertension in children and adolescents.6,7 As noted by the authors, the results of this cross-sectional study need to be validated in prospective longitudinal investigations in this population. Furthermore, the impact of weight reduction and other strategies to improve insulin sensitivity on elevated nocturnal blood pressures would be a potentially important avenue of investigation. Because both nocturnal elevation of blood pressure and insulin resistance are predictive of renal disease,8,9 as well as CVD, the impact of insulin resistance and elevated nocturnal systolic blood pressure in children on blood pressure temporal trends, as well as the impact on development of CVD and renal disease in adulthood, needs to be assessed in future prospective studies.

A loss of the normal 24-hour circadian blood pressure and heart rate pattern has been reported in those with autonomic nervous abnormalities accompanying obesity and insulin resistance.8–11 A nondipping pattern may be promoted by increases in inflammation, oxidative stress, endothelial dysfunction, and early renal disease, as manifested by the presence of microalbuminuria (Figure).8–11 Obesity and insulin resistance contribute to endothelial dysfunction, increased sympathetic nervous system activity, increased cardiovascular and renal oxidative stress, and inflammation (Figure).4 There is increasing evidence suggesting that adipose tissue, especially central fat, is a major source of production of inflammatory cytokines.4 These inflammatory molecules, in turn, may contribute to insulin resistance, endothelial dysfunction, and activation of the sympathetic nervous system, as well as the renin-angiotensin-aldosterone system.12 Collectively, these metabolic and vascular abnormalities are associated with loss of the normal circadian rhythm of blood pressure (Figure).8–11 There are substantial data indicating that the presence of nocturnal nondipping is an important harbinger for CVD and chronic kidney disease in the adult population; the current investigation by Lurbe et al5 highlights the importance of this emerging biomarker for CVD and early renal disease9 in the adolescent population. Therefore, determining its presence and development of strategies to correct this abnormality may be very important in the future management of obesity and insulin resistance in children. This approach could potentially be a preventative measure for the development of CVD and chronic kidney disease in adulthood. Hopefully, publication of this cross-sectional study will lead to prospective studies evaluating the relationship between isolated nocturnal elevations of systolic blood pressure and heart rate and the development of sustained daytime hypertension, as well as biomarkers of CVD and chronic kidney disease during adolescence and early adulthood. Prospective longitudinal studies are also needed to ascertain the impact of weight reduction, exercise, and other hygienic measures in children to determine whether restoration of normal insulin sensitivity and circadian rhythm of blood pressure and heart rate is contemporaneously associated with reductions of albuminuria and other biomarkers of early renal disease and CVD in young adults.

Figure1
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure. Depicts the relationship among nocturnal nondipping, visceral adiposity, and insulin resistance, as mediated by inflammation, oxidative stress, and altered sympathetic nervous system (SNS) output. The presence of nocturnal nondipping is associated with renal (eg, salt retention, microalbuminuria, renin-angiotensin-aldosterone system [RAAS], and chronic kidney disease) and cardiovascular end-organ damage (eg, left ventricular hypertrophy [LVH], ischemic heart disease, and congestive heart failure [CHF]) and increased risk of CVD event.

Acknowledgments

The authors acknowledge the excellent illustrative support of Stacy Turpin.

Sources of Funding

Funding was provided by the National Institutes of Health and the Department of Veterans Affairs.

Disclosures

The authors have received grants from Novartis and have served as consultants to Novartis, Forrest, and Tahula.

Footnotes

  • Correspondence to James R. Sowers, University of Missouri, Columbia School of Medicine, D109 Diabetes Center, UHC, One Hospital Dr, Columbia MO 65212. E-mail sowersj@health.missouri.edu

  • The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.

References

  1. ↵
    Strauss RS, Pollack HA. Epidemic increase in childhood overweight 1986–1998. JAMA. 2001; 286: 2845–2848.
    OpenUrlCrossRefPubMed
  2. ↵
    Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999; 103: 1175–1182.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Lawlor DA, Leon DA. Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: Findings from the Aberdeen children of the 1950s prospective cohort study. Circulation. 2005; 111: 1891–1896.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    Sowers JR. Obesity as a cardiovascular risk factor. Am J Med. 2003; 115: 37–41.
    OpenUrlCrossRef
  5. ↵
    Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, Redon J. Added impact of obesity and insulin resistance in nocturnal blood pressure evaluation in children and adolescents. Hypertension. 2008; 51: 635–641.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    Bao W, Srinivasan SR, Berenson GS. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults: the Bogalusa Heart Study. Circulation. 1996; 93: 54–59.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    Sinaiko AR, Steinberger J, Moran A, Hong CP, Prineas RJ, Jacobs DR 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. 2006; 48: 730–736.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    Anan F, Takahashi N, Ooie T, Yufu K, Saikawa T, Yoshimatsu H. Role of insulin resistance in nondipper essential hypertension. Hypertens Res. 2003; 26: 669–676.
    OpenUrlCrossRefPubMed
  9. ↵
    Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, Batlle D. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med. 2002; 347: 797–805.
    OpenUrlCrossRefPubMed
  10. ↵
    Sowers JR. Metabolic risk factors and renal disease. Kidney Int. 2007; 71: 719–720.
    OpenUrlCrossRefPubMed
  11. ↵
    Sowers JR, White WB, Pitt B, Whelton A, Simon LS, Winer N, Kivitz A, van Ingen H, Brabant T, Fort JG. The effects of cyclooxygenase-2 inhibitors and non-steroidal anti-inflammatory therapy on 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus. Arch Intern Med. 2005; 165: 161–168.
    OpenUrlCrossRefPubMed
  12. ↵
    Cooper SA, Whaley-Connell A, Habibi J, Wei Y, Lastra G, Manrique C, Stas S, Sowers JR. Renin-angiotensin-aldosterone system and oxidative stress in cardiovascular insulin resistance. Am J Physiol Heart Circ Physiol. 2007; 293: H2009–H2023.
    OpenUrlAbstract/FREE Full Text
View Abstract
Back to top
Previous ArticleNext Article

This Issue

Hypertension
March 2008, Volume 51, Issue 3
  • Table of Contents
Previous ArticleNext Article

Jump to

  • Article
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • eLetters

Article Tools

  • Print
  • Citation Tools
    Obesity, Insulin Resistance, and Nocturnal Systolic Blood Pressure
    Adam Whaley-Connell and James R. Sowers
    Hypertension. 2008;51:620-621, originally published February 20, 2008
    https://doi.org/10.1161/HYPERTENSIONAHA.107.100255

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
  •  Download Powerpoint
  • Article Alerts
    Log in to Email Alerts with your email address.
  • Save to my folders

Share this Article

  • Email

    Thank you for your interest in spreading the word on Hypertension.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Obesity, Insulin Resistance, and Nocturnal Systolic Blood Pressure
    (Your Name) has sent you a message from Hypertension
    (Your Name) thought you would like to see the Hypertension web site.
  • Share on Social Media
    Obesity, Insulin Resistance, and Nocturnal Systolic Blood Pressure
    Adam Whaley-Connell and James R. Sowers
    Hypertension. 2008;51:620-621, originally published February 20, 2008
    https://doi.org/10.1161/HYPERTENSIONAHA.107.100255
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo

Related Articles

Cited By...

Subjects

  • Cardiology
    • Etiology
      • Hypertension
        • Hypertension

Hypertension

  • About Hypertension
  • Instructions for Authors
  • AHA CME
  • Guidelines and Statements
  • Permissions
  • Journal Policies
  • Email Alerts
  • Open Access Information
  • AHA Journals RSS
  • AHA Newsroom

Editorial Office Address:
7272 Greenville Ave.
Dallas, TX 75231
email: hypertension@heart.org

Information for:
  • Advertisers
  • Subscribers
  • Subscriber Help
  • Institutions / Librarians
  • Institutional Subscriptions FAQ
  • International Users
American Heart Association Learn and Live
National Center
7272 Greenville Ave.
Dallas, TX 75231

Customer Service

  • 1-800-AHA-USA-1
  • 1-800-242-8721
  • Local Info
  • Contact Us

About Us

Our mission is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all we do. The need for our work is beyond question. Find Out More about the American Heart Association

  • Careers
  • SHOP
  • Latest Heart and Stroke News
  • AHA/ASA Media Newsroom

Our Sites

  • American Heart Association
  • American Stroke Association
  • For Professionals
  • More Sites

Take Action

  • Advocate
  • Donate
  • Planned Giving
  • Volunteer

Online Communities

  • AFib Support
  • Garden Community
  • Patient Support Network
  • Professional Online Network

Follow Us:

  • Follow Circulation on Twitter
  • Visit Circulation on Facebook
  • Follow Circulation on Google Plus
  • Follow Circulation on Instagram
  • Follow Circulation on Pinterest
  • Follow Circulation on YouTube
  • Rss Feeds
  • Privacy Policy
  • Copyright
  • Ethics Policy
  • Conflict of Interest Policy
  • Linking Policy
  • Diversity
  • Careers

©2018 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The American Heart Association is a qualified 501(c)(3) tax-exempt organization.
*Red Dress™ DHHS, Go Red™ AHA; National Wear Red Day ® is a registered trademark.

  • PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program
  • BBB Accredited Charity
  • Comodo Secured