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Hyperinsulinemia for the development of hypertension: data from the Hawaii-Los Angeles-Hiroshima Study
M Imazu1, H Yamamoto, M Toyofuku
1From the Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan. imazu@mcai.med.hiroshima-u.ac.jp
Insights
Hyperinsulinemia, obesity, hyperuricemia, and high triglycerides are linked to developing hypertension in Japanese-Americans. Hyperinsulinemia and hyperuricemia independently predict hypertension risk.
Area of Science:
- Metabolic health and cardiovascular disease epidemiology.
- Hypertension risk factors in specific ethnic populations.
Background:
- Hypertension is a major global health concern.
- Metabolic factors are increasingly recognized as contributors to hypertension development.
Purpose of the Study:
- To investigate the association between metabolic factors, particularly hyperinsulinemia, and the incidence of hypertension.
- To identify independent predictors of hypertension in a Japanese-American cohort.
Main Methods:
- Longitudinal study of 140 normotensive Japanese-Americans (aged 40-69) over 15 years.
- Baseline measurements included BMI, BP, lipids, uric acid, glucose, and insulin response to glucose load.
- Development of hypertension (BP ≥ 160/95 mmHg or drug treatment) was the primary outcome.
Main Results:
- Seventeen subjects developed hypertension during follow-up.
- Higher baseline BMI, BP, uric acid, triglycerides, and insulin levels were observed in those who became hypertensive.
- Hyperinsulinemia, hyperuricemia, and elevated systolic BP were significant independent risk factors for hypertension.
Conclusions:
- Hyperinsulinemia, obesity, hyperuricemia, and hypertriglyceridemia are associated with hypertension development in Japanese-Americans.
- Hyperinsulinemia and hyperuricemia are independent predictors of incident hypertension in this population.
Abstract:
The present study was to assess the association of metabolic factors including hyperinsulinemia, with the development of hypertension in Japanese-Americans. One hundred forty normotensive (<140/90 mmHg) subjects aged 40 to 69 years old from the Hawaii-Los Angeles-Hiroshima study were followed for 15 years. Patients with cardiovascular disease were excluded. Body mass index (BMI), blood pressure (BP), serum total cholesterol (TC), triglycerides (TG), uric acid (UA), and glucose and insulin responses at baseline, 1 h, and 2 h after a glucose load were analyzed. Seventeen subjects became hypertensive (systolic BP > or = 160 mmHg, diastolic BP > or = 95 mmHg, or received drug treatment) during follow-up. Age- and sex-adjusted BMI, BP, serum UA, TG, insulin, and changes in fasting glucose during follow-up were higher in subjects who later became hypertensive than in those who did not. There was no difference in the change in BMI. Age- and sex-adjusted relative risks for the development of hypertension by quartiles of BMI, serum UA, TG, and the sum of insulin values (sigmainsulin) during a glucose load were highest in highest quartile of the distribution. When age, sex, systolic BP, BMI, serum UA, TC, TG, fasting glucose, sigmainsulin, and the change in BMI were used in a proportional hazard analysis, hyperinsulinemia, hyperuricemia, and systolic BP were found to be significant risk factors for hypertension. In conclusion, hyperinsulinemia, as well as obesity, hyperuricemia, and hypertriglyceridemia were associated with hypertension in Japanese-Americans. Hyperinsulinemia and hyperuricemia were independent predictors of the development of hypertension.