Abdominal adiposity and metabolic alterations in hypertension -a case control study

Indians are particularly susceptible to chronic diseases like hypertension, diabetes and coronary heart disease. Several Western studies have documented the role of obesity, especially the role of regional adiposity, and associated metabolic aberrations in the aetiopathogenesis of these chronic diseases. However, there is a paucity of information on the Indian sub-continent. This study was therefore undertaken to investigate the role of regional adiposity and metabolic abnormalities in hypertension. Subjects, aged between 30-50 years, attending the out-patient department of Osmania General Hospital {1000 beds), which caters to middle and low income group of people located at Hyderabad City in India, were screened for hypertension. A total of 158 newly diagnosed subjects were selected along with 172 age and gender matched controls. Body mass index (BMI), waist hip ratio (WHR), total body fat and percentage of body fat were calculated from the anthropometric parameters. Biochemical parameters like serum lipids and plasma glucose and insulin (at fasting as well as 2 h post load glucose) were determined in a subsample of 78 hypertensives and 74 controls. Hypertensives had significantly higher body weight, body fat, BMI and WHR as compared to controls in both men and women. No differences were observed in lipid profile. Plasma glucose, fasting as well as 2 h post load, was significantly higher in both hypertensive men and women. Though there were no differences in plasma insulin at fasting, insulin level at 2 h post-load was elevated in hypertensive women. Higher glucose levels, despite elevated insulin levels, suggested insulin resistance. The calculated odds ratios revealed that increased BMI, WHR, plasma triglycerides, and 2 h post load glucose increased the risk for hypertension in both women and men. Insulin was identified as a risk factor only in women. These results suggest a role for regional adiposity and insulin resistance 1000 in the development of hypertension in the Indian sub-continent.