Serum insulin and blood pressure in an obese population

Serum insulin has been implicated as a determinant of blood pressure (BP) level in obese hypertensive individuals. We examined the relationships among fasting insulin, mean arterial pressure (MAP), body composition, and fat distribution in 204 subjects unselected for glucose tolerance. All met the criteria of taking no oral hypoglycemic agents, insulin or antihypertensive medications. 95 percent were considered obese and 78 percent were female. Mean age was 39 years (range 15-71), percent ideal body weight (IBW) 171 percent (109-332), BP 125/81 mmHg (80-181/50-110) and fasting insulin 44 microU/ml (4-196). Lean body mass (LBM) and body fat were measured by tritium dilution. The correlation coefficient between insulin and MAP was 0.32 (P less than 0.0001). Both insulin and MAP correlated highly with percentage IBW, percentage body fat, fat mass, LBM, body build and upper fat pattern. Controlling for these variables simultaneously eliminated the association between insulin and BP. By contrast, the correlations between MAP and measures of body composition and fat distribution retained significance after controlling for insulin level. These findings suggest that measures of body composition and fat distribution have a relationship with BP that is not entirely accounted for by serum insulin level, and the relationship between serum insulin and BP is indirect and largely accounted for by their mutual association with measures of body composition and fat distribution.