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Hyperinsulinemia in hypertension: associations with race, abdominal obesity, and hyperlipidemia
J G Spangler1, R A Bell, J H Summerson
1Department of Family and Community Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157, USA.
Insights
Race, sex, abdominal obesity, and hyperlipidemia significantly increase fasting insulin levels in hypertensive patients. Understanding these interactions can help prevent hyperinsulinemia complications.
Area of Science:
- Endocrinology and Metabolism
- Cardiovascular Health
- Clinical Research
Background:
- Hyperinsulinemia is a condition characterized by elevated insulin levels.
- Hypertension is a significant risk factor for cardiovascular disease.
- The interplay of demographic and metabolic factors in hyperinsulinemia among hypertensive individuals requires further elucidation.
Purpose of the Study:
- To investigate the independent and combined contributions of race, sex, abdominal obesity, and hyperlipidemia to hyperinsulinemia in patients with hypertension.
Main Methods:
- A cross-sectional survey was conducted on 140 adult patients with essential hypertension.
- Measurements included fasting insulin, lipids, glucose, glycosylated hemoglobin, waist-hip ratio, and blood pressure.
- Logistic regression analysis identified correlates of elevated fasting insulin levels across four patient subgroups.
Main Results:
- Black males exhibited the highest fasting insulin levels, while nonobese white males had the lowest.
- Abdominal obesity or hyperlipidemia independently doubled the risk of hyperinsulinemia in hypertensive patients.
- The combination of abdominal obesity and hyperlipidemia showed additive effects, increasing the risk of elevated insulin levels.
Conclusions:
- Race, sex, abdominal obesity, and hyperlipidemia interact synergistically to elevate fasting insulin levels in hypertensive patients.
- This understanding can guide physicians in preventing adverse outcomes associated with hyperinsulinemia syndrome.
Objective:
To determine the relative contributions of race, sex, abdominal obesity, and hyperlipidemia to the development of hyperinsulinemia among patients with hypertension.
Design:
Cross-sectional survey.
Setting:
A large family practice ambulatory care unit in Winston-Salem, NC.
Patients:
One hundred and forty adult patients with essential hypertension (systolic blood pressure > or = 160 mm Hg or diastolic blood pressure at or above 90 mm Hg on 2 or more occasions) or who were receiving antihypertensive treatment.
Main Outcome Measures:
Fasting insulin, lipid, and glucose levels; glycosylated hemoglobin; waist-hip ratio; and resting blood pressure.
Methods:
Among 4 patient subgroups (hypertension alone; hypertension and abdominal obesity; hypertension and hyperlipidemia; and hypertension, abdominal obesity, and hyperlipidemia) logistic regression analysis was used to determine correlates of elevated fasting insulin levels.
Results:
Controlling for age and blood pressure, black males had the highest fasting insulin levels (135 +/- 70 pmol/L [18.8 +/- 9.6 microU/mL] and 265 pmol/L [37.0 +/- 0.0 microU/mL] [mean +/- SD] for obese and nonobese black males, respectively); nonobese white males had the lowest fasting insulin levels (23 +/- 22 pmol/L [3.2 +/- 3.0 microU/mL]). Multivariate logistic regression indicated that the addition of abdominal obesity or hyperlipidemia to pure hypertension more than doubled the risk of hyperinsulinemia (adjusted odds ratio, 2.69; 95% confidence interval, 1.04-6.89; and adjusted odds ratio, 2.62; 95% confidence interval, 0.37-8.6, respectively). The combination of abdominal obesity and hyperlipidemia exerted additive effects among patients with hypertension for elevated insulin levels (adjusted odds ratio, 5.1; 95% CI, 1.59-16.4).
Conclusions:
Race, sex, abdominal obesity, and hyperlipidemia interact to produce increases in fasting insulin levels. This knowledge may help physicians prevent sequelae from hyperinsulinemia syndrome among their patients with hypertension.