Metabolic precursors of hypertension. The San Antonio Heart Study.

Published on Sep 23, 1996in JAMA Internal Medicine18.652
· DOI :10.1001/ARCHINTE.1996.00440160106013
Steven M. Haffner149
Estimated H-index: 149
(University of Texas Health Science Center at San Antonio),
H. Miettinen30
Estimated H-index: 30
+ 1 AuthorsMichael P. Stern29
Estimated H-index: 29
Sources
Abstract
Background: The relation of possible metabolic precursors (especially insulin resistance) to hypertension has been controversial. In addition, these associations may differ by level of obesity or ethnicity. Methods: We followed up 1039 initially nondiabetic, nonhypertensive subjects from the San Antonio Heart Study for 7 years. Results: Hypertension developed in 93 subjects. Age, body mass index, waist-to-hip ratio, and fasting insulin and triglyceride levels predicted the development of hypertension in univariate analyses. After adjustment for age, body mass index, waist-to-hip ratio, gender, ethnicity, and fasting glucose levels, higher levels of triglyceride and fasting insulin predicted the development of hypertension. Body mass index and fasting insulin and triglyceride levels predicted the development of hypertension in Mexican Americans and non-Hispanic whites. In addition, fasting insulin levels predicted the development of hypertension in lean and obese subjects. Increased insulin secretion (as judged by the 30-minute insulin increment) on an oral glucose tolerance test also predicted the development of hypertension. Conclusions: A cluster of atherogenic changes may precede the development of hypertension, and increased fasting insulin concentration predicts hypertension in important subgroups of subjects. Arch Intern Med. 1996;156:1994-2000
📖 Papers frequently viewed together
2,161 Citations
217 Citations
68 Citations
References64
Newest
#1D C Robbins (UPenn: University of Pennsylvania)H-Index: 1
#1David C. Robbins (UPenn: University of Pennsylvania)H-Index: 1
Last. Kathy Gallagher (UPenn: University of Pennsylvania)H-Index: 1
view all 17 authors...
Recent large-scale epidemiological studies demonstrate that blood concentrations of immunoreactive insulin predict the development of NIDDM and IDDM and are associated with the risk of several degenerative diseases, such as coronary and peripheral vessel atherosclerosis, hypertension, and dyslipidemia. The reliability of these measurements is dependent on a biological assay that has not been well standardized between laboratories. Recognizing this, the American Diabetes Association organized a t...
151 CitationsSource
#1Steven M. Haffner (University of Texas Health Science Center at San Antonio)H-Index: 149
#2Ronald R. Bowsher (University of Texas Health Science Center at San Antonio)H-Index: 32
Last. Michael P. Stern (University of Texas Health Science Center at San Antonio)H-Index: 100
view all 9 authors...
Hyperinsulinemia and insulin resistance have been implicated as risk factors for the development of non-insulin-dependent diabetes mellitus (NIDDM). Recent data suggest that proinsulin may comprise a large proportion of immunoreactive insulin in subjects with NIDDM and possibly in those with impaired glucose tolerance (IGT) as well. Increased proinsulin concentrations are thought to be an early indicator of a failing pancreas. We examined proinsulin, insulin (using an assay that does not display...
79 CitationsSource
#1Mohammed F. Saad (SC: University of Southern California)H-Index: 89
#2R. L. Anderson (Wake Forest University)H-Index: 2
Last. Richard N. Bergman (SC: University of Southern California)H-Index: 141
view all 10 authors...
An insulin-modified frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis was compared with the glucose clamp in 11 subjects with normal glucose tolerance (NGT), 20 with impaired glucose tolerance (IGT), and 24 with non-insulin-dependent diabetes mellitus (NIDDM). The insulin sensitivity index (S I ) was calculated from FSIGTT using 22- and 12-sample protocols (S I(22) and S I(12) , respectively). Insulin sensitivity from the clamp was expressed as S I(clamp)...
361 CitationsSource
#1Susan M. ShetterlyH-Index: 38
#2Marian RewersH-Index: 107
Last. Julie A. MarshallH-Index: 47
view all 4 authors...
Objectives: To determine whether Hispanics are at lower risk for the development of hypertension than non-Hispanic Whites. We also examined selected predictors of hypertension incidence and explored the role of markers of insulin resistance in the development of hypertension. Design: A cohort study of a geographically-based sample of Hispanic and non-Hispanic white southern Colorado residents who were re-examined an average of 4 years after their baseline examination. Methods: These analyses inc...
68 CitationsSource
#1S. M. Haffner (University of Texas Health Science Center at San Antonio)H-Index: 70
#2Leena Mykkänen (University of Texas Health Science Center at San Antonio)H-Index: 72
Last. M. P. Stern (University of Texas Health Science Center at San Antonio)H-Index: 43
view all 4 authors...
Recent data suggest that proinsulin is associated with cardiovascular risk factors in nondiabetic and diabetic subjects. Since most conventional insulin assays cross-react with proinsulin, it has been suggested that the associations of insulin concentrations with dyslipidemia and hypertension could actually reflect associations with proinsulin. We examined these associations by using both a conventional immunoreactive insulin assay and a specific Linco insulin assay that does not cross-react wit...
11 CitationsSource
#1D. I. W. Phillips (Southampton General Hospital)H-Index: 31
#2Penelope M.S. Clark (University of Cambridge)H-Index: 24
Last. Clive Osmond (Southampton General Hospital)H-Index: 141
view all 4 authors...
The extent to which the oral glucose tolerance test can be used to estimate insulin secretion and insulin resistance has been evaluated by comparing glucose and insulin concentrations during an oral glucose tolerance test with specific measurements of insulin secretion and insulin resistance in 85 normoglycaemic subjects and 23 subjects with impaired glucose tolerance (IGT). Insulin secretion was measured by the first phase insulin response to intravenous glucose and insulin resistance by the in...
525 CitationsSource
#1Stephen Lillioja (NIH: National Institutes of Health)H-Index: 24
#2David M. MottH-Index: 29
Last. Clifton BogardusH-Index: 69
view all 9 authors...
Background The relative roles of obesity, insulin resistance, insulin secretory dysfunction, and excess hepatic glucose production in the development of non-insulin-dependent diabetes mellitus (NIDDM) are controversial. We conducted a prospective study to determine which of these factors predicted the development of the disease in a group of Pima Indians. Methods A body-composition assessment, oral and intravenous glucose-tolerance tests, and a hyperinsulinemic-euglycemic clamp study were perfor...
1,331 CitationsSource
#1Steven E. Kahn (UW: University of Washington)H-Index: 125
#2Ronald L. PrigeonH-Index: 30
Last. Jerry P. PalmerH-Index: 79
view all 10 authors...
To determine the relationship between insulin sensitivity and β-cell function, we quantified the insulin sensitivity index using the minimal model in 93 relatively young, apparently healthy human subjects of varying degrees of obesity (55 male, 38 female; 18–44 yr of age; body mass index 19.5–52.2 kg/m 2 ) and with fasting glucose levels I was compared with measures of body adiposity and β-cell function. Although lean individuals showed a wide range of S I , body mass index and S I were related ...
1,245 CitationsSource
#1Steven M. HaffnerH-Index: 149
#2Leena MykkänenH-Index: 72
Last. Ronald R. BowsherH-Index: 32
view all 6 authors...
Recent data suggest that proinsulin is strongly associated with cardiovascular risk factors in diabetic subjects. However, this relationship has not been examined in nondiabetic subjects. Therefore, we examined the relation of proinsulin to lipids, obesity (body mass index), and waist-to-hip ratio in 260 nondiabetic individuals from the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Proinsulin was measured by radioimmunoassay, and insulin was measured b...
95 CitationsSource
#1Leena MykkänenH-Index: 72
#2Johanna KuusistoH-Index: 104
Last. Markku LaaksoH-Index: 137
view all 4 authors...
Risk factors measured in a cross-sectional study in subjects aged 65–74 years living in eastern Finland were correlated with the risk of developing diabetes 3.5 years later. Sixty-nine of 892 initially non-diabetic subjects developed diabetes during the follow-up. Subjects who subsequently developed diabetes had multiple adverse changes in risk factor levels before the diagnosis of diabetes. Subjects who developed diabetes had higher body mass index and waist-hip ratio as well as higher levels o...
190 CitationsSource
Cited By117
Newest
Objective The purpose of the present study was to investigate the effects of serum triglyceride levels on the risk of new-onset hypertension in Japanese. Methods Five thousand nine hundred and thirty-three Japanese workers without hypertension at baseline, who participated in medical check-ups from 2006 to 2018, were followed retrospectively. The participants were divided into quartiles of casual serum triglyceride levels and were followed from the first to last visit of the study period. The ou...
Source
#1Zh. D. Kobalava (Peoples' Friendship University of Russia)H-Index: 5
#2E. V. Kokhan (Peoples' Friendship University of Russia)H-Index: 1
Despite the widespread awareness that hypertension and dyslipidemia are risk factors of prime importance for cardiovascular disease, the prevalence of these risk factors is still high, and the success of their control can hardly be considered satisfactory. The latest European guidelines for the management of hypertension strengthened the position of fixed-dose combinations, the main advantage of which is increased adherence to treatment. The purpose of this review was to discuss the background a...
Source
#1Nupur Mahajan (DU: University of Delhi)H-Index: 1
#2Gautam K. Kshatriya (DU: University of Delhi)H-Index: 8
Abstract Background and aim Metabolic syndrome is rising at an alarming rate in developing countries. In India, increasing influence of urbanization in the rural areas is responsible for transition in lifestyle and diet of the indigenous people. Therefore, this study aims to estimate the prevalence of metabolic syndrome and the associated risk factors among the adolescents of Kukana tribe of Valsad district, Gujarat. Methods A cross-sectional study was conducted on 296 adolescents (128 boys and ...
1 CitationsSource
#1Gina Gheorghe (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 3
#2Peter P. Toth (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 53
Last. Camelia Cristina Diaconu (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 12
view all 10 authors...
Despite major progress in the prevention and treatment of cardiovascular diseases, women remain an underdiagnosed and insufficiently treated group, with higher hospitalization and death rates compared to men. Obesity, more frequently encountered in women, raises the risk of metabolic syndrome and cardiovascular diseases as women age. There are some differences based on sex regarding the screening, diagnosis, and treatment of dyslipidemia, as it has been observed that women are less frequently pr...
7 CitationsSource
#1Yi-Ting Lin (Uppsala University)H-Index: 13
#2Samira Salihovic (Örebro University)H-Index: 25
Last. Johan Sundström (Uppsala University)H-Index: 88
view all 8 authors...
OBJECTIVE The pathophysiology of hypertension remains incompletely understood. We investigated associations of circulating metabolites with longitudinal blood pressure (BP) changes in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort and validated the findings in the Uppsala Longitudinal Study of Adult Men cohort. Approach and Results: Circulating metabolite levels were assessed with liquid- and gas-chromatography coupled to mass spectrometry among persons without BP-low...
6 CitationsSource
#1Yuan Wang (Bengbu Medical College)H-Index: 3
#2Wenmin Liu (Bengbu Medical College)H-Index: 1
Last. Lianguo Fu (Bengbu Medical College)H-Index: 4
view all 11 authors...
Childhood hypertension has become an important public health issue. This study explored a novel indicator, namely, childhood lipid accumulation product (CLAP), which is associated with hypertension among children and adolescents. A total of 683 children and adolescents aged 8-15 years were measured for body weight, height, waist circumference (WC), abdominal skinfold thickness (AST), triacylglycerol (TG), blood pressure, dietary behaviors, and physical activity time. The novel childhood lipid ac...
1 CitationsSource
#1Johan Sundström (Uppsala University)H-Index: 6
#1Johan Sundström (Uppsala University)H-Index: 88
Last. Annika Rosengren (University of Gothenburg)H-Index: 110
view all 25 authors...
OBJECTIVE: Although the causality of the obesity--hypertension association is established, the potential for prevention is not. We hypothesized that weight gain between early adulthood and mid-life is associated with higher mid-life blood pressure. METHODS: We investigated the hypothesis using a large contemporaneous population-based mid-life cohort of men and women aged 50-64 years. Recalled body weight at age 20 years was self-reported, and mid-life body weight and office blood pressures were ...
2 CitationsSource
#1Xiaoyan Yin (BU: Boston University)H-Index: 32
#2Christine M. Willinger (NIH: National Institutes of Health)H-Index: 5
Last. Daniel Levy (NIH: National Institutes of Health)H-Index: 241
view all 20 authors...
Abstract Background Metabolic syndrome (MetS), the clustering of metabolic risk factors, is associated with cardiovascular disease risk. We sought to determine if dysregulation of the lipidome may contribute to metabolic risk factors. Methods We measured 154 circulating lipid species in 658 participants from the Framingham Heart Study (FHS) using liquid chromatography-tandem mass spectrometry and tested for associations with obesity, dysglycemia, and dyslipidemia. Independent external validation...
11 CitationsSource
#1Enoch Odame Anto (KNUST: Kwame Nkrumah University of Science and Technology)H-Index: 9
#2Christian Obirikorang (KNUST: Kwame Nkrumah University of Science and Technology)H-Index: 11
Last. Evans Adu Asamoah (KNUST: Kwame Nkrumah University of Science and Technology)H-Index: 4
view all 7 authors...
Background and Objectives: Dyslipidaemia and its associated complications have been reported to increase mortality among type 2 diabetes mellitus (T2DM) patients. However, there is a dearth of data on the incidence of dyslipidemia among Ghanaian patients with T2DM. This study evaluated dyslipidemia among newly diagnosed T2DM patients at Dormaa Presbyterian Hospital, Ghana. Materials and Methods: This cross-sectional study recruited a total of 215 participants at the Presbyterian Hospital, Dormaa...
1 CitationsSource
#1Luis E. Simental-Mendía (Mexican Social Security Institute)H-Index: 28
#2Gabriela Hernández-Ronquillo (Mexican Social Security Institute)H-Index: 4
Last. Fernando Guerrero-Romero (Mexican Social Security Institute)H-Index: 40
view all 6 authors...
Prevalence of elevated blood pressure in pediatric population has been increasing worldwide. Thus, the aim of this study was to examine whether the triglycerides and glucose (TyG) index is associated with the presence of prehypertension or hypertension in children and adolescents. Apparently healthy children aged 6 to 15 years were enrolled in a population-based cross-sectional study. Participants were allocated into groups with normal blood pressure (NBP), prehypertension, and hypertension. Smo...
7 CitationsSource