An increased visceral-subcutaneous adipose tissue ratio is associated with difficult-to-treat hypertension in men.
ABSTRACT Excess visceral adipose tissue (VAT) is considered to be a component in metabolic syndrome, an accumulation of cardiovascular risk factors that includes increased blood pressure; however, there are no previous data showing an association between increases in the VAT-subcutaneous adipose tissue (SAT) ratio and difficult-to-treat hypertension.
In 572 patients who had cardiovascular risk factors and who were under stable antihypertensive treatment, we evaluated whether the VAT-SAT ratio, as assessed by abdominal computed tomography, predicted difficult-to-treat hypertension, which we defined as an elevation of clinic blood pressure (i.e., clinic blood pressure >or=140/90 mmHg) during treatment with at least three antihypertensive drugs.
In men, an elevated VAT-SAT ratio [odds ratio (OR) 1.44 per 1 SD (0.52), 95% confidence interval (CI) 1.08-1.92] and alcohol drinking habit (OR 2.16, 95% CI 1.07-4.36) were significant predictors of difficult-to-treat hypertension, independently of the presence of metabolic syndrome or the insulin level. However, when we included diuretic use in the diagnosis of difficult-to-treat hypertension (i.e., resistant hypertension), the significance of the VAT-SAT ratio disappeared (P = 0.06), and a decreased estimated glomerular filtration rate (OR 0.74 per 10 ml/min per 1.73 m, 95% CI 0.58-0.94) and alcohol drinking habit (OR 4.31, 95% CI 1.74-10.68) were the significant predictors. In contrast, in women, the VAT-SAT ratio did not predict difficult-to-treat hypertension (P = 0.18).
An increased VAT-SAT ratio was associated with difficult-to-treat hypertension in men, but not with resistant hypertension, suggesting that diuretic use may partly affect the relationship between the VAT-SAT ratio and difficult-to-treat hypertension.
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ABSTRACT: Both diabetes mellitus (DM) and obesity are prevalent in adults. The relationship between DM and body adipose tissue (AT) distribution is complex and although it has been investigated extensively, the subject remains controversial. Although a causal association between DM and obesity and AT distribution cannot be established on the basis of existing data, it is possible to conclude from many studies that gene, serum sex steroids level, daily physical activity and food supply can be the risk of obesity and AT redistribution factor among type 2 DM patients (T2DM). Obesity and AT redistribution of T2DM patients can increase the risk of insulin resistant (IR), cardiovascular disease and many other disorders. Even though obesity and AT redistribution screening or prophylactic treatment in all patients with T2DM is not being recommended at present, such patient populations should be given general guidelines regarding exercise, food intake control, and even medicinal treatment. The extent of diagnostic and therapeutic interventions should be based on the individual's risk profile.Obesity Research & Clinical Practice 10/2012; 6(4):e270–e279. · 0.70 Impact Factor
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ABSTRACT: The relationships between home blood pressure (BP), masked hypertension defined by home BP, and integrated flow-mediated vasodilation (FMD) response remain unclear. The authors enrolled 257 patients (mean age, 63.5 years; 51% men) who had at least one cardiovascular risk factor. FMD of the brachial artery was measured with a semiautomatic edge-detection algorithm. The integrated FMD response was calculated as the area under the dilation curve during 120 seconds after deflation (FMD-AUC120 ) and the FMD magnitude as the percentage change in peak diameter (ΔFMD). Masked hypertension was defined by office BP <140/90 mm Hg and home BP ≥135 mm Hg and/or 85 mm Hg. Home systolic BP was inversely correlated with FMD-AUC120 and ΔFMD (FMD-AUC120 : r=-.23, P<.001; ΔFMD: r=-.13, P=.041), and office systolic BP was inversely associated with FMD-AUC120 (r=-.16, P=.011), but not with ΔFMD. After adjusting for covariates, home systolic BP (β=-.27, P=.003), but not office BP, was inversely associated with FMD-AUC120 , whereas ΔFMD was not associated with office or home systolic BP. FMD-AUC120 was significantly lower in patients with masked hypertension compared with those with normotension (7.7±6.7 vs 11.5±8.8 mm × s, P=.048). Home systolic BP and masked hypertension defined by home BP were associated with a decrease in FMD-AUC120 .Journal of Clinical Hypertension 09/2013; 15(9):630-6. · 2.36 Impact Factor
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ABSTRACT: To evaluate the prevalence of and characterize resistant hypertension in a large representative population with successful hypertension management and reliable health information. We performed a cross-sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system between January 1, 2006, and December 31, 2007. From individuals older than 17 years with hypertension, resistant hypertension was identified and prevalence was determined. Multivariable logistic regression was used to calculate odds ratios (ORs), with adjustments for demographic characteristics, clinical variables, and medication use. Of 470,386 hypertensive individuals, 60,327 (12.8%) were identified as having resistant disease, representing 15.3% of those taking medications. Overall, 37,061 patients (7.9%) had uncontrolled hypertension while taking 3 or more medicines. The ORs (95% CIs) for resistant hypertension were greater for black race (1.68 [1.62-1.75]), older age (1.11 [1.10-1.11] for every 5-year increase), male sex (1.06 [1.03-1.10]), and obesity (1.46 [1.42-1.51]). Medication adherence rates were higher in those with resistant hypertension (93% vs 89.8%; P<.001). Chronic kidney disease (OR, 1.84; 95% CI, 1.78-1.90), diabetes mellitus (OR, 1.58; 95% CI, 1.53-1.63), and cardiovascular disease (OR, 1.34; 95% CI, 1.30-1.39) were also associated with higher risk of resistant hypertension. In a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable with that of previous studies using more fragmented data sources. Past observations have been limited due to nonrepresentative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort, which was established using an electronic medical record-based approach, has the potential to provide a better understanding of resistant hypertension and outcomes.Mayo Clinic Proceedings 10/2013; 88(10):1099-1107. · 5.79 Impact Factor