Prehypertension Is Associated With Insulin Resistance State and Not With an Initial Renal Function ImpairmentA Metabolic Syndrome in Active Subjects in Spain (MESYAS) Registry Substudy

Cardiology Department, Clinica Universitaria de Navarra, Pamplona, Spain.
American Journal of Hypertension (Impact Factor: 2.85). 03/2006; 19(2):189-96; discussion 197-8. DOI: 10.1016/j.amjhyper.2005.08.018
Source: PubMed


The aim of this study was to assess the prevalence of metabolic syndrome (MS) and other surrogate markers of insulin resistance, and whether these markers are better for defining the prehypertensive state than is renal dysfunction.
Data from 19,041 healthy active workers, mean age 42.2 (10.7) years, from three health insurance companies, were prospectively collected. Presence of MS, assessed according to the modified criteria of the National Cholesterol Education Program Third Adult Treatment Panel, and the ratio of triglycerides to high-density lipoprotein were considered as surrogate markers of insulin resistance. Renal function was assessed by the Modification of Diet in Renal Disease Study equation. Blood pressure was classified as normotension (NT), prehypertension (PHT), or hypertension (HT) according to the guidelines of the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
The global presence of MS was 11.8% The higher prevalence was found in subjects with hypertension (30%), followed by those with PHT (9.6%). The prevalence in normotensive subjects was very low (0.9%). The presence of MS and hypertension increased in parallel with age. Metabolic syndrome (odds ratio [OR] 4.3), obesity (OR 2.2), overweight (OR 1.7), impaired fasting glucose (OR 1.3), and elevated triglycerides to HDL ratio (OR 1.2), but no degree of renal dysfunction, were independent risk factors for the progression from NT to PHT.
Prehypertension is associated with markers of insulin resistance, assessed by the presence of MS and other surrogate markers, and not with an initial renal dysfunction. In this study, MS was found to be present in almost one third of hypertensive but asymptomatic and otherwise healthy workers.

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    • "In several multivariate analyses, high BMI was the strongest predictor of prehypertension among traditional risk factors [4,34,35]. In large populations, individuals with prehypertension are also more likely to have diabetes [5], impaired fasting glucose [4], metabolic syndrome [36], and dyslipidemia than normotensive individuals [4]. After controlling for these risk factors, some prospective studies have demonstrated prehypertension is still an independent risk factor for CVD [6-9], while others have not shown the same results [10,11]. "
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    ABSTRACT: Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity. Databases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality. Pooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (chi2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05). Prehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.
    BMC Medicine 08/2013; 11(1):177. DOI:10.1186/1741-7015-11-177 · 7.25 Impact Factor
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    • "Among the factors considered to be the main cause of increased CV risk in patients with high normal pressure there is resistance to insulin. Resistance to insulin assessed on the basis of fasting blood glucose levels and HOMA (Homeostasis Model Assessment) is about 60% more frequent in people with preHT, but after taking into account gender, it appears that only in males the relationship between insulin resistance and preHT is statistically significant [46] [47]. "
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    ABSTRACT: In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure established a definition of a new category of BP levels called 'prehypertension'(preHT) that included individuals with a systolic BP of 120-139 mm Hg or a diastolic BP of 80-89 mm Hg. Patients with preHT were considered to be at increased risk for progression to hypertension and in individuals with BP in the range 130/80 to 139/89 mmHg the risk of developing hypertension was twice as high as in subjects with lower values. Still then there has been a large debate whether the introduction of preHT was based on evidence and as a consequence, it was fully justified. It has been suggested that the term prehypertension may in many subjects create anxiety and a need for unnecessary medical visits and examinations. This group of patients is also very heterogeneous and it has been pointed out that subdividing preHT group into individuals with normal BP and high normal BP would much better correspond to the continuum of BP risk for CV disease. Finally, despite some data suggesting the potential benefits of antihypertensive therapy in patients with preHT (high normal BP), there are still no hard evidences on the outcome reduction by giving antihypertensive drugs in these individuals.
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    • "Relatively little is known about the epidemiological burden of MetS in patients with hypertension in the general population in Europe. Using ATP III criteria, European population studies suggest that the prevalence is around 8% to 13%[20-22]. The reported proportion of hypertensive patients that have MetS is wide-ranging. "
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