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(Circulation. 2005;112:1719-1727.)
© 2005 American Heart Association, Inc.

Epidemiology

Relations of Insulin Sensitivity to Longitudinal Blood Pressure Tracking

Variations With Baseline Age, Body Mass Index, and Blood Pressure

Johan Ärnlöv, MD, PhD; Michael J. Pencina, PhD; Byung-Ho Nam, PhD; James B. Meigs, MD; Caroline S. Fox, MD, MPH; Daniel Levy, MD; Ralph B. D’Agostino, MD; Ramachandran S. Vasan, MD

From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (J.Ä., M.J.P., B.H.N., C.S.F., D.L., R.B.D., R.S.V.), National Heart, Lung, and Blood Institute, Bethesda, Md (C.S.F., D.L.); the Cardiology Section (R.S.V.), Preventive Medicine and Epidemiology (D.L., R.S.V.), Department of Medicine, Boston University School of Medicine, Boston, Mass; the Mathematics Department, Boston University, Boston, Mass (M.J.P., B.H.N., R.B.D.); Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.B.M.); and the Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (J.Ä.).

Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702-5827. E-mail vasan{at}bu.edu

Received January 8, 2005; revision received May 28, 2005; accepted June 6, 2005.

Background— The relations of insulin sensitivity (IS) to hypertension incidence may vary according to baseline age, body mass index (BMI), and blood pressure (BP).

Methods and Results— We investigated the relations of IS (insulin sensitivity index, ISI_0,120) to 4-year incidence of hypertension and BP progression in 1933 nonhypertensive Framingham Study participants (median age, 51 years; 56% women). Analyses were stratified by age (less than versus greater than or equal to median), BMI (<25 [normal], 25 to <30 [overweight], 30 kg/m² [obese]), and BP category (systolic BP130 or diastolic BP85, "high normal" per the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP [JNC-VI] versus BP<130/85 mm Hg). On follow-up, 41% of participants had BP progression (1 BP stage increase) and 18% had development of hypertension (systolic BP140 or diastolic BP90 mm Hg or antihypertensive medication use). In younger (<51 years) people with normal BMI and baseline BP<130/85 mm Hg, the second-to-fourth ISI_0,120 quartiles were associated with lower multivariable-adjusted odds for hypertension incidence (0.27; 95% CI, 0.09 to 0.83; P<0.05) and BP progression (0.37; 95% CI, 0.18 to 0.77; P<0.01) relative to the lowest (most insulin resistant) quartile. IS was not related to BP progression or hypertension incidence in older individuals, in obese participants, or in people with BP130/85 mm Hg.

Conclusions— In our large community-based sample, reduced IS predicted BP tracking principally in younger people with normal BMI and BP<130/85 mm Hg. Effect modification by age, BMI, and baseline BP may explain variation in the results of prior clinical investigations relating IS to hypertension incidence.

Key Words: blood pressure • epidemiology • hypertension • insulin • obesity

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