Fasting Insulin Level Is Positively Associated With Incidence of Hypertension Among American Young Adults: A 20-year follow-up study Full Text
Diabetes Care, Exclusive Author Commentary

Xun P et al. – Fasting serum insulin levels or hyperinsulinemia in young adulthood was positively associated with incidence of hypertension (HTN) later in life for both men and women, African Americans and Caucasians, and those with normal weight and overweight. The findings suggested that fasting insulin ascertainment may help clinicians identify those at high risk of HTN.

Methods
  • A prospective cohort of 3,413 Americans, aged 18–30 years, without HTN in 1985 (baseline) were enrolled.
  • Six follow-ups were conducted in 1987, 1990, 1992, 1995, 2000, and 2005.
  • Fasting insulin and glucose levels were assessed by a radioimmunoassay and hexokinase method, respectively.
  • Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs of incident HTN (defined as the initiation of antihypertensive medication, systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg).

Results
  • During the 20-year follow-up, 796 incident cases were identified.
  • After adjustment for potential confounders, participants in the highest quartile of insulin levels had a significantly higher incidence of HTN (HR 1.85 [95% CI 1.42–2.40]; Ptrend < 0.001) compared with those in the lowest quartile.
  • The positive association persisted in each sex/ethnicity/weight status subgroup.
  • A similar dose-response relation was observed when insulin-to-glucose ratio or homeostatic model assessment of insulin resistance was used as exposure.

We believe our study will make important additional contribution to the literature because of the following reasons: 1) A randomized placebo-controlled trial on insulin and hypertension may not be feasible, which makes the results from a well-designed prospective cohort study with relatively large sample size and long-term follow-up highly valuable; 2) blood pressure of our participants is measured by trained personnel using standardized procedures rather than self-reported, which may substantially reduce the possible measurement error in blood pressure; and 3) the participants at baseline were at their ages of 18-30, which enable us to investigate the evolution of CVD risk by following the course of blood pressure and the appearance of incident hypertension in young adulthood.

Please login or register to follow this author.
► Click here to access Full Text, PubMed, Publisher and related articles...

Your Unread Messages in Family Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Family Medicine Articles

1 Association of fat density with subclinical atherosclerosis Full Text Journal of the American Heart Association, September 19, 2014    Free full text

2 Androgen deprivation therapy for prostate cancer is associated with cardiovascular morbidity and mortality: A meta-analysis of population-based observational studies PLOS ONE, October 3, 2014    Clinical Article

3 A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients International Journal of Impotence Research: The Journal of Sexual Medicine, August 12, 2014    Clinical Article

4 Rapid and durable protection against Ebola virus with new vaccine regimens Full Text National Institute of Allergy and Infectious Disease - News, September 9, 2014    Free full text

5 Prostate health index vs percent free prostate-specific antigen for prostate cancer detection in men with “gray” prostate-specific antigen levels at first biopsy: Systematic review and meta-analysis Translational Research, The Journal of Laboratory and Clinical Medicine, October 8, 2014    Clinical Article

6 Neuroendocrine prostate cancer (NEPC) progressing from conventional prostatic adenocarcinoma: Factors associated with time to development of NEPC and survival from NEPC diagnosis-a systematic review and pooled analysis Journal of Clinical Oncology, September 22, 2014    Evidence Based Medicine    Review Article

7 Transurethral intraprostatic injection of botulinum toxin type a for the treatment of chronic prostatitis/chronic pelvic pain syndrome: Results of a prospective pilot double-blind and randomized placebo-controlled study BJU International, October 24, 2014    Clinical Article

8 Single animal to human transmission event responsible for 2014 Ebola outbreak Full Text NIH News, September 2, 2014    Free full text

9 Dutasteride plus Tamsulosin fixed-dose combination first-line therapy versus Tamsulosin Monotherapy in the treatment of benign prostatic hyperplasia: A budget impact analysis in the Greek healthcare setting Full Text BMC Urology, October 1, 2014    Free full text    Clinical Article

10 Midlife dietary vitamin D intake and subsequent performance in different cognitive domains Annals of Nutrition and Metabolism, September 16, 2014    Clinical Article

11 Thiopurines and risk of colorectal neoplasia in patients with inflammatory bowel disease: A meta-analysis Clinical Gastroenterology and Hepatology , September 26, 2014    Evidence Based Medicine

12 Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: A meta-analysis Family Practice, October 1, 2014    Evidence Based Medicine

13 Aromatherapy for stress reduction in healthy adults: A systematic review and meta-analysis of randomized clinical trials Maturitas, September 3, 2014    Evidence Based Medicine

14 The effect of bupropion XL and escitalopram on memory and functional outcomes in adults with major depressive disorder: Results from a randomized controlled trial Psychiatry Research, August 4, 2014    Clinical Article

15 A randomized controlled study to evaluate the efficacy of tamsulosin monotherapy and its combination with mirabegron on patients with overactive bladder induced by benign prostatic obstruction The Journal of Urology, October 30, 2014    Clinical Article

16 Effect of anti-inflammatory treatment on depression, depressive symptoms, and adverse effects: A systematic review and meta-analysis of randomized clinical trials JAMA Psychiatry, October 21, 2014    Evidence Based Medicine    Clinical Article

17 Effect of reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations Pain Management Nursing, October 6, 2014    Review Article

18 Daily aspirin use and prostate cancer–specific mortality in a large cohort of men with nonmetastatic prostate cancer Journal of Clinical Oncology, October 24, 2014    Clinical Article

19 Early short-term doxycycline therapy in patients with acute myocardial infarction and left ventricular dysfunction to prevent the ominous progression to adverse remodelling: The TIPTOP trial Full Text European Heart Journal, October 18, 2013    Free full text    Clinical Article

20 Urinating standing versus sitting: Position is of influence in men with prostate enlargement. A systematic review and meta-analysis PLOS ONE, August 1, 2014    Evidence Based Medicine    Review Article
Exclusive Author Commentary

Indexed Journals in Family Medicine: American Family Physician, Archives of Family Med, Annals of Family Medmore