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Plasma Insulin Levels and Incidence of Hypertension in African Americans and Whites
Jiang He, MD, PhD;
Michael J. Klag, MD, MPH;
Benjamin Caballero, MD, PhD;
Lawrence J. Appel, MD, MPH;
Jeanne Charleston, RN;
Paul K. Whelton, MD, MSc
Arch Intern Med. 1999;159:498-503.
Background Hyperinsulinemia may play an important role in the pathogenesis of hypertension in whites but the role of hyperinsulinemia in hypertension in African Americans is controversial.
Subjects and Methods We studied the relationship between insulin levels and subsequent incidence of hypertension in 140 African Americans and 237 whites who were initially screened for possible participation in the Trials of Hypertension Prevention, phase 1. Plasma insulin and serum glucose were measured at baseline and at a follow-up examination 7 years later. Blood pressure was measured by trained observers using a random-zero sphygmomanometer. Incident hypertension was defined as an average systolic pressure of 160 mm Hg or higher and/or diastolic pressure of 95 mm Hg or higher at a single visit and/or use of antihypertensive medication during follow-up.
Results Over the 7 years of follow-up, the incidence of hypertension was 25.7% in the African Americans and 25.3% in the whites. Baseline plasma insulin and insulin-to-glucose ratio were associated with an increased risk of hypertension in both the African Americans and the whites. After adjustment for age, sex, race, body mass, heart rate, and alcohol consumption at baseline as well as intervention assignment in the Trials of Hypertension Prevention, phase 1, a 1-SD (21 pmol/mmol) difference in baseline insulin-to-glucose ratio was associated with a 2.77 (95% confidence interval, 1.48-5.19) odds ratio of hypertension in the African Americans and a 1.69 (95% confidence interval, 1.08-2.64) odds ratio in the whites.
Conclusion These results suggest that higher plasma insulin levels are associated with an increased risk of hypertension in both African Americans and whites.
From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La (Drs He and Whelton); and the Welch Center for Prevention, Epidemiology, and Clinical Research (Drs Klag and Appel), the Departments of Medicine (Drs Klag and Appel), Epidemiology (Drs Klag and Appel and Ms Charleston), Health Policy and Management (Dr Klag), and Center for Human Nutrition (Drs Caballero and Appel), Johns Hopkins Medical Institutions, Baltimore, Md.
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