title: Impact of visceral fat on blood pressure and insulin sensitivity in hypertensive obese women.
abstract: OBJECTIVE
  The relationship among body fat distribution, blood pressure, serum leptin levels, and insulin resistance was investigated in hypertensive obese women with central distribution of fat.
  
  
  METHODS
  We studied 74 hypertensive women (age, 49.8 +/- 7.5 years; body mass index, 39.1 +/- 5.5 kg/m(2); waist-to-hip ratio, 0.96 +/- 0.08). All patients were submitted to 24-hour blood pressure ambulatory monitoring (24h-ABPM). Abdominal ultrasonography was used to estimate the amount of visceral fat (VF). Fasting blood samples were obtained for serum leptin and insulin determinations. Insulin resistance was estimated by homeostasis model assessment insulin resistance index (HOMA-r index).
  
  
  RESULTS
  Sixty-four percent of the women were postmenopausal, and all patients showed central distribution of fat (waist-to-hip ratio > 0.85). The VF correlated with systolic 24h-ABPM values (r = 0.28, p = 0.01) and with HOMA-r index (r = 0.27; p = 0.01). VF measurement (7.5 +/- 2.3 vs. 5.9 +/- 2.2 cm, p < 0.001) and the systolic 24h-ABPM (133 +/- 14.5 vs. 126 +/- 9.8 mm Hg, p = 0.04), but not HOMA-r index, were significantly higher in the postmenopausal group (n = 48) than in the premenopausal group (n = 26). No correlations were observed between blood pressure levels and HOMA-r index, leptin, or insulin levels. In the multiple regression analysis, visceral fat, but not age, body fat mass, or HOMA-r index, correlated with the 24h-ABPM (p = 0.003).
  
  
  CONCLUSIONS
  In centrally obese hypertensive women, the accumulation of VF, more often after menopause, is associated with higher levels of blood pressure and insulin resistance. The mechanism through which VF contributes to higher blood pressure levels seems to be independent of leptin or insulin levels.
authors.affiliation: Department of Endocrinology, University of São Paulo, School of Medicine, Hospital do Rim e da Hipertensão, Brazil. ale_faria@uol.com.br
authors.forename: Alessandra Nunes
authors.initials: AN
authors.lastname: Faria
authors.forename: Fernando Flexa
authors.initials: FF
authors.lastname: Ribeiro Filho
authors.forename: Sandra Roberta
authors.initials: SR
authors.lastname: Gouveia Ferreira
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Zanella
mesh_terms: D000273:Adipose Tissue; D000328:Adult; D001794:Blood Pressure; D001823:Body Composition; D001824:Body Constitution; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000175:diagnosis; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D015228:Hypertriglyceridemia / Q000453:epidemiology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D017698:Postmenopause; D012044:Regression Analysis; D014781:Viscera
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007328:Insulin; D020738:Leptin