The insulin gradient phenomenon: a manifestation of the effects of body weight on blood pressure and insulin resistance.
The relationship between hyperinsulinemia and hypertension is frequently observed in overweight patients; however, population studies have not confirmed an independent association. A population study was conducted to assess whether differences in body mass index and levels of insulinemia modify cardiovascular hemodynamics and arterial pressure. In all, 322 healthy adults underwent a medical evaluation including insulin sensitivity and cardiac performance assessment with echocardiography. A direct relationship between body mass index and blood pressure (r=0.36; P<.01) was shown along with increments in fasting insulin levels. The underlying and progressive rise in insulin levels during blood pressure increase is named the insulin gradient. Left ventricular systolic indexes were significantly greater in the higher-insulin quartile. These findings suggest that body weight increases accompany a rise in systolic pressure and a drop in insulin sensitivity related to the insulin gradient. Increments in ejection fraction and cardiac output with normal total peripheral resistance are related to the blood pressure shift in these persons.
Aristizabal
Dagnovar
D
Department of Preventive Cardiology, Clínica Medellín, Medellín, Colombia. dagnovar@une.net.co
Gallo
Jaime
J
Fernández
Ricardo
R
Restrepo
Maria A
MA
Zapata
Nora
N
Correa
Monica
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001835:Body Weight / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D003105:Colombia / Q000453:epidemiology; D018618:Echocardiography, Doppler, Color; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D012016:Reference Values; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology; D055815:Young Adult
D007328:Insulin