title: An increased visceral-subcutaneous adipose tissue ratio is associated with difficult-to-treat hypertension in men.
abstract: BACKGROUND
  Excess visceral adipose tissue (VAT) is considered to be a component in metabolic syndrome, an accumulation of cardiovascular risk factors that includes increased blood pressure; however, there are no previous data showing an association between increases in the VAT-subcutaneous adipose tissue (SAT) ratio and difficult-to-treat hypertension.
  
  
  METHODS
  In 572 patients who had cardiovascular risk factors and who were under stable antihypertensive treatment, we evaluated whether the VAT-SAT ratio, as assessed by abdominal computed tomography, predicted difficult-to-treat hypertension, which we defined as an elevation of clinic blood pressure (i.e., clinic blood pressure >or=140/90 mmHg) during treatment with at least three antihypertensive drugs.
  
  
  RESULTS
  In men, an elevated VAT-SAT ratio [odds ratio (OR) 1.44 per 1 SD (0.52), 95% confidence interval (CI) 1.08-1.92] and alcohol drinking habit (OR 2.16, 95% CI 1.07-4.36) were significant predictors of difficult-to-treat hypertension, independently of the presence of metabolic syndrome or the insulin level. However, when we included diuretic use in the diagnosis of difficult-to-treat hypertension (i.e., resistant hypertension), the significance of the VAT-SAT ratio disappeared (P = 0.06), and a decreased estimated glomerular filtration rate (OR 0.74 per 10 ml/min per 1.73 m, 95% CI 0.58-0.94) and alcohol drinking habit (OR 4.31, 95% CI 1.74-10.68) were the significant predictors. In contrast, in women, the VAT-SAT ratio did not predict difficult-to-treat hypertension (P = 0.18).
  
  
  CONCLUSIONS
  An increased VAT-SAT ratio was associated with difficult-to-treat hypertension in men, but not with resistant hypertension, suggesting that diuretic use may partly affect the relationship between the VAT-SAT ratio and difficult-to-treat hypertension.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Ishikawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Haimoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Kazuo
authors.initials: K
authors.lastname: Eguchi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D050153:Abdominal Fat; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D050151:Subcutaneous Fat; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents