title: Interplay of overweight and insulin resistance on hypertension development.
abstract: OBJECTIVE
  Obesity and hypertension are associated, possibly through causal pathways involving insulin resistance and metabolic derangements. We aimed to investigate in a whites sample if overweight or obese persons without insulin resistance are at risk of developing hypertension or blood pressure progression.
  
  
  METHODS
  In a meta-analysis, using multivariable-adjusted mixed-effects logistic regression models, we investigated the risks of hypertension development and blood pressure progression by combinations of relative weight classes and presence or absence of insulin resistance (defined as highest vs. lower three quartiles using the homeostatic model assessment method) in the Uppsala Longitudinal Study of Adult Men (n = 2322) and the Prospective Investigation of the Vasculature in Uppsala Seniors studies (n = 1066). These two samples, consisting mainly of middle-aged and elderly men, provided 1846 observations for the development of hypertension in normotensive individuals and 4223 observations for progressing to a higher blood pressure stage.
  
  
  RESULTS
  During a median of 10 years of follow-up, 884 (47.9%) developed hypertension and 1639 (38.8%) progressed to a higher blood pressure stage. Overweight or obese persons without insulin resistance had an increased risk of hypertension development [odds ratio (OR) 1.46, 95% confidence interval 1.14-1.88] and blood pressure progression (OR 1.32, 1.10-1.59) compared with normal-weight persons without insulin resistance.
  
  
  CONCLUSIONS
  According to this study, being overweight or obese without insulin resistance increases the risk of hypertension and blood pressure progression. This adds to the evidence that overweight and obesity may be harmful per se, and that overweight and obesity without glucometabolic derangements are not benign conditions.
authors.affiliation: aDepartment of Medical Sciences, Uppsala University bDepartment of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University cDepartment of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala dDepartment of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Lytsy
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome