title: Hyperinsulinemia and obese phenotype differently influence blood pressure in young normotensive patients with polycystic ovary syndrome.
abstract: To differentiate the impact of insulin levels/resistance per se from that of excess weight on blood pressure (BP) daily changes, we evaluated, using 24-h ambulatory blood pressure monitoring (ABPM), systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a cohort of young normotensive patients affected by polycystic ovary syndrome (PCOS). A cross-sectional study was performed. Fifty-four patients were studied according to (a) insulinemic state: 32 hyperinsulinemic and/or insulin-resistant (h-INS) and 22 normoinsulinemic (n-INS) patients; and (b) body mass index (BMI): 22 obese (BMI > 30) and 32 lean (18.0 < BMI < 24.9) patients. Each subject's SBP and DBP and heart rate (HR) were measured by ABPM. Supine and upright plasma renin activity (PRA), and aldosterone levels were also assayed. Patients in the h-INS group showed higher 24-h, daytime, and nighttime diastolic blood pressure (DBP), higher nighttime systolic blood pressure (SBP) levels, as well as an increased 24-h, daytime and nighttime HR, compared to both obese and lean patients in the n-INS group. In relation to BMI, only 24-h, daytime, and nighttime DBP were higher in obese than in lean patients. At variance, when both h-INS and obesity were considered, 24-h SBP and DBP were higher in h-INS obese subjects than in the other groups. In multivariate analysis, insulin (max peak), area under the curve of insulin and insulin sensitivity index was independently associated with SBP. (1) Within a normotensive range, hyperinsulinemia and/or insulin resistance influence daily BP variation more than obesity does, suggesting a pivotal role of insulin on BP control in PCOS; (2) altered insulinemic state and ABPM-derived higher nighttime BP and HR may represent early markers to identify PCOS subjects prone to high cardiovascular risk.
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy. robertomioni@libero.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mioni
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Anna Dalla
authors.initials: AD
authors.lastname: Cà
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Jenni
authors.initials: J
authors.lastname: Turra
authors.affiliation: Pediatric Endocrinology Unit - Department of Woman's and Child's Health, University of Padua, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Azzolini
authors.affiliation: Internal Medicine Unit - Civic Hospital, Bassano del Grappa (VI), Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Xamin
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bleve
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Maffei
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vettor
authors.affiliation: Clinica Medica 3 - Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallo
mesh_terms: D000293:Adolescent; D000328:Adult; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D009765:Obesity / Q000097:blood / Q000503:physiopathology*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000503:physiopathology*; D012083:Renin / Q000097:blood; D055815:Young Adult
chemical_list: D007328:Insulin; D000450:Aldosterone; D012083:Renin
keywords: Blood pressure; Heart rate; Insulin; Obesity; PCOS