(10-01-11) Glucose, insulin, and incident hypertension in the multi-ethnic study of atherosclerosis.

Levin G, Kestenbaum B, Ida Chen YD, Jacobs DR Jr, Psaty BM, Rotter JI,
Siscovick DS, de Boer IH.

Cedars-Sinai Medical Center, Los Angeles, California, USA.
Abstract
Diabetes mellitus and hypertension commonly coexist, but the nature of this
link is not well understood. The authors tested whether diabetes and higher
concentrations of fasting serum glucose and insulin are associated with
increased risk of developing incident hypertension in the community-based Multi-
Ethnic Study of Atherosclerosis. At baseline, 3,513 participants were free of
hypertension, defined as systolic blood pressure ??140 mm Hg, diastolic blood
pressure ??90 mm Hg, or use of antihypertensive medications to treat high blood
pressure. Of these, 965 participants (27%) developed incident hypertension over
4.7 years' median follow-up between 2002 and 2007. Compared with participants
with normal baseline fasting glucose, those with impaired fasting glucose and
diabetes had adjusted relative risks of hypertension of 1.16 (95% confidence
interval (CI): 0.96, 1.40) and 1.41 (95% CI: 1.17, 1.71), respectively (P =
0.0015). The adjusted relative risk of incident hypertension was 1.08 (95% CI:
1.04, 1.13) for each mmol/L higher glucose (P < 0.0001) and 1.15 (95% CI: 1.05,
1.25) for each doubling of insulin (P = 0.0016). Further adjustment for serum
cystatin C, urinary albumin/creatinine ratio, and arterial elasticity measured
by tonometry substantially reduced the magnitudes of these associations. In
conclusion, diabetes and higher concentrations of glucose and insulin may
contribute to the development of hypertension, in part through kidney disease
and arterial stiffness.

Fonte :Am J Epidemiol. 2010 Nov 15;172(10):1144-54. Epub 2010 Oct 20.

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