Abstract
BackgroundTo examine the association between changes in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin-glucose ratio (IGR) levels, over approximately 3 years with incident hypertension.MethodsA total of 2814 Iranian participants (1123 men) without hypertension and known diabetes at baseline and the first examination were followed for a median of 6.32 years. The associations between quartiles of changes in fasting insulin and IR indices with incident hypertension were assessed using multivariate Cox proportional hazard regression analyses with first quartile as reference. The models were adjusted for baseline values of insulin or each IR index, and age, sex, smoking, physical activity, educational levels, marital status, history of cardiovascular diseases, baseline levels of systolic and diastolic blood pressures, estimated glomerular filtration rate, triglycerides, total cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose (only for insulin change) and both body mass index (BMI) per se, and its change. Akaike’s information criteria (AIC) was applied as indicator for goodness of fit of each predictive model. The discrimination ability of models was calculated using the Harrell’s C statistic.ResultsDuring the study, 594 incident cases of hypertension (253 men) were identified. The 4th quartile of changes in insulin, HOMA-IR, and IGR showed hazard ratios (95% confidence interval) of 1.31 (1.01–1.69), 1.18 (0.92–1.52), and 1.53 (1.18–1.98) for hypertension, respectively, in fully-adjusted models. Changes in fasting insulin levels and IR indices showed significant increasing trends for incident hypertension, moving from 1st to 4th quartiles (all P-values < 0.05). Focusing on model fitness, no superiority was found between changes in fasting insulin, HOMA-IR, and IGR to predict incident hypertension. The discriminatory powers of changes in fasting insulin and IR indices as assessed by C index were similar (i.e. about 80%).ConclusionChanges in fasting insulin and IR indices were significantly associated with developing hypertension among normotensive population even after considering BMI changes.
Highlights
Hypertension as a leading cause of cardiovascular morbidity and mortality, remains a persistent public health challenge due to its high prevalence rate worldwide [1]
Considering the high incidence of both Insulin resistance (IR) and hypertension among Iranian population [21], in the current study we aimed to examine the association of changes in levels of fasting insulin and IR indices including homeostasis model assessment of insulin resistance (HOMA-IR) and insulin-glucose ratio (IGR) over approximately 3 years with incident hypertension in an adult Middle-Eastern population
systolic blood pressure (SBP), diastolic blood pressure (DBP), and Fasting plasma glucose (FPG) over 3 years have been summarized in Table 2, by quartiles of HOMA-IR changes and in Additional files 3 and 4: Tables S3 and S4, according to quartiles of insulin and IGR changes, as well
Summary
Hypertension as a leading cause of cardiovascular morbidity and mortality, remains a persistent public health challenge due to its high prevalence rate worldwide [1]. Several methods have been proposed for assessment of IR in humans; among these, the homeostasis model assessment of insulin resistance (HOMA-IR) index is the most well-known [6]. In a meta-analysis study, showed elevated fasting insulin concentrations and IR were independently correlated with an exacerbated risk of hypertension in the general population [16]. The positive association of baseline fasting insulin, HOMA-IR, and insulin-glucose ratio (IGR) with incident hypertension among an Iranian population has been previously reported [17]. To examine the association between changes in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin-glucose ratio (IGR) levels, over approximately 3 years with incident hypertension
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