Department of Endocrinology, Hospital Universitario Insular de Gran Canaria, Av Marítima del sur 35016 Las Palmas de Gran Canaria, Spain.
J Endocrinol Invest. 2011 Dec;34(11):e409-12. doi: 10.3275/7325. Epub 2010 Oct 27.
Most studies describing an association between hypertension and an inflammatory/pro-thrombotic state do not assess insulin resistance.
To examine the association between hypertension and new cardiovascular risk factors when considering both classical risk factors and insulin resistance.
In a population-based sample of 1030 subjects, clinical information and blood samples were obtained. Subjects were classified according to the presence or absence of hypertension, and insulin resistance was estimated using the homeostasis model of assessment (HOMA). To identify variables independently associated with hypertension, a four-model multiple logistic regression was performed: model 1 included novel risk factors (Plasminogen Activator Inhibitor- 1 [PAI-1], fibrinogen, von Willebrand Factor [vWF], lipoprotein(a), homocysteine and C-reactive Protein [CRP]); model 2, novel risk factors plus HOMA; model 3 included both classical (smoking, triglycerides, HDL cholesterol, total cholesterol, waist circumference and diabetes) and novel risk factors and model 4, model 3 plus HOMA. All were adjusted for age, BMI and gender and compared using Akaike's Information Criterion (AIC).
In model 1, only PAI-1, age and BMI showed association with hypertension.When HOMA and classical risk factors were also included, PAI-1 was replaced by triglyceride, smoking and diabetes. The lowest AIC value (best adjustment) was displayed by model 4, comprising all of the variables. Only age, BMI, HOMA and smoking remained significantly associated with hypertension.
The novel cardiovascular risk factors assessed do not add information as markers of hypertension when classical risk factors or insulin resistance are included in the evaluation.
大多数描述高血压与炎症/血栓形成状态之间关联的研究都没有评估胰岛素抵抗。
当考虑到经典风险因素和胰岛素抵抗时，检查高血压与新的心血管危险因素之间的关联。
在一项基于人群的 1030 名受试者的样本中，获得了临床信息和血液样本。根据是否存在高血压对受试者进行分类，并使用稳态模型评估（HOMA）估计胰岛素抵抗。为了确定与高血压独立相关的变量，进行了四项模型多元逻辑回归：模型 1 包括新的危险因素（纤溶酶原激活物抑制剂-1 [PAI-1]、纤维蛋白原、血管性血友病因子 [vWF]、脂蛋白（a）、同型半胱氨酸和 C 反应蛋白 [CRP]）；模型 2，新的危险因素加 HOMA；模型 3 包括经典（吸烟、甘油三酯、高密度脂蛋白胆固醇、总胆固醇、腰围和糖尿病）和新的危险因素，模型 4，模型 3 加 HOMA。所有模型均根据年龄、BMI 和性别进行调整，并使用赤池信息量准则（AIC）进行比较。
在模型 1 中，只有 PAI-1、年龄和 BMI 与高血压相关。当 HOMA 和经典风险因素也包括在内时，PAI-1 被甘油三酯、吸烟和糖尿病所取代。AIC 值最低（最佳调整）的是包含所有变量的模型 4。只有年龄、BMI、HOMA 和吸烟与高血压显著相关。
当在评估中包含经典风险因素或胰岛素抵抗时，评估的新心血管危险因素不能作为高血压的标志物提供更多信息。
