Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease (G.W., X.H., X.W.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Department of Environmental Health and Engineering (J.P.B.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Hypertension. 2023 May;80(5):1092-1101. doi: 10.1161/HYPERTENSIONAHA.122.20347. Epub 2023 Mar 13.
Although insulin resistance is closely related to hypertension, the debate continues as to whether insulin resistance is a cause or a consequence of hypertension. This study investigated the associations of cord blood insulin concentration with blood pressure (BP) and hypertension in childhood and adolescence.
This study included 951 children enrolled from 1998 to 2012 and followed from birth onwards at the Boston Medical Center, Boston, MA. Cord blood insulin concentration was measured using a sandwich immunoassay. Hypertension in childhood and adolescence was defined based on the 2017 American Academy of Pediatrics Clinical Practice Guidelines.
The median (interquartile range) for cord blood insulin concentration was 12.1 (7.2-19.0) µIU/mL. The age range of BP measurements was 3 to 18 years (median, 10.6 years). Cord blood insulin concentration was positively associated with systolic and diastolic BP as well as the risk of hypertension at age 3 to 18 years. Compared with the lowest tertile of cord blood insulin concentration, the top tertile insulin concentration was associated with a 5.18 (95% CI, 1.97-8.39) percentile increase in systolic BP, 4.29 (95% CI, 1.74-6.84) percentile increase in diastolic BP, and 1.62-fold (95% CI, 1.27-2.08) higher risk of hypertension. The association between insulin and hypertension was stronger among children born preterm ( for interaction=0.048). Furthermore, preterm birth and childhood overweight or obesity enhanced the associations.
Our results suggest that elevated insulin concentration at birth plays a critical role in the early life origins of hypertension and support the hypothesis implicating insulin resistance in the etiology of hypertension.
尽管胰岛素抵抗与高血压密切相关，但关于胰岛素抵抗是高血压的原因还是结果，仍存在争议。本研究旨在探讨脐血胰岛素浓度与儿童和青少年时期血压（BP）和高血压的相关性。
本研究纳入了自 1998 年至 2012 年在波士顿医疗中心出生并持续随访的 951 名儿童。使用夹心免疫测定法测量脐血胰岛素浓度。根据 2017 年美国儿科学会临床实践指南定义儿童和青少年高血压。
脐血胰岛素浓度的中位数（四分位距）为 12.1（7.2-19.0）µIU/mL。BP 测量的年龄范围为 3 至 18 岁（中位数 10.6 岁）。脐血胰岛素浓度与收缩压和舒张压以及 3 至 18 岁时高血压的风险呈正相关。与脐血胰岛素浓度最低三分位相比，最高三分位胰岛素浓度与收缩压增加 5.18（95%CI，1.97-8.39）个百分点、舒张压增加 4.29（95%CI，1.74-6.84）个百分点和高血压风险增加 1.62 倍（95%CI，1.27-2.08）相关。胰岛素与高血压之间的关联在早产儿中更为强烈（交互作用=0.048）。此外，早产和儿童超重或肥胖增强了这些关联。
我们的结果表明，出生时升高的胰岛素浓度在高血压的早期生命起源中起着关键作用，并支持胰岛素抵抗在高血压病因学中的作用的假说。
