Masuo K, Mikami H, Ogihara T, Tuck M L
Department of Geriatric Medicine, Osaka University Medical School, Suita City, Japan.
Hypertension. 1998 Jul;32(1):96-100. doi: 10.1161/01.hyp.32.1.96.
This study evaluated the effects of a positive family history of hypertension (FH+) on the contributions of sympathetic nervous system (SNS) activity and insulin to blood pressure elevation (BPE). The study design was longitudinal and evaluated BP, body mass index (BMI), and fasting plasma insulin and norepinephrine (NE) levels for 10 years in 557 young, nonobese Japanese men who were normotensive at entry. FH+ was defined as hypertension in first-degree relatives as verified by historical records or direct determination. BPE was defined as a > or = 10% rise in systolic and diastolic BP over entry levels during the 10-year period. In the total group FH+ was noted in 16%, and BPE occurred in 18% of normotensive subjects. When evaluated by FH, the prevalence of BPE was 33% in FH+ compared with 16% in FH- (P<0.05). BP levels were greater both at entry and at year 10 in the FH+ group. The absolute increment in plasma NE over 10 years was greater in the BPE group than in those without BPE (P<0.01). Of note, the rise in plasma NE levels in BPE individuals was identical in FH+ and FH- subjects. Plasma insulin increments were also greater in normotensive subjects with BPE than in normotensive subjects without BPE. However, compared with NE, development of hyperinsulinemia was more pronounced in the FH+ subjects. The results indicate that SNS hyperactivity may be a less genetically determined predictor of hypertension than is hyperinsulinemia. Because SNS changes in this initially normotensive population appeared more closely related to the development of hypertension than to hyperinsulinemia, environmental rather than genetic factors may be the main determinant of early BPE in nonobese normotensive subjects.
本研究评估了高血压家族史阳性（FH+）对交感神经系统（SNS）活动和胰岛素在血压升高（BPE）中所起作用的影响。研究设计为纵向研究，对557名年轻、非肥胖且入组时血压正常的日本男性进行了为期10年的血压、体重指数（BMI）、空腹血浆胰岛素和去甲肾上腺素（NE）水平评估。FH+定义为经历史记录或直接测定证实的一级亲属患有高血压。BPE定义为在10年期间收缩压和舒张压较入组水平升高≥10%。在总人群中，16%有FH+，18%的血压正常受试者出现BPE。按FH评估时，FH+组BPE的患病率为33%，而FH-组为16%（P<0.05）。FH+组在入组时和第10年时的血压水平均更高。10年期间血浆NE的绝对增量在BPE组中比无BPE组更大（P<0.01）。值得注意的是，BPE个体中血浆NE水平的升高在FH+和FH-受试者中是相同的。有BPE的血压正常受试者的血浆胰岛素增量也比无BPE的血压正常受试者更大。然而，与NE相比，高胰岛素血症在FH+受试者中更为明显。结果表明，与高胰岛素血症相比，SNS功能亢进可能是一种受遗传因素影响较小的高血压预测指标。由于在这个最初血压正常的人群中，SNS变化似乎与高血压的发生比与高胰岛素血症的关系更密切，环境因素而非遗传因素可能是非肥胖血压正常受试者早期BPE的主要决定因素。
