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Five-year weight changes associate with blood pressure alterations independent of changes in serum insulin

Seven, Ekima,b; Husemoen, Lise L.N.b; Wachtell, Kristiana,c; Ibsen, Hansc,d; Linneberg, Allanb,c; Jeppesen, Jørgen L.a,c

doi: 10.1097/HJH.0000000000000317

Objective: In overweight-related hypertension, the effect of weight changes on blood pressure (BP) is believed to be mediated by insulin. To test this hypothesis, we studied 5-year changes in weight, BP, and insulin in a general population of Danish adults (n = 3443; mean age 45.7 ± 7.6 years).

Methods: We assessed the glucose–insulin metabolism by a standard oral glucose tolerance test. We divided the antihypertensive and antidiabetic medication-free participants into three groups: weight loss (n = 515), weight stable (n = 1778), and weight gain (n = 1150).

Results: Losing on average 6.5 kg body weight, the weight loss group experienced a 28.2% reduction [(95% confidence interval [CI] −31 to −25); P < 0.001] in fasting insulin and a 23.9% reduction [(95% CI −28 to −19); P < 0.001] in 2-h insulin. Gaining on average 6.4 kg, the weight gain group experienced a 12.5% increase [(95% CI 9 to 16); P < 0.001] in fasting insulin and 32.8% increase [(95% CI 28 to 38); P < 0.001] in 2-h insulin. Using linear regression adjusting for differences in sex, age, family history of hypertension, baseline BMI, SBP and DBP, lifestyle risk factors, and their 5-year changes, weight loss was associated with a decrease in SBP of −1.8 mmHg (95% CI −2.8 to −0.7), whereas weight gain with an increase in SBP of 1.9 mmHg (95% CI 1.2 to 2.6), both with P less than 0.001. Adding fasting insulin, 2-h insulin, Δfasting insulin, and Δ2-h insulin only marginally attenuated the association, and furthermore, none of the insulin variables was significantly associated with SBP or DBP (P ≥ 0.08). The results for changes in DBP were similar to SBP.

Conclusion: Five-year weight changes associate with BP alterations independent of the insulin changes.

aCardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup

bResearch Centre for Prevention and Health, Copenhagen University Hospital Glostrup, Glostrup

cFaculty of Health Sciences, University of Copenhagen, Copenhagen

dDepartment of Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark

Correspondence to Ekim Seven, MD, Research Centre for Prevention and Health, Copenhagen University Hospital Glostrup, Nordre Ringvej 57, Building 84–85, 2600 Glostrup, Denmark. Tel: +45 38633257; fax: +45 38633977; e-mail:

Abbreviations: 2HRPG, 2-h postglucose; BP, blood pressure; CI, confidence interval; HOMA-IR, homeostasis model assessment; OGTT, oral glucose tolerance test; OR, odds ratio; RTM, regression to the mean

Received 16 March, 2014

Revised 24 June, 2014

Accepted 24 June, 2014

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