Background
Excess visceral adipose tissue (VAT) is considered to be a component in metabolic syndrome, an accumulation of cardiovascular risk factors that includes increased blood pressure; however, there are no previous data showing an association between increases in the VAT–subcutaneous adipose tissue (SAT) ratio and difficult-to-treat hypertension.
Methods
In 572 patients who had cardiovascular risk factors and who were under stable antihypertensive treatment, we evaluated whether the VAT–SAT ratio, as assessed by abdominal computed tomography, predicted difficult-to-treat hypertension, which we defined as an elevation of clinic blood pressure (i.e., clinic blood pressure ≥140/90 mmHg) during treatment with at least three antihypertensive drugs.
Results
In men, an elevated VAT–SAT ratio [odds ratio (OR) 1.44 per 1 SD (0.52), 95% confidence interval (CI) 1.08–1.92] and alcohol drinking habit (OR 2.16, 95% CI 1.07–4.36) were significant predictors of difficult-to-treat hypertension, independently of the presence of metabolic syndrome or the insulin level. However, when we included diuretic use in the diagnosis of difficult-to-treat hypertension (i.e., resistant hypertension), the significance of the VAT–SAT ratio disappeared (P = 0.06), and a decreased estimated glomerular filtration rate (OR 0.74 per 10 ml/min per 1.73 m2, 95% CI 0.58–0.94) and alcohol drinking habit (OR 4.31, 95% CI 1.74–10.68) were the significant predictors. In contrast, in women, the VAT–SAT ratio did not predict difficult-to-treat hypertension (P = 0.18).
Conclusion
An increased VAT–SAT ratio was associated with difficult-to-treat hypertension in men, but not with resistant hypertension, suggesting that diuretic use may partly affect the relationship between the VAT–SAT ratio and difficult-to-treat hypertension.
