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Interplay of overweight and insulin resistance on hypertension development

Lytsy, Pera; Ingelsson, Erikb; Lind, Larsa; Ärnlöv, Johanc,d; Sundström, Johana

doi: 10.1097/HJH.0000000000000081
ORIGINAL PAPERS: Overweight and obesity

Objectives: Obesity and hypertension are associated, possibly through causal pathways involving insulin resistance and metabolic derangements. We aimed to investigate in a whites sample if overweight or obese persons without insulin resistance are at risk of developing hypertension or blood pressure progression.

Methods: In a meta-analysis, using multivariable-adjusted mixed-effects logistic regression models, we investigated the risks of hypertension development and blood pressure progression by combinations of relative weight classes and presence or absence of insulin resistance (defined as highest vs. lower three quartiles using the homeostatic model assessment method) in the Uppsala Longitudinal Study of Adult Men (n = 2322) and the Prospective Investigation of the Vasculature in Uppsala Seniors studies (n = 1066). These two samples, consisting mainly of middle-aged and elderly men, provided 1846 observations for the development of hypertension in normotensive individuals and 4223 observations for progressing to a higher blood pressure stage.

Results: During a median of 10 years of follow-up, 884 (47.9%) developed hypertension and 1639 (38.8%) progressed to a higher blood pressure stage. Overweight or obese persons without insulin resistance had an increased risk of hypertension development [odds ratio (OR) 1.46, 95% confidence interval 1.14–1.88] and blood pressure progression (OR 1.32, 1.10–1.59) compared with normal-weight persons without insulin resistance.

Conclusion: According to this study, being overweight or obese without insulin resistance increases the risk of hypertension and blood pressure progression. This adds to the evidence that overweight and obesity may be harmful per se, and that overweight and obesity without glucometabolic derangements are not benign conditions.

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aDepartment of Medical Sciences, Uppsala University

bDepartment of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University

cDepartment of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala

dDepartment of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden

Correspondence to Per Lytsy, MD, PhD, Department of Medical Sciences, Entrance 40, 5th floor, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. Tel: +46 18 6110000; fax: +46 18 509297; e-mail:

Abbreviations: AHA/NHLBI, American Heart Association/National Heart Lung and Blood Institute; HDL, high-density lipoprotein; HOMA, homeostasis model assessment; IR, insulin resistance; LDL, low-density lipoprotein; MetS, metabolic syndrome

Received 30 August, 2013

Accepted 20 November, 2013

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