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Insulin resistance and vascular remodelling, in relation to left ventricular mass, geometry and function: an answer to LIFE?

Journal of Human Hypertension volume 17, pages 299–304 (2003)Cite this article

Many pathophysiological processes have been intimately linked to hypertension and its complications, including insulin resistance, left ventricular mass (LVM) and geometry, central vascular hypertrophy and peripheral vascular remodelling, LV systolic and diastolic function, etc. What appears to be much less certain are the (complex) inter-relations between all these diverse processes.

In elderly patients with essential hypertension and LV hypertrophy (LVH), Olsen et al1 recently reported that peripheral vascular remodelling (assessed as minimal forearm vascular resistance, MFVR), hypertrophy and low distensibility of the common carotid arteries are associated with increased systolic blood pressure (BP) but not with insulin resistance (as assessed by euglycaemic hyperinsulinaemic clamp) or hyperinsulinaemia. Their findings suggest that long-standing systolic BP load may be a far more important determinant of structural vascular changes than insulin resistance in hypertension. However, in never-treated hypertensives, insulin resistance and hyperinsulinaemia were associated with low distensibility of the common carotid arteries, independent of BP and lumen diameter; perhaps because of a direct effect of insulin on the carotid arteries, resulting in changes in collagen metabolism.1 Indeed, the subsequent publication from Olsen et al2 suggests that insulin sensitivity was unrelated not only to parameters of peripheral vascular remodelling, but also to endothelial function or microvascular rarefaction.

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References

  1. Olsen MH et al. Relative influence of insulin resistance versus blood pressure on vascular changes in longstanding hypertension. ICARUS, a LIFE sub study. Insulin Carotids US Scandinavia. J Hypertens 2000; 18: 75–81.

    Article  CAS  PubMed  Google Scholar 

  2. Olsen MH et al. A possible link between endothelial dysfunction and insulin resistance in hypertension. A LIFE substudy. Losartan Intervention for Endpoint-reduction in hypertension. Blood Pressure 2000; 9: 132–139.

    Article  CAS  PubMed  Google Scholar 

  3. Olsen MH et al. Are left ventricular mass, geometry and function related to vascular changes and/or insulin resistance in longstanding hypertension? ICARUS—a LIFE substudy. J Hum Hypertens 2003; 17: 305–311.

    Article  CAS  PubMed  Google Scholar 

  4. Koren MJ et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114: 345–352.

    Article  CAS  PubMed  Google Scholar 

  5. Verdecchia P et al. Prognostic value of left ventricular mass and geometry in systemic hypertension with left ventricular hypertrophy. Am J Cardiol 1996; 78: 197–202.

    Article  CAS  PubMed  Google Scholar 

  6. Feinstein SB, Voci P, Pizzuto F . Noninvasive surrogate markers of atherosclerosis. Am J Cardiol 2002; 89: 31C–43C.

    Article  PubMed  Google Scholar 

  7. Vaudo G et al. Arterial wall thickening at different sites and its association with left ventricular hypertrophy in newly diagnosed essential hypertension. Am J Hypertens 2000; 13: 324–331.

    Article  CAS  PubMed  Google Scholar 

  8. Schillaci G et al. Prognostic significance of left ventricular diastolic dysfunction in essential hypertension. J Am Coll Cardiol 2002; 39: 2005–2011.

    Article  PubMed  Google Scholar 

  9. Devereux RB et al. Left ventricular hypertrophy and geometric remodeling in hypertension: stimuli, functional consequences and prognostic implications. J Hypertens Suppl 1994; 12: S117–S127.

    CAS  PubMed  Google Scholar 

  10. Watanabe K et al. Effect of insulin resistance on left ventricular hypertrophy and dysfunction in essential hypertension. J Hypertens 1999; 17: 1153–1160.

    Article  CAS  PubMed  Google Scholar 

  11. Schillaci G et al. Left ventricular mass and systolic dysfunction in essential hypertension. J Hum Hypertens 2002; 16: 117–122.

    Article  CAS  PubMed  Google Scholar 

  12. Malmqvist K et al. Relationships between left ventricular mass and the renin–angiotensin system, catecholamines, insulin and leptin. J Intern Med 2002; 252: 430–439.

    Article  CAS  PubMed  Google Scholar 

  13. Olsen MH et al. Is cardiovascular remodeling in patients with essential hypertension related to more than high blood pressure? A LIFE substudy. Losartan Intervention for Endpoint-reduction in Hypertension. Am Heart J 2002; 144: 530–537.

    Article  PubMed  Google Scholar 

  14. DeFronzo RA, Ferrannini E . Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173–194.

    Article  CAS  PubMed  Google Scholar 

  15. Verdecchia P et al. Circulating insulin and insulin growth factor-1 are independent determinants of left ventricular mass and geometry in essential hypertension. Circulation 1999; 100: 1802–1807.

    Article  CAS  PubMed  Google Scholar 

  16. Devereux RB et al. Relation of insulin to left ventricular geometry and function in African American and white hypertensive adults: the HyperGEN study. Am J Hypertens 2002; 15: 1029–1035.

    Article  CAS  PubMed  Google Scholar 

  17. Jain A et al. Left ventricular diastolic function in hypertension and role of plasma glucose and insulin. Comparison with diabetic heart. Circulation 1996; 93: 1396–1402.

    Article  CAS  PubMed  Google Scholar 

  18. Jeng JR . Carotid wall thickening, left ventricular hypertrophy, and insulin resistance in patients with hypertension. Am J Hypertens 2002; 15: 422–425.

    Article  CAS  PubMed  Google Scholar 

  19. Vetta F et al. Hyperinsulinaemia, regional adipose tissue distribution and left ventricular mass in normotensive, elderly, obese subjects. Eur Heart J 1998; 19: 326–331.

    Article  CAS  PubMed  Google Scholar 

  20. Malmqvist K et al. Left ventricular mass is not related to insulin sensitivity in never-treated primary hypertension. J Hypertens 2001; 19: 311–317.

    Article  CAS  PubMed  Google Scholar 

  21. de Simone G et al. Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study. J Hypertens 2002; 20: 323–331.

    Article  CAS  PubMed  Google Scholar 

  22. Messerli FH . Cardiovascular effects of obesity and hypertension. Lancet 1982; 1: 1165–1168.

    Article  CAS  PubMed  Google Scholar 

  23. Lauer MS et al. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA 1991; 266: 231–236.

    Article  CAS  PubMed  Google Scholar 

  24. de Simone G et al. Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension 1994; 23: 600–606.

    Article  CAS  PubMed  Google Scholar 

  25. Steinberger J et al. Relation of insulin resistance and body composition to left ventricular mass in children. Am J Cardiol 2002; 90: 1177–1180.

    Article  CAS  PubMed  Google Scholar 

  26. Paternostro G et al. Insulin resistance in patients with cardiac hypertrophy. Cardiovasc Res 1999; 42: 246–253.

    Article  CAS  PubMed  Google Scholar 

  27. Olsen MH et al. Left ventricular hypertrophy is associated with reduced vasodilatory capacity in the brachial artery in patients with longstanding hypertension. A LIFE substudy. Blood Pressure 2002; 11: 285–292.

    Article  PubMed  Google Scholar 

  28. Olsen MH et al. Vasodilatory capacity and vascular structure in long-standing hypertension: a LIFE substudy. Losartan Intervention for Endpoint-reduction in hypertension. Am J Hypertens 2002; 15: 398–404.

    Article  PubMed  Google Scholar 

  29. Muiesan ML et al. Structural changes in small resistance arteries and left ventricular geometry in patients with primary and secondary hypertension. J Hypertens 2002; 20: 1439–1444.

    Article  CAS  PubMed  Google Scholar 

  30. Shigematsu Y et al. Left ventricular geometry as an independent predictor for extracardiac target organ damage in essential hypertension. Am J Hypertens 1998; 11: 1171–1177.

    Article  CAS  PubMed  Google Scholar 

  31. Olsen MH et al. The importance of changes in conduit and peripheral arteries for coronary flow reserve in patients with hypertension. A LIFE substudy. J Am Coll Cardiol 1999; 33: 279A.

    Google Scholar 

  32. Galderisi M et al. Coronary flow reserve and myocardial diastolic dysfunction in arterial hypertension. Am J Cardiol 2002; 90: 860–864.

    Article  PubMed  Google Scholar 

  33. Schafer S et al. Left ventricular remodeling impairs coronary flow reserve in hypertensive patients. J Hypertens 2002; 20: 1431–1437.

    Article  CAS  PubMed  Google Scholar 

  34. Pereira V et al. Coronary flow velocity reserve in hypertensive patients with left ventricular systolic dysfunction. Clin Cardiol 2002; 25: 95–102.

    Article  PubMed  Google Scholar 

  35. Matsumura Y et al. Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity. Heart 2002; 87: 247–251.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Pela G et al. Doppler tissue echocardiography: myocardial wall motion velocities in essential hypertension. Eur J Echocardiogr 2001; 2: 108–117.

    Article  CAS  PubMed  Google Scholar 

  37. Giorgi D et al. Ultrasonic tissue characterization and Doppler tissue imaging in the analysis of left ventricular function in essential arterial hypertension: a preliminary study. Echocardiography 2002; 19: 187–198.

    Article  PubMed  Google Scholar 

  38. Weber KT . Cardioreparation in hypertensive heart disease. Hypertension 2001; 38: 588–591.

    Article  CAS  PubMed  Google Scholar 

  39. Gavras I, Gavras H . Angiotensin II as a cardiovascular risk factor. J Hum Hypertens 2002; 16 (Suppl 2): S2–S6.

    Article  CAS  PubMed  Google Scholar 

  40. Ilercil A et al. Associations of insulin levels with left ventricular structure and function in American Indians: the strong heart study. Diabetes 2002; 51: 1543–1547.

    Article  CAS  PubMed  Google Scholar 

  41. Rheeder P et al. Insulin resistance syndrome and left ventricular mass in an elderly population (the Rotterdam Study). Am J Cardiol 1999; 84: 233–236, A9.

    Article  CAS  PubMed  Google Scholar 

  42. Lind L et al. Left ventricular hypertrophy in hypertension is associated with the insulin resistance metabolic syndrome. J Hypertens 1995; 13: 433–438.

    CAS  PubMed  Google Scholar 

  43. Costa CH et al. Serum insulin levels, 24-hour blood pressure profile, and left ventricular mass in nonobese hypertensive patients. Hypertension 1995; 26: 1085–1088.

    Article  CAS  PubMed  Google Scholar 

  44. Sasson Z et al. Insulin resistance is an important determinant of left ventricular mass in the obese. Circulation 1993; 88: 1431–1436.

    Article  CAS  PubMed  Google Scholar 

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  1. University Department of Medicine, Haemostasis, Thrombosis and Vascular Biology Unit, City Hospital, Birmingham, UK

    K W Lee & G Y H Lip

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Lee, K., Lip, G. Insulin resistance and vascular remodelling, in relation to left ventricular mass, geometry and function: an answer to LIFE?. J Hum Hypertens 17, 299–304 (2003). https://doi.org/10.1038/sj.jhh.1001561

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