Insulin resistance helps explain BP rise due to arterial stiffness in adolescents
Click Here to Manage Email Alerts
Reducing insulin resistance may help lower BP in adolescents and young adults, according to a study published in Frontiers in Cardiovascular Medicine.
The association between arterial stiffness and high BP in adolescents was mediated by insulin resistance but not by total fat mass, according to the study.
“We recently reported that arterial stiffness may be a strong risk factor for elevated blood pressure and insulin resistance in mostly normal-weight adolescents independent of established risk factors. A recent clinical trial aimed at lowering blood pressure by increasing physical activity and lifestyle intervention in adolescents was unsuccessful. Similarly, clinical trials on reducing arterial stiffness in adults have yielded inconclusive findings,” Andrew O. Agbaje, MD, MPH, a clinical epidemiologist with the Institute of Public Health and Clinical Nutrition at the University of Eastern Finland, told Healio. “Therefore, the current study was undertaken to shed light on the mechanism through which arterial stiffness indirectly raises blood pressure. This finding may potentially offer a pathway through which blood pressure could be lowered in the young population.”
The study included 3,764 participants (45% male) aged 17 years from the ALSPAC birth cohort in the U.K. All participants had data for arterial stiffness as determined by carotid-femoral pulse wave velocity, body composition, BP and homeostatic model assessment of insulin resistance (HOMA-IR).
Higher carotid-femoral pulse wave velocity was associated with elevated systolic and diastolic BP, independent of mediators (beta = 0.248-0.37; P for all = .002), Agbaje found.
Lean mass and HOMA-IR partly mediated the association between arterial stiffness and high systolic BP (beta for lean mass = 0.01; P = .026; 3.3% mediation; beta for HOMA-IR = 0.004; P = .033; 1.1% mediation), but total fat mass did not (beta < .0001; P = .615; 0% mediation).
The mediation data for the association between arterial stiffness and high diastolic BP were similar (beta for lean mass = –0.004; P = .021; 1.4% mediation; beta for HOMA-IR = 0.007; P = .039; 2.8% mediation; beta for total fat mass = –0.002; P = .665; 0.7% mediation).
The findings on total fat mass are “surprising because we have been inundated with recommendations to reduce obesity in order to lower blood pressure,” Agbaje told Healio. “This message may be effective for extremely obese persons and adults, but in a general population of optimal-weight adolescents with raised blood pressure, the culprit is not fat mass. We found that lowering insulin resistance may be a step toward lowering blood pressure potentially caused by higher arterial stiffness.”
Adolescents with high BP should have their insulin resistance level assessed, he said.
“This approach to concurrently managing blood pressure and incident insulin resistance could yield promising results in blood pressure reduction,” Agbaje told Healio. “Pediatricians should not focus on blood pressure reduction alone, but approach the management of blood pressure as having a metabolic component.”
Clinical trials of methods to reduce arterial stiffness in adolescents and young adults are needed, as are trials examining whether reducing insulin resistance lowers BP in that population, he said.
In addition, Agbaje told Healio, lifestyle modifications can be made to reduce insulin resistance.
“Lifestyle intervention trials have reported lower insulin resistance in the young population. Thus, increasing physical activity, reducing screen time, quitting smoking or vaping, reducing salt and sugar intake, increasing vegetable and fiber portions of diet, and having optimal daily sleep are healthy lifestyle choices that may prevent or lower insulin resistance,” he told Healio.
For more information:
Andrew O. Agbaje, MD, MPH, can be reached at andrew.agbaje@uef.fi.
Collapse
Read more about
Click Here to Manage Email Alerts