Cardiac autonomic function and insulin resistance for the development of hypertension: a six-year epidemiological follow-up study.
BACKGROUND AND AIMS
To explore the impact of cardiac autonomic function (CAF) and insulin resistance (IR) on incident hypertension.


METHODS AND RESULTS
In 1996, 1638 subjects finished baseline examination, which included anthropometry, blood pressures, CAF, blood biochemistry, plasma insulin, urine examination and electrocardiogram. CAF included standard deviation of normal-to-normal intervals or RR intervals (SDNN), low- and high-frequency power spectrum (LF and HF), and LF/HF ratio at supine for 5 min, the RR interval changes during lying-to-standing maneuver, and the ratio between the longest RR interval during expiration and the shortest RR interval during inspiration (E/I ratio). We used homeostasis model assessment to define beta cell function (HOMA-B) and insulin resistance (HOMA-IR). In total, 992 non-hypertensive participants completed the follow-up assessment in 2003 and 959 participants were included for the final analysis. Incident hypertension was determined by blood pressure status at follow-up. In unadjusted model, both square root of HOMA-IR (OR:3.37, 95%CI: 2.10-6.64) and HOMA-B (OR:0.996, 95%CI: 0.992-0.999) were related to incident hypertension. In multivariate model, square root of HOMA-IR (OR:1.97, 95%CI: 1.05-3.70), but not HOMA-B, was associated with incident hypertension. After further adjustment for baseline CAF, the positive relationship between the square root of HOMA-IR and incident hypertension disappeared. In contrast, LF/HF ratio (OR:1.18, 95%CI: 1.01-1.37), HF power (OR:0.98, 95%CI: 0.96-0.999), and E/I ratio (OR:0.71, 95%CI: 0.54-0.95) were each independently associated with incident hypertension after further adjustment for HOMA measures.


CONCLUSION
Sympathovagal imbalance with an apparently decreased parasympathetic tone is an important predictor of incident hypertension independent of IR.
['Wu|J S|JS|', 'Yang|Y C|YC|', 'Lu|F H|FH|', 'Lin|T S|TS|', 'Chen|J J|JJ|', 'Huang|Y H|YH|', 'Yeh|T L|TL|', 'Chang|C J|CJ|']
D000328:Adult D000368:Aged D000886:Anthropometry D001794:Blood Pressure D016021:Epidemiologic Studies D005260:Female D005500:Follow-Up Studies D006321:Heart D006801:Humans D006973:Hypertension D007333:Insulin Resistance D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D010275:Parasympathetic Nervous System D011795:Surveys and Questionnaires
Cardiac autonomic function Cardiac autonomic function Insulin resistance Insulin resistance CAF IR Incident hypertension standard deviation of normal-to-normal intervals or RR intervals SDNN LF HF E/I ratio homeostasis model assessment to define beta cell function HOMA-B HOMA-IR 30max/15min ratio a ratio between the RR intervals during expiration and inspiration a ratio between the longest RR interval around the 30th beat and the shortest RR interval around the 15th beat after standing cardiac autonomic function high frequency homeostasis model assessment for insulin resistance insulin resistance low frequency