Key result
In hypertensive patients with increased proximal sodium reabsorption, higher insulin resistance was associated with higher pulse wave augmentation indexes (e.g., AIxP 99.4% vs. 86.2%; P=0.007).
Why the study?
Insulin resistance and renal tubular sodium handling influence arterial structure and function and play an essential role in salt-sensitive forms of hypertension.
Observational
Absolute Event Rate: 99.4% vs 86.2%
p-value: p=0.007
In hypertensive patients with high sodium intake, insulin resistance combined with increased proximal tubular sodium reabsorption is associated with increased arterial stiffness.
Association of insulin resistance with higher augmentation index in this subgroup is hypothesis-generating; leaves open causal role and need for prospective studies.
BACKGROUND: Insulin resistance and renal tubular sodium handling influence arterial structure and function and play an essential role in salt-sensitive forms of hypertension. METHODS: In a population with prevailing sodium consumption, we assessed the relationship between cardiovascular phenotypes (peripheral and central blood pressures, elastic properties of large arteries, the left ventricular structure) and sodium handling parameters (daily urinary sodium excretion, fractional urinary lithium excretion in proximal-FELi and distal tubules), as a function of insulin sensitivity-measured by homeostasis model assessment-insulin resistance (HOMA-IR), leptin-to-adiponectin (L/A) ratio, and homeostasis model assessment-adiponectin (HOMA-AD). RESULTS: In patients with FELi below the median value (corresponding to the group with increased proximal sodium reabsorption) and higher insulin resistance as measured by HOMA-IR, pulse wave augmentation indexes were significantly higher-AIxP (99.4% vs. 86.2%; P = 0.007), AIxC1 (159.4% vs. 144.2%; P = 0.04), and AIxC2 (36.1% vs. 28.3%; P = 0.02), than in patients with lower insulin resistance. The same trend was observed in relation to L/A ratio-AIxP (98.7% vs. 87.1%; P = 0.005), AIxC1 (158.6% vs. 144.5%; P = 0.02), and AIxC2 (35.6% vs. 28.5%; P = 0.01) and HOMA-AD-AIxP (99.7% vs. 83.8%; P = 0.001), AIxC1 (160.5% vs. 140.3%; P = 0.007), and AIxC2 (36.6% vs. 26.3%; P = 0.003). Such relationships were not observed in patients with FELi above the median value. CONCLUSIONS: In the hypertensive population with prevailing sodium intake, insulin resistance and increased sodium reabsorption in proximal tubules may affect arterial wall function.
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Cwynar et al. (2019) conducted an observational in Hypertension. Higher insulin resistance and increased proximal sodium reabsorption vs. Lower insulin resistance was evaluated on Pulse wave augmentation index (AIxP) (p=0.007). In hypertensive patients with increased proximal sodium reabsorption, higher insulin resistance was associated with higher pulse wave augmentation indexes (e.g., AIxP 99.4% vs. 86.2%; P=0.007).
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