Hypertension Clinical Trial
Official title:
Searching for Accomplices in the Transgression of Insulin Resistance in Prehypertension: Aldosterone?
The purposes of the study are to evaluate the relative contributions of insulin resistance and renin-angiotensin-aldosterone system to blood pressure (BP) in subjects with prehypertension. This is a cross-sectional study. Anthropometric and BP measurements will be performed in 50 prehypertensive subjects. The subjects will receive a 75-g oral glucose tolerance test and a postural stimulation test for the measurements of insulin resistance, plasma rennin concentration and aldosterone level. Log (ISI0,120), an insulin sensitivity index from the oral glucose tolerance test, will be calculated. Statistical analyses will be performed to compare the degree to which aldosterone and Log (ISI0,120) predicted systolic and diastolic BP in these prehypertensive subjects.
Background: Prehypertension, a new category of blood pressure (BP) classification introduced
by The Seven Report of the Joint National Commission (JNC-7) on High BP for individuals with
systolic BP in the range of 120-139 mmHg or diastolic BP between 80-89 mmHg, is a strong
predictor for the development of hypertension. Insulin resistance (IR) is reported to be
associated with prehypertension. Activation of the renin-angiotensin-aldosterone (RAA)
system is a major player in IR and elevation of high BP.
Aim: The purposes of the study are to evaluate the interactions of IR-RAA and their relative
contributions to BP in subjects with prehypertension.
Design: This is a cross-sectional study. Methods: Anthropometric and BP measurements will be
performed in 50 prehypertensive subjects. The subjects will receive a 75-g oral glucose
tolerance test (OGTT) and a postural stimulation test for the measurements of IR, plasma
rennin concentration (PRC) and aldosterone level. The study participants will be divided
into three subgroups by tertiles of Log (ISI0,120), an insulin sensitivity index from the
OGTT. Analysis of variance (ANOVA) will be applied to compare the differences in clinical
characteristics among the three groups. Univariate analyses of general linear models will be
used to compare the differences in PRC, aldosterone, and aldosterone/rennin ratio (ARR) in
postural stimulation tests among the three subgroups, showing effects of confounding
variables including age, sex, BMI and physical inactivity scores. Repeated-measures ANOVA
will be used to assess the differences in post-challenge PRC, aldosterone, and ARR responses
in the OGTT with or without adjustments of the above covariates. Pearson and partial
correlation procedures will be used to test the correlations of PRC, aldosterone, ARR with
insulin sensitivity and BP. Multiple linear regression models will be used in an attempt to
compare the degree to which aldosterone (or ARR) and Log (ISI0,120) predicted systolic and
diastolic BP in these prehypertensive subjects.
Expected results and contributions: We hope the study can explore the contribution of the
IR-RAA interactions to BP in subjects with prehypertension.
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Observational Model: Cohort, Time Perspective: Cross-Sectional
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