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(Circulation. 1999;100:1802-1807.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Circulating Insulin and Insulin Growth Factor-1 Are Independent Determinants of Left Ventricular Mass and Geometry in Essential Hypertension

Presented in part at the 68th Scientific Sessions of the American Heart Association, Anaheim, Calif, November 13–16, 1995, and published in abstract form (Circulation. 1995;92[suppl I]:I-154).

Paolo Verdecchia, MD; Gianpaolo Reboldi, MD, MSc, PhD; Giuseppe Schillaci, MD; Claudia Borgioni, MD; Antonella Ciucci, MD; Maria Pia Telera, MD; Fausto Santeusanio, MD; Carlo Porcellati, MD; Paolo Brunetti, MD

From the Ospedale Generale Regionale Raffaello Silvestrini, Unità Operativa di Malattie Cardiovascolari, Perugia (P.V., C.B., A.C., M.P.T., C.P.); Ospedale Beato G. Villa, Città della Pieve (G.S.); and Dipartmento di Medicina Interna e Scienze Endocrine e Metaboliche, Università di Perugia (G.R., F.S., P.B.), Italy.

Correspondence to Dr Paolo Verdecchia, Ospedale R. Silvestrini, Dipartimento di Discipline Cardiovascolari, Località Ponte della Pietra, 06156 Perugia PG, Italy. E-mail verdec{at}tin.it

Background—It is unclear whether insulin and insulin-like growth factor-1 (IGF-1) are independent determinants of left ventricular (LV) mass in essential hypertension.

Methods and Results—We studied 101 never-treated nondiabetic subjects with essential hypertension. All had 24-hour noninvasive ambulatory blood pressure (ABP) monitoring and a 75-g oral glucose tolerance test. We determined fasting glucose, insulin, and IGF-1 and postload glucose and insulin 2 hours after glucose. Insulin resistance was estimated by the homeostasis model assessment (HOMA_IR) formula. LV mass showed an association with body mass index (BMI) (r=0.47; P<0.01), postload insulin (r=0.54; P<0.01), HOMA_IR (r=0.39; P<0.01), and IGF-1 (r=0.43; P<0.01) and a weaker association with average 24-hour systolic and diastolic ABPs (r=0.29 and r=0.26; P<0.05) and basal insulin (r=0.31; P<0.05). Relative wall thickness was positively related to IGF-1 (r=0.39; P<0.01) but not to fasting or 2-hour postload insulin, HOMA_IR, and glucose. In a multiple regression analysis, the final LV mass model (R²=0.64) included IGF-1, postload insulin, average 24-hour systolic ABP, sex, and BMI. IGF-1 and postload insulin accounted for >40% of variability of LV mass. The final model (R²=0.36) for relative wall thickness included IGF-1 (16% total explained variability), average 24-hour systolic ABP, sex, BMI, and age but not insulin and HOMA_IR.

Conclusions—These data indicate that insulin and IGF-1 are powerful independent determinants of LV mass and geometry in untreated subjects with essential hypertension and normal glucose tolerance.

Key Words: hypertension • hypertrophy • echocardiography • insulin • growth substances

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