Relation among Left Ventricular Mass, Insulin Resistance, and Blood Pressure in Nonobese Subjects

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Abstract
Because left ventricular (LV) mass (LVM) is a powerful predictor of future cardiovascular events, it is important to identify hemody- namic and nonhemodynamic factors that increase LVM. We studied the separate contribution to LVM of daily arterial blood pressure (BP) and insulin resistance in a consecutive series of 29 (mean 6 SD age, 43 6 13 yr) nonobese (body mass index, 24 6 1.8 kg/m2), nondiabetic, glucose-tolerant subjects with untreated borderline or mild hyper- tension. The insulin sensitivity index (SI) was quantitatively deter- mined from the frequently sampled iv glucose tolerance test. BP was characterized by ambulatory 24-h BP monitoring, and LVM index (LVMI) was determined by two-dimensional directed M-mode echo- cardiography. LVMI was directly related to 24-h mean BP (r 5 0.47; P 5 0.01). LMVI was also significantly related to SI (r 52 0.43; P 5 0.02). In this nonobese group, neither LVMI nor SI was related to body mass index or age. After adjustment for the influence of BP on LVMI, a significant relation remained between LVMI and SI (P , 0.05). We conclude that in nonobese subjects with high normal BP, in- sulin sensitivity is related to LVM independently of BP and may be an important modulator of LV growth. In addition to a reduction of arterial BP, optimal prevention of LV hypertrophy in hypertensives may require improved insulin sensitivity. (J Clin Endocrinol Metab 83: 4284 - 4288, 1998) A

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