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Hyperinsulinemia and obese phenotype differently influence blood pressure in young normotensive patients with polycystic ovary syndrome

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Abstract

To differentiate the impact of insulin levels/resistance per se from that of excess weight on blood pressure (BP) daily changes, we evaluated, using 24-h ambulatory blood pressure monitoring (ABPM), systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a cohort of young normotensive patients affected by polycystic ovary syndrome (PCOS). A cross-sectional study was performed. Fifty-four patients were studied according to (a) insulinemic state: 32 hyperinsulinemic and/or insulin-resistant (h-INS) and 22 normoinsulinemic (n-INS) patients; and (b) body mass index (BMI): 22 obese (BMI > 30) and 32 lean (18.0 < BMI < 24.9) patients. Each subject’s SBP and DBP and heart rate (HR) were measured by ABPM. Supine and upright plasma renin activity (PRA), and aldosterone levels were also assayed. Patients in the h-INS group showed higher 24-h, daytime, and nighttime diastolic blood pressure (DBP), higher nighttime systolic blood pressure (SBP) levels, as well as an increased 24-h, daytime and nighttime HR, compared to both obese and lean patients in the n-INS group. In relation to BMI, only 24-h, daytime, and nighttime DBP were higher in obese than in lean patients. At variance, when both h-INS and obesity were considered, 24-h SBP and DBP were higher in h-INS obese subjects than in the other groups. In multivariate analysis, insulin (max peak), area under the curve of insulin and insulin sensitivity index was independently associated with SBP. (1) Within a normotensive range, hyperinsulinemia and/or insulin resistance influence daily BP variation more than obesity does, suggesting a pivotal role of insulin on BP control in PCOS; (2) altered insulinemic state and ABPM-derived higher nighttime BP and HR may represent early markers to identify PCOS subjects prone to high cardiovascular risk.

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Acknowledgments

We kindly thank Mrs Barbara Martin, Mrs Mariangela Auleta, Mrs Sonia Leandri, and Mr Flaviano Favaro for their expert nursing and technical assistance.

Author contribution

All authors cited in the manuscript have provided a substantial contribution. Roberto Mioni: project authorship and promotion and data interpretation, Anna Dalla Cà: data collection and acquisition, Sara Azzolini: data collection and acquisition, Nadia Xamin: data collection and acquisition, Jenni Turra: technical and laboratory determinations and data collection, Luigi Bleve: data elaboration and statistical analysis, Pietro Maffei: data interpretation and statistical analysis, Franco Fallo: data interpretation and substantial intellectual contribution, Roberto Vettor—Head of Department: data interpretation, substantial intellectual contribution, and final article revision.

Funding

This research was partially supported by a Grant (N. A00000D150 SICDE PPR/08) of the University of Padua to Prof. Roberto Vettor.

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Authors and Affiliations

  1. Clinica Medica 3 – Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128, Padua, Italy

    Roberto Mioni, Anna Dalla Cà, Jenni Turra, Luigi Bleve, Pietro Maffei, Roberto Vettor & Francesco Fallo

  2. Pediatric Endocrinology Unit – Department of Woman’s and Child’s Health, University of Padua, Padua, Italy

    Sara Azzolini

  3. Internal Medicine Unit – Civic Hospital, Bassano del Grappa (VI), Italy

    Nadia Xamin

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  1. Roberto Mioni
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  2. Anna Dalla Cà
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Correspondence to Roberto Mioni.

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Mioni, R., Cà, A.D., Turra, J. et al. Hyperinsulinemia and obese phenotype differently influence blood pressure in young normotensive patients with polycystic ovary syndrome. Endocrine 55, 625–634 (2017). https://doi.org/10.1007/s12020-016-0958-x

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