Plasma insulin, plasminogen activator inhibitor, and ankle-brachial systolic blood pressure ratio in overweight hypertensive subjects

Background: In hypertensive subjects, the ratio between ankle and brachial systolic blood pressure (ABI) has been shown to be an independent risk fact or for cardiovascular diseases, particularly in the elderly. Plasma insulin may be an important interconnecting factor explaining this observation. Purpose: In a population of middle-aged subjects with essential hypertensio n and moderate overweight, we identified whether the decrease in the ABI ra tio was associated with the clinical and biochemical factors involved in re sistance to insulin. Patients with diabetes and/or arteriosclerosis obliter ans of the lower limbs were excluded from the population. Subjects were or were not on antihypertensive therapy. Result: On the basis of univariate correlations, the ABI ratio was found to be significantly and negatively associated not only with the degree of abd ominal fat distribution, but also with the usual biological features of res istance to insulin: plasma triglycerides and cholesterol; plasma glucose an d insulin; and plasminogen activator inhibitor (PAI) antigen. In a multivar iate analysis in subjects with untreated hypertension, the ABI ratio was si gnificantly and negatively associated with only three variables: age, plasm a insulin and PAI antigen. In treated hypertensive subjects, only the role of age and insulin remained significant. Conclusion: Since the alterations of the ABI ratio may be considered as a m arker of the changes in the structure and function of arteries of the lower limbs, the study provides evidence that plasma insulin and PAI antigen, in dependently of the presence of significant atherosclerotic occlusive lesion s, are susceptible to alter the pressure wave transmission in conduit arter ies of the lower limbs.