Hypertension and its treatment influence changes in fasting nonesterified fatty acid concentrations: A link between the sympathetic nervous system and the metabolic syndrome?

In previous studies, a cross-sectional association has been described betwe en blood pressure (BP) and nonesterified fatty acid (NEFA) concentrations. The direction of causality, and thus, the mechanism explaining this relatio nship, remains uncertain. Therefore, we analyzed a prospective population-b ased cohort of 937 subjects who underwent an oral glucose tolerance test (O GTT) on two occasions separated by 4.5 years. In cross-sectional analysis, NEFA measures were correlated with systolic and diastolic BP, both at basel ine and at follow-up study. In longitudinal analysis, baseline systolic and diastolic BP predicted changes in fasting NEFA levels (both P < .01). Howe ver, baseline NEFA levels did not predict change in BP. In multivariate ana lysis, the relationship between baseline BP and change in fasting NEFA was independent of age and sex. Obesity and its interaction with BP did not exp lain this association. Absolute changes in NEFA concentrations were greater among subjects who were hypertensive at baseline compared with the normote nsive individuals. This change was greater in subjects treated with diureti cs compared with those treated with beta-adrenergic antagonists (P < .01), an observation that provides support for a role of sympathetic nervous syst em (SNS) activity in explaining the relationship between BP and NEFA concen tration. Copyright (C) 2000 by W.B. Saunders Company.