Abstract Body: Background: Early-onset hypertension is linked to higher risk of hypertensive organ damage compared to late-onset hypertension. Insulin resistance has been shown to be associated with greater risk of hypertension. Greater triglyceride-to-high density lipoprotein cholesterol ratio (TG/HDL-C), a surrogate marker of insulin resistance, has been linked to higher risk of hypertension. However, whether elevated long-term TG/HDL-C variability from childhood is associated with higher risk of early-onset hypertension is unclear.
Methods: We studied 1271 participants of the Bogalusa Heart Study (age at enrollment: 9.9 ± 4.0 years, follow-up : 38.3 ± 3.8 years, age at last exam: 48.2 ± 5.2 years, 59.5% women, 34.4% Black participants) with ≥3 lipid measurements during follow-up. TG/HDL-C was obtained as TG (mg/dL) divided by HDL-C (mg/dL). Onset of hypertension was defined as blood pressure ≥140/90 mmHg or taking antihypertensive medications detected during follow-up. According to age at onset of hypertension, 4 subgroups were formed: <35 years (early-onset hypertension), 35-44 years, ≥45 years, and people without hypertension. Long-term TG/HDL-C variability from childhood was calculated as the deviation from age predicted values (DEV) and residual SD (RSD). DEV and RSD were obtained from the growth curves derived from linear mixed effect models, as the mean and SD of the residuals of observed and predicted TG/HDL-C levels. Associations between TG/HDL-C variability and hypertension onset subgroups were evaluated using multinomial logistic regression models. People who did not have hypertension during follow-up were the reference group. Interactions by race and sex were performed.
Results: Among the 1271 participants, 585 (46.0%) had hypertension at last exam; among the 585, 124 (21.2%) had early-onset hypertension. For 1 SD increase in DEV and RSD of TG/HDL-C, the odds of early-onset hypertension increased by 30.6% (95% CI 1.06, 1.61) and 28.8% (95% CI 1.06,1.57), compared to people without hypertension, after adjusting for race, sex, diabetes, obesity, and smoking status, education, and TG/HDL-C at last exam. No significant associations were observed between DEV and RSD of TG/HDL-C and other hypertension onset subgroups. No significant interactions were found between both DEV and RSD and race and sex.
Conclusions: Our results suggest that individuals with higher long-term variability in insulin resistance may be at a greater risk of having early-onset hypertension.