Share this Article
Jian WX, Jin J, Qin L, Fang WJ, Chen XR, Chen HB, Su Q, Xing HL
Correspondence: Prof Hui-Li Xing, dr_huilixing@126.com
ABSTRACT
Introduction Hypothyroidism and subclinical hypothyroidism may be associated with hypertension and metabolic syndrome. The aim of this study was to investigate the relationship between thyroid-stimulating hormone (TSH) and blood pressure, as well as the relationship between thyroid function and insulin resistance in middle-aged and elderly Chinese.
Methods This was a cross-sectional, community-based study. Serum TSH, fasting glucose and insulin were measured in 2,988 subjects aged 35–80 years. Logistic regression analysis was used to identify the risk factors for hypertension. Analysis of variance and multiple linear regression analysis were performed to characterise the relationship among TSH, insulin resistance and blood pressure.
Results Higher serum TSH concentration was found to be an independent risk factor for hypertension in females (odds ratio 1.4, 95% confidence interval 1.02–1.93; p-value = 0.039). The female group with subclinical hypothyroidism and high normal TSH (2.5–4.8 mIU/L) were more susceptible to high blood pressure than those with low normal TSH (0.3–2.5 mIU/L) (p-value < 0.05). After adjustment for waist-hip ratio and body mass index, neither the correlation between blood pressure and homeostasis model assessment of insulin resistance (HOMA-IR) nor the correlation between TSH and HOMA-IR were found to be significant in this study.
Conclusion This study provides evidence that both subclinical hypothyroidism and high normal TSH are independent risk factors for hypertension in middle-aged and elderly Chinese women.
Keywords: hypertension, hypothyroidism, insulin resistance, thyrotropin
Singapore Med J 2013; 54(7): 401-405; http://dx.doi.org/10.11622/smedj.2013142
REFERENCES
| 1. Danzi S, Klein I. Thyroid hormone and blood pressure regulation. Curr Hypertens Rep 2003; 5:513-20. http://dx.doi.org/10.1007/s11906-003-0060-7 | ||||
| 2. Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007; 116:1725-35. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.678326 | ||||
| 3. Asvold BO, Bjøro T, Nilsen TI, Vatten LJ. Association between blood pressure and serum thyroid-stimulating hormone concentration within the reference range: a population-based study. J Clin Endocrinol Metab 2007; 92:841-5. http://dx.doi.org/10.1210/jc.2006-2208 | ||||
| 4. Ruhla S, Weickert MO, Arafat AM, et al. A high normal TSH is associated with the metabolic syndrome. Clin Endocrinol (Oxf) 2010; 72:696-701. http://dx.doi.org/10.1111/j.1365-2265.2009.03698.x | ||||
| 5. Taddei S, Caraccio N, Virdis A, et al. Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. J Clin Endocrinol Metab 2003; 88:3731-7. http://dx.doi.org/10.1210/jc.2003-030039 | ||||
| 6. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction and blood pressure: a community-based study. Clin Endocrinol (Oxf) 2006; 65:486-91. http://dx.doi.org/10.1111/j.1365-2265.2006.02619.x | ||||
| 7. Kawamoto R, Kohara K, Tabara Y, et al. Insulin resistance and prevalence of prehypertension and hypertension among communitydwelling persons. J Atheroscler Thromb 2010; 17:148-55. http://dx.doi.org/10.5551/jat.2584 | ||||
| 8. Sung KC, Kim BJ, Kim BS, et al. In normoglycemic Koreans, insulin resistance and adipocity are independently correlated with high blood pressure. Circ J 2004; 68:898-902. http://dx.doi.org/10.1253/circj.68.898 | ||||
| 9. Boucai L, Surks MI. Reference limits of serum TSH and free T4 are significantly influenced by race and age in an urban outpatient medical practice. Clin Endocrinol (Oxf) 2009; 70:788-93. http://dx.doi.org/10.1111/j.1365-2265.2008.03390.x | ||||
| 10. Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. J Clin Endocrinol Metab 2005; 90:5483-8. http://dx.doi.org/10.1210/jc.2005-0455 | ||||
| 11. Liu D, Jiang F, Shan Z, et al. A cross-sectional survey of relationship between serum TSH level and blood pressure. J Hum Hypertens 2010; 24:134-8. http://dx.doi.org/10.1038/jhh.2009.44 | ||||
| 12. Fommei E, Iervasi G. The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab 2002; 87:1996-2000. http://dx.doi.org/10.1210/jc.87.5.1996 | ||||
| 13. Dickey RA, Wartofsky L, Feld S. Optimal thyrotropin level: normal ranges and reference intervals are not equivalent. Thyroid 2005; 15:1035-9. http://dx.doi.org/10.1089/thy.2005.15.1035 | ||||
| 14. Fernández-Real JM, López-Bermejo A, Castro A, Casamitjana R, Ricart W. Thyroid function is intrinsically linked to insulin sensitivity and endothelium-dependent vasodilation in healthy euthyroid subjects. J Clin Endocrinol Metab 2006; 91:3337-43. http://dx.doi.org/10.1210/jc.2006-0841 | ||||
| 15. Iqbal A, Figenschau Y, Jorde R. Blood pressure in relation to serum thyrotropin: The Tromsø study. J Hum Hypertens 2006; 20:932-6. http://dx.doi.org/10.1038/sj.jhh.1002091 | ||||
| 16. Gumieniak O, Hurwitz S, Perlstein TS, et al. Aggregation of high-normal thyroid-stimulating hormone in hypertensive families. J Clin Endocrinol Metab 2005; 90:5985-90. http://dx.doi.org/10.1210/jc.2005-0373 | ||||
| 17. De Pergola G, Ciampolillo A, Paolotti S, Trerotoli P, Giorgino R. Free triiodothyronine and thyroid stimulating hormone are directly associated with waist circumference, independently of insulin resistance, metabolic parameters and blood pressure in overweight and obese women. Clin Endocrinol (Oxf) 2007; 67:265-9. http://dx.doi.org/10.1111/j.1365-2265.2007.02874.x | ||||
| 18. Park HT, Cho GJ, Ahn KH, et al. Thyroid stimulating hormone is associated with metabolic syndrome in euthyroid postmenopausal women. Maturitas 2009; 62:301-5. http://dx.doi.org/10.1016/j.maturitas.2009.01.007 | ||||