Association between a metabolic score for insulin resistance and hypertension: results from National Health and Nutrition Examination Survey 2007-2016 analyses

Abstract

Background: The Metabolic Score for Insulin Resistance (METS-IR) offers a promising and reliable non-insulin-based approach to assess insulin resistance and evaluate cardiometabolic risk. However, evidence for the association between METS-IR and hypertension was still limited.

Methods: Participants from the National Health and Nutrition Examination Survey (NHANES) database from 2007-2016 were selected for weighted multivariable regression analyses, subgroup analyses and restricted cubic spline (RCS) modeling to assess the association between the METS-IR and hypertension, as well as systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Results: This study enrolled 7,721 adults aged ≥20 years, 2,926 (34.03%) of whom was diagnosed as hypertension. After adjusting for all potential covariates, an increased METS-IR (log₂ conversion, denoted as log₂METS-IR) was independently associated with a higher prevalence of hypertension (odd ratio [OR] 3.99, 95% confidence interval [CI] 3.19~5.01). The OR for hypertension in subjects with the highest quartile of METS-IR was 3.89-fold (OR 3.89, 95% CI 3.06~4.94) higher than that in those with the lowest quartile of METS-IR. This positive correlation became more significant as METS-IR increased (p for trend < 0.001). Log₂METS-IR was significantly correlated with increase in SBP (β 6.75, 95% CI 5.65~7.85) and DBP (β 5.59, 95% CI 4.75~6.43) in a fully adjusted model. Consistent results were obtained in subgroup analyses. Hypertension, SBP and DBP all exhibited a non-linear increase with the rise in METS-IR. The minimal threshold for the beneficial association of METS-IR with hypertension, SBP and DBP were all identified to be 46.88.

Conclusion: The findings of this study revealed a significant positive association between METS-IR and hypertension among US adults, suggesting METS-IR as a potential tool for assessing hypertension risk.

Keywords: NHANES; hypertension; insulin resistance; metabolic score for insulin resistance (METS-IR); metabolic syndrome.

Figure 1

Flowchart of participant selection. NHANES, National Health and Nutrition Examination Survey. METS-IR, metabolic score for insulin resistance.

Figure 2

Subgroup analysis for the association between log₂METS-IR and hypertension, as well as SBP and DBP. (A) Hypertension; (B) SBP; (C) DBP. Except for the stratification component itself,each stratification factor was adjusted for all other variables (sex, age, race, education level, family income, smoking status, drinking status, physical activity, UA, TC, LDL-C, diabetes and CVD).

Figure 3

Examination of the dose-response relationship between log₂METS-IR and hypertension, as well as SBP and DBP by RCS model. (A) Hypertension; (B) SBP; (C) DBP. The RCS model adjusted for sex, age, race, education level, family income, smoking status, drinking status, physical activity, UA, TC, LDL-C, diabetes and CVD. Only 99% of the data is shown.