*Article* **Postprandial Responses to a Standardised Meal in Hypertension: The Mediatory Role of Visceral Fat Mass**

**Panayiotis Louca 1, Sarah E. Berry 2, Kate Bermingham 1,2, Paul W. Franks 3, Jonathan Wolf 4, Tim D. Spector 1, Ana M. Valdes 5, Phil Chowienczyk 6,† and Cristina Menni 2,\*,†**


**Abstract:** Postprandial insulinaemia, triglyceridaemia and measures of inflammation are thought to be more closely associated with cardiovascular risk than fasting measures. Although hypertension is associated with altered fasting metabolism, it is unknown as to what extent postprandial lipaemic and inflammatory metabolic responses differ between hypertensive and normotensive individuals. Linear models adjusting for age, sex, body mass index (BMI), visceral fat mass (VFM) and multiple testing (false discovery rate), were used to investigate whether hypertensive cases and normotensive controls had different fasting and postprandial (in response to two standardised test meal challenges) lipaemic, glycaemic, insulinaemic, and inflammatory (glycoprotein acetylation (GlycA)) responses in 989 participants from the ZOE PREDICT-1 nutritional intervention study. Compared to normotensive controls, hypertensive individuals had significantly higher fasting and postprandial insulin, triglycerides, and markers of inflammation after adjusting for age, sex, and BMI (effect size: Beta (Standard Error) ranging from 0.17 (0.08), *<sup>p</sup>* = 0.04 for peak insulin to 0.29 (0.08), *<sup>p</sup>* = 4.4 <sup>×</sup> <sup>10</sup>−<sup>4</sup> for peak GlycA). No difference was seen for postprandial glucose. When further adjusting for VFM effects were attenuated. Causal mediation analysis suggests that 36% of the variance in postprandial insulin response and 33.8% of variance in postprandial triglyceride response were mediated by VFM. Hypertensive individuals have different postprandial insulinaemic and lipaemic responses compared to normotensive controls and this is partially mediated by visceral fat mass. Consequently, reducing VFM should be a key focus of health interventions in hypertension. **Trial registration:** The ClinicalTrials.gov registration identifier is NCT03479866.

**Keywords:** postprandial; hypertension; insulinaemia; triglyceridaemia; inflammation
