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Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges.

Plasma glucose, insulin, and triglyceride concentration, blood pressure, and insulin action on isolated adipocytes were determined in weight-matched Sprague-Dawley, Dahl salt-resistant, and Dahl salt-sensitive rats. Blood pressure and plasma glucose concentrations were not significantly different in the three groups. However, Dahl salt-sensitive rats had significantly higher plasma insulin (39±2 microunits/ml) and triglyceride (213±11 mg/dl) concentrations than did SpragueDawley rats (27±2 microunits/ml and 101±6 mg/dl, respectively). Values for insulin (34±4 microunits/ml) and triglyceride (159 ±11 mg/dl) were intermediate in Dahl salt-resistant rats. In contrast, maximal insulin-stimulated glucose transport was significantly lower in adipocytes isolated from Dahl salt-sensitive as compared with Sprague-Dawley rats (400 ±16 versus 523 ±14 ft/cell/sec), with Dahl salt-resistant rats again having intermediate values. However, the ability of insulin to maximally inhibit catecholamine-stimulated lipolysis was similar in all three groups, averaging -20% of the activity present in the absence of insulin. All of these differences were seen when the rats were eating conventional chow and did not change in Dahl rats after 2 weeks of an 8% NaCl diet On the other hand, the predicted rise in blood pressure took place in Dahl salt-sensitive rats, increasing from 147±4 to 181 ±6 mm Hg. These data indicate that Dahl rats have higher values for plasma triglyceride and insulin concentration than control Sprague-Dawley rats, associated with a defect in insulin-stimulated glucose uptake by isolated adipocytes. These metabolic changes are not dependent on Dahl rats eating a high salt diet and do not vary as a function of salt intake. (Hypertension 1991;18:630-635) I t has recently become apparent that patients with high blood pressure tend to be hyperinsulinemic, hypertriglyceridemic, and resistant to insulinstimulated glucose uptake. -5 Similar changes have also been demonstrated in rats with spontaneous hypertension (SHR), 6 -8 as well as in normal Sprague-Dawley (S-D) rats when the cornstarch in their diet is replaced with fructose. 9 -12 Furthermore, it has been possible to show that adipocytes isolated from SHR are resistant to insulin-stimulated glucose uptake, 7 and the magnitude of this cellular defect is significantly related to the associated increases in blood pressure and plasma insulin and triglyceride concentrations.8 Because plasma triglyceride concentrations also seem to be increased in Dahl salt-sensitive (S) rats, 13 the current study was initiated to see if changes in insulin action and concentration accompany the previously noted abnormality in lipid metabolism in this genetic form of rodent hypertension. MethodsMale Dahl S and salt-resistant (R) Brookhavenderived rats were obtained from Harlan Sprague Dawley, Inc., Indianapolis, Ind., as were male control S-D rats. They were fed ad libitum with conventional rat chow (Ralston Purina Co., St. Louis, Mo.) containing 0.6% NaCl, which in some experiments was replac...