Hyperinsulinemia. A link between hypertension obesity and glucose intolerance.

Abstract

Hypertension and glucose intolerance, determined in a random population sample (n = 2,475), showed a highly significant (P < 0.001) association from the mildest levels of both conditions, independent of the confounding effects of age, sex, obesity, and antihypertensive medications. Summary rate ratios for hypertension were 1.48 (1.18-1.87) in abnormal tolerance and 2.26 (1.69-2.84) in diabetes compared with normal tolerance. Altogether, 83.4% of the hypertensives were either glucoseintolerant or obese-both established insulin-resistant conditions. Fasting and post-load insulin levels in a representative subgroup (a = 1,241) were significantly elevated in hypertension independent of obesity, glucose intolerance, age, and antihypertensive medications. The mean increment in summed 1-and 2-h insulin levels (milliunits per liter) compared with nonobese normotensives with normal tolerance was 12 for hypertension alone, 47 for obesity alone, 52 for abnormal tolerance alone, and 124 when all three conditions were present. The prevalence of concentrations (milliequivalents per liter) of erythrocyte Na' 2 7.0, K+ < 92.5, and plasma K+ 2 4.5 in a subsample of 59 individuals with all combinations of abnormal tolerance obesity and hypertension was compared with those in 30 individuals free of these conditions. Altogether, 88.1% of the former vs. 40.0% of the latter group presented at least one of these three markers of internal cation imbalance (P < 0.001). We conclude that insulin resistance and/or hyperinsulinemia (a) are present in the majority of hypertensives, (b) constitute a common pathophysiologic feature of obesity, glucose intolerance, and hypertension, possibly explaining their ubiquitous association, and (c) may be linked to the increased peripheral vascular resistance of hypertension, which is putatively related to elevated intracellular sodium concentration.

Hypertension, hyperinsulinaemia and obesity in middle-aged Finns with impaired glucose tolerance

“…This suggested the coexistence of hypertension and glucose intolerance, which has been observed in many other studies. [1][2][3][4][5][6] An independent association of hyperinsulinaemia with hypertension has also been reported in many other studies. 5,[22][23][24][25][26] However, most of the studies have been cross-sectional, and thus the presence of hyperinsulinaemia could be a consequence of hypertension or hyperlipidaemia rather than a cause of these disorders.…”

“…This may suggest that hyperinsulinaemia is a link between hypertension and obesity and that the association of hypertension with obesity is mediated by hyperinsulinaemia. 1,5 It is concluded that an elevated fasting insulin concentration as well as an increased BMI preceded the onset of hypertension in subjects with IGT at baseline. It may suggest a causal relationship between hypertension and hyperinsulinemia.…”

“…Hypertension, obesity, and glucose intolerance (impaired glucose tolerance and non-insulin-dependent diabetes) are so commonly associated [1][2][3][4][5][6] as to suggest common pathogenic mechanisms. There is a strong belief that hyperinsulinaemia is directly linked to hypertension, 1,2 and insulin resistance has been observed among lean hypertensive patients.…”

Hyperinsulinemia induces hypertension associated with neurogenic vascular dysfunction resulting from abnormal perivascular innervations in rat mesenteric resistance arteries

“…[1][2][3] Modan et al 4 suggested that there is a relationship between insulin levels and blood pressure, and several groups have hypothesized that insulin resistance and/or hyperinsulinemia contribute to the pathogenesis of hypertension. 5,6 Thus, insulin has an important role in pathophysiological regulation of the cardiovascular system.…”

Differential blood pressure effects of oral glucose and intravenous L-arginine in healthy lean normotensive and obese hypertensive subjects

“…[10][11][12][13] Insulin resistance with compensatory hyperinsulinaemia has been observed in lean hypertensives, obese normotensives and hypertensives and in patients with type 2 diabetes mellitus. 2,[14][15][16][17][18] Infusions of insulin have been shown to increase blood pressure (BP) in rats. 19,20 In addition to insulin, glucose per se may play a role in hypertension.…”