Hypertension and Associated Metabolic Abnormalities — The Role of Insulin Resistance and the Sympathoadrenal System

Reaven, Gerald M.; Lithell, Hans; Landsberg, Lewis

doi:10.1056/nejm199602083340607

Cited by 1,302 publications

(816 citation statements)

References 70 publications

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“…However, to estimate whether glucose metabolism/insulin resistance affects renal arterio-arteriolosclerosis independently of hypertension seems difficult, because insulin resistance is commonly related to hypertension. 24 Indeed, in our previous study including 23 patients, there were only 2 normotensive patients with renal arterio-arteriolosclerosis. Moreover, in this study, 30 of the 48 patients had hypertension.…”

Section: Discussionmentioning

confidence: 91%

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

et al. 2010

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Hypertension has an important function in the formation of renal arterio-arteriolosclerosis. However, renal arterioarteriolosclerosis is sometimes found in biopsy specimens of normotensive patients, which indicates unknown factors may contribute to renal arterio-arteriolosclerosis. In this study, we aimed to evaluate the effects of glucose metabolism/insulin resistance on renal arterio-arteriolosclerosis. Forty-eight patients with biopsy-proven non-diabetic chronic glomerular disease were included. Renal arterio-arteriolosclerosis was evaluated as the percentage of vessels showing hyaline changes or wall thickening. We correlated renal arterio-arteriolosclerosis with clinical parameters including indices obtained by 75 g oral glucose tolerance test. Of the 48 patients, 30 had hypertension. The results of univariate analysis showed significant association of renal arterio-arteriolosclerosis with hypertension, increased serum creatinine (S-Cr), hypertriglyceridemia, increased 2-h plasma glucose (PG) and increased 2-h plasma insulin (PI). In stepwise multiple regression analysis, hypertension (b¼0.344, P¼0.009), S-Cr (b¼0.287, P¼0.03) and 2-h PG (b¼0.274, P¼0.03) were independently associated with renal arterioarteriolosclerosis. Eleven of the 30 hypertensive patients did not have renal arterio-arteriolosclerosis. The hypertensive patients with renal arterio-arteriolosclerosis showed significantly higher 2-h PG (134 ± 25 vs. 106 ± 26 mg per 100 ml, P¼0.008) and higher 2-h PI (67.7 ± 34.9 vs. 48.3 ± 30.0 lU ml À1 , P¼0.04) compared with those without renal arterio-arteriolosclerosis, but the difference in S-Cr was not significant. Postprandial hyperglycemia and hyperinsulinemia may contribute to the formation of renal arterio-arteriolosclerosis independently of hypertension.

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Section: Discussionmentioning

confidence: 91%

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

et al. 2010

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“…13 A 10% loss of the body weight was reported to independently predict a 4.3/3.8 mm Hg decrease in 24-h SBP/DBP in overweight subjects. 14 NPs 4,7,15 and insulin resistance 9 are two of the factors under research in relation to the pathogenesis of obesity-related hypertension. Both ANP and BNP are found to be effective on lowering blood pressure through their effects on natriuresis, sympathetic tonicity and renin-angiotensin-aldosterone system.…”

Section: Discussionmentioning

confidence: 99%

“…It is suggested that through boosting the sympathetic activity, increasing renal sodium and water uptake, increasing sodium potassium adenosine phosphatase activity or upregulating the angiotensin II type 1 receptors, hyperinsulinaemia may lead to hypertension. 9 Using fasting insulin levels and two simple, yet widely accepted, indices such as HOMA and QUICKI, 11,12 we defined the insulin resistant state of these obese individuals with a significant correlation to lower BNP concentrations. However, to our knowledge, there is not adequate data on the correlation of hyperinsulinaemia and/or insulin resistance and NPs.…”

Section: Discussionmentioning

confidence: 99%

“…8 Either by boosting the sympathetic activity, increasing sodium and water reabsorption or upregulating the angiotensinogen type 1 receptors, insulin resistance can lead to the inextricable component of obesity and hypertension. 9 The aim of this study is to evaluate the correlations between BNP, insulin resistance and blood pressure in the obese subjects.…”

Section: Introductionmentioning

confidence: 99%

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The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

Cikim

2007

J Hum Hypertens

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Hypertension is frequently associated with obesity and natriuretic peptide levels are reported to decrease in obese subjects. Both the lower brain natriuretic peptide (BNP) concentration and insulin resistance are suggested to be associated with hypertension. However, their involvement in obesity-related hypertension has not been clearly defined. Forty-four obese women (21 normotensive and 23 hypertensive) and 25 healthy women matched for age were included in the study. Anthropometrical parameters were determined. Serum BNP, fasting insulin and glucose concentrations, and lipid parameters were evaluated. Insulin resistance was calculated using Homeostasis Model Assessment (HOMA) and Quantative Insulin Sensitivity Check Index (QUICKI) formulations. Within the obese groups, HOMA and QUICKI reflected the increased insulin resistance in hypertensive obese subjects with a significant correlation to blood pressure. The decrease in BNP in the obese groups was in favour of the hypertensive obese subjects (31.4376.43; 26.3674.29; and 17.5173.08 pg/ ml, respectively) with a fractional statistical significance between the hypertensive obese group and the controls (P ¼ 0.047). Only for the obese hypertensive group, fasting glucose, HOMA and QUICKI were significantly correlated with BNP. Moreover, fasting plasma glucose (R 2 ¼ 0.22, P ¼ 0.007) and fasting plasma insulin (R 2 ¼ 0.39, P ¼ 0.03) were independently correlated with BNP only for the obese hypertensive group. It can be concluded that the decrease in BNP concentrations in the obese hypertensive subjects seem to be well correlated with the insulin resistance.

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“…Body of evidence support hypertension a complex disease strongly associated with dyslipidaemia and insulin resistance. 18 Hyperuricaemia has been considered an independent predictor for hypertension incidence in longitudinal cohort studies. 19,20 We have also confirmed hyperuricaemia as a predictor of cardiovascular events in a populationbased cohort study in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Ethnic variation in hypertension prevalence of women in Taiwan

Hwang

You

et al. 2008

J Hum Hypertens

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The prevalence and risk factors of hypertension vary in ethnic groups. This study aimed to estimate the hypertension prevalence and to compare risk factors associated with hypertension in women of four ethnic groups in Taiwan. The study subjects were participants in the Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia (TwSHHH) enrolled in 2002. In this analysis, only 2810 women who were at age of 20-80 years old and whose father and mother had same ethnic background (Minnan, Hakka, Aborigines or Mainland Chinese) were included. Results showed that there were significant ethnic differences in the prevalence of hypertension, obesity indices, fasting glucose, dyslipidaemia, hyperuricaemia, history of alcohol drinking and tobacco smoking and socioeconomic status. Aborigines had the highest prevalence of hypertension (28.6%) and diabetes mellitus (8.9%), whereas the Minnan group had the second highest prevalence of hypertension (19.2%) and diabetes mellitus (7.9%). Both age and central obesity were associated with an increased prevalence of hypertension except central obesity in Mainland Chinese in all four ethnic groups. Compared with the Mainland Chinese as the referent, the multivariateadjusted odds ratio (OR) (95% CI) was 1.19 (0.63-2.26), 1.92 (1.15-3.21) and 2.03 (1.00-4.12) for Hakka, Minnan and Aborigines, respectively. Elevated body mass index (X27.0 vs o24.0 kg m À2 ) and central obesity were significantly associated with hypertension showing multivariate-adjusted OR (95% CI) of 1.68 (1.18-2.38) and 1.95 (1.48-2.57), respectively. In addition, dyslipidaemia, hyperuricaemia and diabetes associated with higher OR for hypertension in Minnan women. In conclusion, there were ethnic variations in hypertension prevalence and determinants in Taiwanese women.

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Hypertension and Associated Metabolic Abnormalities — The Role of Insulin Resistance and the Sympathoadrenal System

Cited by 1,302 publications

References 70 publications

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

Ethnic variation in hypertension prevalence of women in Taiwan

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