Insulin Resistance in Systemic Hypertension: Pharmacotherapeutic Implications

Abstract

Systemic hypertension, a vascular disease with multiple origins, now is being linked to subtle abnormalities in glucose metabolism, which include insulin resistance and hyperinsulinemia. These conditions often occur together in patients with obesity, noninsulin-dependent diabetes, or both. Hyperinsulinemia and insulin resistance may cause systemic hypertension through multiple mechanisms. Insulin has a salt-retaining effect on the kidney. Also, insulin can augment catecholamine release, increase vascular sensitivity to vasoconstrictor substances, and decrease vascular sensitivity to vasodilator substances. In addition, insulin can increase production of tissue growth factors and help retain sodium and calcium in cells. Insulin resistance in patients can be treated with regular aerobic exercise, weight reduction, and a high-fiber diet. Pharmacologic approaches include hypoglycemic drugs, weight-reducing agents, and certain antihypertensive drugs that may have a favorable impact on both blood pressure and insulin resistance.

Elevated resistin levels in chronic kidney disease are associated with decreased glomerular filtration rate and inflammation, but not with insulin resistance

“…Thus, while b-blockers and thiazolidinediones appear to decrease insulin sensitivity, most (but not all) ACE inhibitors and calcium blockers appear to improve it. 46 As the majority of these patients are taking more than one class of drugs, we think that this confounder is of minor importance and will not unduly affect the reported results. Indeed, we could find no significant differences in either QUICKI or HOMA-IR between non-diabetic patients taking ACEI and those not taking ACEI.…”

Weight Loss in Overweight Adults and the Long-term Risk of Hypertension

“…In recent years, there has been a great deal of focus on the roles of hyperinsulemia and insulin resistance in the development of hypertension. [27][28][29][30] These factors may increase blood pressure in a number of ways: via an increase in circulating epinephrine or norepinephrine, increased vascular sensitivity to vasoconstrictor or vasodilator substances, enhanced sodium retention by the distal renal tubules, and other mechanisms associated with intracellular retention of free calcium or sodium (in turn, stimulating vascular smooth muscle contraction).…”

Hypertension and the Insulin Resistance Syndrome of Rats

“…A number of reviews emphasizing various aspects of the association of insulin resistance with hypertension have covered the issue until now 2,4–16 . Nevertheless, a number of issues (including the impact of existing genetic background) remain open, and a clear demarcation between rat and human studies has not always been made.…”