Insulin Resistance the Hinge Between Hypertension and Type 2 Diabetes

Abstract

Epidemiological studies have documented a high incidence of diabetes in hypertensive patients.Insulin resistance is defined as a less than expected biologic response to a given concentration of the hormone and plays a pivotal role in the pathogenesis of diabetes. However, over the last decades, it became evident that insulin resistance is not merely a metabolic abnormality, but is a complex and multifaceted syndrome that can also affect blood pressure homeostasis. The dysregulation of neurohumoral and neuro-immune systems is involved in the pathophysiology of both insulin resistance and hypertension. These mechanisms induce a chronic low grade of inflammation that interferes with insulin signalling transduction. Molecular abnormalities associated with insulin resistance include the defects of insulin receptor structure, number, binding affinity, and/or signalling capacity. For instance, hyperglycaemia impairs insulin signalling through the generation of reactive oxygen species, which abrogate insulin-induced tyrosine autophosphorylation of the insulin receptor. Additional mechanisms have been described as responsible for the inhibition of insulin signalling, including proteasome-mediated degradation of insulin receptor substrate 1/2, phosphatase-mediated dephosphorylation and kinase-mediated serine/threonine phosphorylation of both insulin receptor and insulin receptor substrates. Insulin resistance plays a key role also in the pathogenesis and progression of hypertension-induced target organ damage, like left ventricular hypertrophy, atherosclerosis and chronic kidney disease. Altogether these abnormalities significantly contribute to the increase the risk of developing type 2 diabetes.

Prevalence and Patterns of Comorbidity Among Middle-Aged and Elderly People in China: A Cross-Sectional Study Based on CHARLS Data

“…The reason may be that insulin resistance (defined as the biologic response to a given concentration of the hormone is lower than expected) often occurs in patients with hypertension, which plays a key role in the pathogenesis of diabetes. 17 Hypertension (15.4%) had the highest prevalence rate among the 14 diseases investigated, and existed in a variety of comorbidity patterns, and the…”

Interaction between Autonomic Regulation, Adiposity Indexes and Metabolic Profile in Children and Adolescents with Overweight and Obesity

“…Hypertension often coexists with IR [50]. IR may contribute to increased blood pressure through several mechanisms, including the enhanced tissue angiotensin II and aldosterone activities, increased sympathetic nervous system activity and oxidative stress; the genetic predisposition for IR and hypertension could be also considered [51]. The links between autonomic indices and insulin levels and HOMA-IR could confirm the role of hyperinsulinemia in the sympathetic and vagal activity leading to hypertension [52].…”

Association Between Triglyceride-Glucose Index and Hypertension: A Meta-Analysis

“…Early identification of population at higher risk for the development of hypertension is critical to reduce the incidence of the disease and its cardiovascular complications (3). Previous studies showed that insulin resistance may be involved in the pathogenesis of hypertension via mediating low-degree systematic inflammation (4,5). Conventionally, hyperinsulinemic-euglycemic clamp test is considered as the "gold standard" method for the evaluation of insulin sensitivity (6).…”