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European Heart Journal 1994 15(Supplement C):78-81; doi:10.1093/eurheartj/15.suppl_C.78
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

New Aspects of Insulin Resistance in Hypertension

K. Rett, M. Wicklmayr and H. Mehnert

Institute for Diabetes Research and IIIrd Medical Department, Schwabing Hospital Munich, Germany

Correspondence: PD Dr K. Rett, IIIrd Medical Department, Schwabing Hospital, Koelner Platz 1, 80804 München Germany

Primary hypertension is a frequent polygenic disease with strong genetic and environmental components. During the last decade, evidence has been increasing that insulin resistance as a marker of increased risk for Type 2 diabetes and cardiovascular atherosclerotic disease is present not only in individuals with obesity, Type 2 diabetes and impaired glucose tolerance, but also in the majority of the hypertensive population.

Insulin resistance describes a tissue- and pathway-specific defect of glucose metabolism present in the so called ‘metabolic syndrome’. Hyperinsulinaemia compensates for insulin resistance, leading to a cluster of undesirable processes predisposing to diabetes, atheroma and, directly or indirectly, hypertension.

Candidate mechanisms whereby this metabolic syndrome might lead to hypertension include renal sodium retention, vascular hyperresponsiveness, arteriolar smooth muscle cell proliferation, altered cellular electrolyte transport and composition, stimulation of sympatho-adrenergic activity and growth promoting effects. Insulin per se does not appear to be the cause of elevated blood pressure as frequently seen in insulin-resistant states, but it may act with other factors to promote hypertension and atherosclerotic cardiovascular disease.

Key Words: Primary hypertension • hypertensive effects of insulin • integrated life style approach • primary prevention


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