INSULIN-RESISTANCE IN SYSTEMIC HYPERTENSION - PHARMACOTHERAPEUTIC IMPLICATIONS

Systemic hypertension, a vascular disease with multiple origins, now i s being linked to subtle abnormalities in glucose metabolism, which in clude 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 dec rease vascular sensitivity to vasodilator substances. In addition, ins ulin can increase production of tissue growth factors and help retain sodium and calcium in cells. Insulin resistance in patients can be tre ated with regular aerobic exercise, weight reduction, and a high-fiber diet. Pharmacologic approaches include hypoglycemic drugs, weight-red ucing agents, and certain antihypertensive drugs that may have a favor able impact on both blood pressure and insulin resistance.