INSULIN-RESISTANCE AND HYPERTENSION

In non obese, nondiabetic patients, essential hypertension is associat ed with an insulin resistance that is peripheral in location and metab olically selective. The correlations between hyperinsulinemia, insulin resistance and blood pressure values do not prove that the relationsh ip is a causal one. Different data support this hypothesis, however, t he demonstration in humans that insulin resistance play a central role in the development of essential hypertension and coronary heart disea se is still lacking. The relative current failure of coronary heart di sease prevention in hypertensive patients may be related to the metabo lic side effects of diuretics and beta-blockers. These drugs increase insulin resistance and lipid disorders. Angiotensin-converting enzyme inhibitors and calcium antagonists do not decrease insulin sensitivity neither alter lipid profile. Angiotensin-converting enzyme inhibitors and calcium antagonists have significantly improve compliance to phar macological therapy, however their use has been associated with a dram atic cost increase and we do not yet know if they would reduce morbidi ty and mortality as well as or better than older and cheaper antihyper tensive agents. Nonpharmacological interventions are usually very effe ctive to reduce insulin resistance and the different cardiovascular ri sk factors present in most hypertensive patients. To improve patient's compliance to diet and regular exercise we have to develop new strate gies.