INSULIN-RESISTANCE AND CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH ESSENTIAL-HYPERTENSION

Hyperinsulinemia or insulin resistance is suggested to play a role in the pathogenesis of hypertension and its target organ diseases. We des igned this study to evaluate the role of insulin resistance in cardiac function, cardiac hypertrophy, wall thickness of the common carotid a rtery, and endothelial function of the brachial artery in essential hy pertensive patients without diabetes mellitus. Insulin resistance was evaluated by the constant glucose infusion rate (M value) during the e uglycemic-hyperinsulinemic glucose clamp test. In correlation analysis for several indices of glucose metabolism, only M value correlated wi th left ventricular mass index (LVMI), ratio of peak velocity during a trial contraction to that during early left ventricular filling phase (E/A ratio) and intima-media complex (IMC). In stepwise regression ana lysis of various risk factors for cardiovascular diseases, only M valu e and age were dependent factors for LVMI, E/A ratio, and IMC. No indi ces of glucose metabolism or risk factors for cardiovascular diseases correlated with endothelium-dependent and -independent vasodilation. T hese results suggest that insulin resistance, but not glucose intolera nce and hyperinsulinemia, partly accelerates cardiovascular complicati ons such as left ventricular hypertrophy and wall thickening of the ca rotid artery in patients with essential hypertension. (C) 1996 America n Journal of Hypertension, Ltd.