HYPERINSULINEMIA, INSULIN-RESISTANCE, AND HYPERGLYCEMIA - CONTRIBUTING FACTORS IN THE PATHOGENESIS OF HYPERTENSION AND ATHEROSCLEROSIS

Subtle abnormalities of carbohydrate metabolism and overt diabetes mel litus are both associated with a substantial increase in the prevalenc e of hypertension and the accelerated development of atherosclerosis. Hypertension is also a presumed independent risk factor for atheroscle rosis, although some of the atherogenic properties of hypertension may be related to the recently recognized subtle metabolic abnormalities commonly found in persons with essential hypertension. The results of epidemiologic studies suggest that the elevated fasting and post-prand ial insulin levels that often occur in patients with essential hyperte nsion, as well as in patients with type II diabetes mellitus, are an i ndependent risk factor for atherosclerotic cardiovascular disease. Ele vated glucose levels in patients with diabetes and hypertension appear to contribute to the acceleration of atherosclerosis, perhaps through toxic effects on the vascular endothelium. Other cardiovascular risk factors that are accentuated in persons with carbohydrate intolerance and hypertension include abnormalities in platelet function, clotting factors, the fibrinolytic system, and dyslipidemia. The goals of both nonpharmacologic and pharmacologic therapy for patients with abnormal carbohydrate metabolism and hypertension are to decrease cardiovascula r risk as well as lower blood pressure.