EPIDEMIOLOGIC, PHYSIOLOGICAL, AND CLINICAL IMPLICATIONS OF HYPERTENSION AND INSULIN-RESISTANCE

Hypertension and dyslipidemia tend to cluster within individuals, and insulin resistance may be the link between these two cardiovascular di sease risk factors. However, despite a recognized association between insulin resistance and hypertension, evidence that insulin resistance elevates blood pressure is inconclusive. Insulin has an antinatriureti c effect, stimulates sympathetic nervous system activity, alters ion t ransport, and stimulates cell growth, all of which may contribute to h ypertension. Conversely, there is evidence to suggest that hypertensio n and vascular disease may contribute to insulin resistance. Clinicall y, the evaluation and therapy of hypertensive patients should address overall cardiovascular disease risk. Medications currently available f or the treatment of hypertension have various effects on insulin sensi tivity and dyslipidemia, with thiazide diuretics and beta-blockers hav ing the most detrimental effects.