HYPERTENSION AND CARBOHYDRATE-METABOLISM ABNORMALITIES

Abnormalities of glucose, insulin, and lipoprotein metabolism are comm on in patients with hypertension. This constellation of risk factors m ay be recognized at a young ages and is, at least in part, inheritable . Insulin resistence and compensatory hyperinsulinemia may be primary events, and enhanced sympathetic activity and diminished adrenal medul lary activity could be important links between the defect in insulin a ction and the development of hypertension and the associated metabolic abnormalities. But not all hypertensive patients have insulin resiste nce. It is possible that insulin resistence, and compensatory hyperins ulinemia have major roles in the regulation of blood pressure in susce ptible subjects predisposed to hypertension by hereditary or environme ntal factors. Considerable evidence, both in experimental animal model s and in humans, points to hypertension as being of critical importanc e in the pathogenesis of severe diabetic heart disease. In diabetic hy pertensive cardiomyopathy, coronary artery disease as well as structur al and functional abnormalities are more pronounced than would be expe cted from either process alone. The hypertension increases the risk of diabetic nephropathy in non-insulin-dependent diabetic patients. Micr oalbuminuria is a powerful predictor of mortality in these patients. I t seems that angiotensin-converting-inhibitors have efficacy in postpo ning nephropathy in hypertensive non-insulin-dependent diabetic patien ts. In patients with hypertension and diabetes, additional clinical tr ials are required to identify the interventions that will most effecti vely reduce not only overall risk but also improve cardiovascular dise ase prognosis.