Didenko V A, Simonov D V
Ter Arkh. 1999;71(1):26-31.
To analyse relationships between blood insulin concentration, renin-angiotensin-aldosteron system and clinical picture of hypertension.
Measurements of insulin, renin, aldosteron, angiotensin I, total cholesterol, HDLP cholesterol and triglycerides in the blood were made in 60 males with essential hypertension. The examination also included echo-CG, glucose tolerance test, Ketle's index estimation.
Patients suffering from essential hypertension with borderline hyperinsulinemia (insulin within 5.7-12.7 mcU/ml) were characterized by a combination of blood hypertension with a metabolic disorder (obesity or defects in carbohydrate metabolism), activation of renin-angiotensin-aldosteron system and left ventricular diastolic dysfunction. Patients with essential hypertension and marked hyperinsulinemia (insulin exceeded 12.7 mcU/ml) had manifest metabolic syndrome (hypertension, obesity, disturbance of carbohydrate metabolism and hypertriglyceridemia), hyperactivity of renin-angiotensin-aldosterone system, elevated diastolic arterial pressure, remodelling of left ventricular myocardium with development of its concentric hypertrophy and impairment of the diastolic function.
It is suggested that enhanced activity of renin-angiotensin-aldosterone system may underlie development of insulin-resistance and hyperinsulinemia. The latter plays a significant pathogenetic role in forming clinical picture of essential hypertension in insulin levels > 12.7 mcU/ml.
分析血液胰岛素浓度、肾素 - 血管紧张素 - 醛固酮系统与高血压临床表现之间的关系。
对60例原发性高血压男性患者进行血液中胰岛素、肾素、醛固酮、血管紧张素I、总胆固醇、高密度脂蛋白胆固醇和甘油三酯的测量。检查还包括超声心动图、葡萄糖耐量试验、凯特勒指数评估。
患有临界高胰岛素血症（胰岛素水平在5.7 - 12.7 mU/ml之间）的原发性高血压患者的特征为高血压合并代谢紊乱（肥胖或碳水化合物代谢缺陷）、肾素 - 血管紧张素 - 醛固酮系统激活以及左心室舒张功能障碍。患有明显高胰岛素血症（胰岛素超过12.7 mU/ml）的原发性高血压患者具有明显的代谢综合征（高血压、肥胖、碳水化合物代谢紊乱和高甘油三酯血症）、肾素 - 血管紧张素 - 醛固酮系统活性亢进、舒张压升高、左心室心肌重塑并发展为同心性肥厚以及舒张功能受损。
提示肾素 - 血管紧张素 - 醛固酮系统活性增强可能是胰岛素抵抗和高胰岛素血症发生的基础。当胰岛素水平>12.7 mU/ml时，后者在原发性高血压临床表现的形成中起重要的致病作用。
