Hypertension, insulin resistance and atherosclerosis.

Hypertension, in a sizable number of patients, though not all, is associated with and possibly caused by insulin resistance. The later is also associated with a cluster of other risk factors of atherosclerosis and coronary artery disease, namely, obesity, glucose intolerance with or without overt diabetes, hypercholesterolaemia, low high density lipoprotein (HDL), hypertriglyceridaemia, hypercoagulability, etc. Currently, all these disorders are together called insulin resistance syndrome (IRS) as insulin resistance is the common denominator of these abnormalities. The clinicians should identify the individuals who are at risk or already have manifestations of IRS, especially among the hypertensives, and direct their antihypertensive therapy to improve insulin sensitivity and to minimise atherosclerotic coronary heart disease.