Ribstein J, DuCailar G, Mimran A
Service de Médecine Interne et Policlinique, CHU, Hôpital Lapeyronie, Montpellier.
Presse Med. 1992 Sep 9;21(28):1318-23.
The incidence of hypertension is increased in obesity, a state associated with an insulin resistance syndrome. By using an euglycemic clamp method, Ferrannini et al. demonstrated the existence of an insulin resistance state in patients with essential hypertension. However, the body mass index of the subjects studied appeared to be slightly excessive. This abnormality has not been observed in patients with secondary hypertension. Insulin resistance is probably localized to peripheral tissues such as muscles and may be associated with other cellular abnormalities. Can insulin resistance, characterized by a raised circulating insulin concentration in the presence of normal blood glucose, be responsible for certain "modifications" associated with essential hypertension? Insulin induces sodium retention and increases the aldosterone-secreting effect of angiotensin II. These effects are likely to promote a rise in blood pressure and an increase in the sensitivity of vessels to endogenous substances. Moreover, insulin is a known growth factor and is involved in lipoprotein metabolism. If insulin resistance plays an important role in the maintenance of complications of essential hypertension, it is important that the treatments used tend to correct this anomaly. Thiazide diuretics and beta-blockers aggravate insulin resistance while angiotensin converting-enzyme inhibitors correct this condition.
肥胖人群中高血压的发病率会升高，肥胖是一种与胰岛素抵抗综合征相关的状态。通过使用正常血糖钳夹技术，费兰尼尼等人证明了原发性高血压患者存在胰岛素抵抗状态。然而，所研究对象的体重指数似乎略高。继发性高血压患者未观察到这种异常情况。胰岛素抵抗可能局限于肌肉等外周组织，并且可能与其他细胞异常有关。在血糖正常的情况下，以循环胰岛素浓度升高为特征的胰岛素抵抗是否会导致与原发性高血压相关的某些“改变”呢？胰岛素会导致钠潴留，并增强血管紧张素 II 的醛固酮分泌作用。这些作用可能会促使血压升高以及血管对内源性物质的敏感性增加。此外，胰岛素是一种已知的生长因子，并且参与脂蛋白代谢。如果胰岛素抵抗在原发性高血压并发症的维持中起重要作用，那么所用治疗方法倾向于纠正这种异常情况就很重要。噻嗪类利尿剂和β受体阻滞剂会加重胰岛素抵抗，而血管紧张素转换酶抑制剂则可纠正这种情况。
