Sowers J R, Standley P R, Ram J L, Zemel M B, Resnick L M
Division of Endocrinology, Wayne State University, Detroit, Michigan.
Am J Hypertens. 1991 Jul;4(7 Pt 2):466S-472S. doi: 10.1093/ajh/4.7.466s.
Hypertension and diabetes are common diseases in Westernized civilizations, and in the United States, the frequency of both diseases is increasing as the society ages. Factors contributing to the high prevalence and increasing frequency of these diseases include obesity, hyperinsulinemia and insulin resistance, genetic factors, and abnormal cellular handling of calcium and other cations. Obesity is a strong early predictor for the development of hypertension as a person progresses from childhood into adult life. Important factors contributing to obesity-related hypertension likely include enhanced sympathetic nervous system activity and insulin resistance and hyperinsulinemia. Recent evidence has also shown that many nonobese adults with untreated hypertension have insulin resistance and hyperinsulinemia. This observation strongly suggests that the disease called "hypertension" is characterized by fundamental metabolic abnormalities as well as by hemodynamic abnormalities. Recent observations have shown that impaired cellular responses to insulin are associated with increased vascular smooth muscle contraction. Insulin appears to attenuate the vascular response to both receptor-mediated and voltage-mediated calcium-induced contractions. Thus, insulin resistance, and the resultant reduction in the normal attenuating effect of insulin on vascular smooth muscle responses, appear to be associated with abnormal vascular smooth muscle handling of calcium and with exaggerated vascular contraction.
高血压和糖尿病是西方文明中的常见疾病，在美国，随着社会老龄化，这两种疾病的发病率都在上升。导致这些疾病高患病率和发病率上升的因素包括肥胖、高胰岛素血症和胰岛素抵抗、遗传因素以及细胞对钙和其他阳离子的异常处理。肥胖是一个人从童年到成年过程中高血压发展的强有力早期预测指标。导致肥胖相关高血压的重要因素可能包括交感神经系统活动增强以及胰岛素抵抗和高胰岛素血症。最近的证据还表明，许多未经治疗的高血压非肥胖成年人存在胰岛素抵抗和高胰岛素血症。这一观察结果强烈表明，“高血压”这种疾病的特征是基本代谢异常以及血流动力学异常。最近的观察表明，细胞对胰岛素的反应受损与血管平滑肌收缩增加有关。胰岛素似乎能减弱血管对受体介导和电压介导的钙诱导收缩的反应。因此，胰岛素抵抗以及胰岛素对血管平滑肌反应正常减弱作用的相应降低，似乎与血管平滑肌对钙的异常处理以及血管过度收缩有关。
