Saad M F, Lillioja S, Nyomba B L, Castillo C, Ferraro R, De Gregorio M, Ravussin E, Knowler W C, Bennett P H, Howard B V
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Ariz.
N Engl J Med. 1991 Mar 14;324(11):733-9. doi: 10.1056/NEJM199103143241105.
Insulin resistance and the concomitant compensatory hyperinsulinemia have been implicated in the pathogenesis of hypertension. However, reports on the relation between insulin and blood pressure are inconsistent. This study was designed to investigate the possibility of racial differences in this relation.
We studied 116 Pima Indians, 53 whites, and 42 blacks who were normotensive and did not have diabetes; the groups were comparable with respect to mean age (29, 30, and 31 years, respectively) and blood pressure (113/70, 111/68, and 113/68 mm Hg, respectively). Insulin resistance was determined by the euglycemic-hyperinsulinemic clamp technique during low-dose (40 mU per square meter of body-surface area per minute) and high-dose (400 mU per square meter per minute) insulin infusions.
The Pima Indians had higher fasting plasma insulin concentrations than the whites or blacks (176, 138, and 122 pmol per liter, respectively; P = 0.002) and lower rates of whole-body glucose disposal during both the low-dose (12.7, 17.1, and 19.5 mmol per minute; P less than 0.001) and the high-dose (38.0, 43.1, and 45.7 mmol per minute; P less than 0.001) insulin infusions. After adjustment for age, sex, body weight, and percentage of body fat, mean blood pressure (calculated as 1/3 systolic pressure + 2/3 diastolic pressure) was significantly correlated with the fasting plasma insulin concentration (r = 0.42) and the rate of glucose disposal during the low-dose (r = -0.41) and high-dose (r = -0.49) insulin infusions (P less than 0.01 for each) in whites, but not in Pima Indians (r = -0.06, -0.02, and -0.04, respectively) or blacks (r = -0.10, -0.04, and 0.02, respectively).
The relations between insulinemia, insulin resistance, and blood pressure differ among racial groups and may be mediated by mechanisms active in whites, but not in Pima Indians or blacks.
胰岛素抵抗及随之出现的代偿性高胰岛素血症与高血压的发病机制有关。然而，关于胰岛素与血压之间关系的报道并不一致。本研究旨在探讨这种关系中种族差异的可能性。
我们研究了116名皮马印第安人、53名白人和42名黑人，他们血压正常且无糖尿病；这些组在平均年龄（分别为29、30和31岁）和血压（分别为113/70、111/68和113/68 mmHg）方面具有可比性。在低剂量（每分钟每平方米体表面积40 mU）和高剂量（每分钟每平方米400 mU）胰岛素输注期间，通过正常血糖 - 高胰岛素钳夹技术测定胰岛素抵抗。
皮马印第安人的空腹血浆胰岛素浓度高于白人和黑人（分别为176、138和122 pmol/L；P = 0.002），并且在低剂量（每分钟12.7、17.1和19.5 mmol；P < 0.001）和高剂量（每分钟38.0、43.1和45.7 mmol；P < 0.001）胰岛素输注期间全身葡萄糖处置率较低。在调整年龄、性别、体重和体脂百分比后，白人的平均血压（计算为1/3收缩压 + 2/3舒张压）与空腹血浆胰岛素浓度（r = 0.42）以及低剂量（r = -0.41）和高剂量（r = -0.49）胰岛素输注期间的葡萄糖处置率显著相关（每项P < 0.01），但在皮马印第安人（分别为r = -0.06、-0.02和-0.04）或黑人（分别为r = -0.10、-0.04和0.02）中则不然。
种族群体之间胰岛素血症、胰岛素抵抗和血压之间的关系存在差异，可能由在白人中起作用但在皮马印第安人或黑人中不起作用的机制介导。
