Second Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
Am J Hypertens. 2010 May;23(5):495-500. doi: 10.1038/ajh.2010.3. Epub 2010 Jan 28.
Although insulin resistance (IR) is thought to be related to vascular dysfunction, the difference in the relationship of IR to microvasculature and macrovasculature reactivity has not yet been clarified. The present study was conducted to clarify whether the IR is more closely related to the macrovasculature reactivity (flow-mediated vasodilatation of the brachial artery induced by reactive hyperemia: FMD) or microvasculature reactivity (skin reactive hyperemia as assessed by laser Doppler flowmetry: SRH) in patients with hypertension.
In 75 consecutive hypertensive patients (61 +/- 11 years of age) without obvious cardiovascular (CV) disease and/or risk factors for CV disease other than hypertension, FMD, SRH, and homeostasis model assessment index of IR (HOMA(IR)) were measured.
No significant relationship was observed between FMD with the parameters of SRH. In the univariate linear regression analysis, HOMA(IR) showed a significant correlation with the FMD (R(2) = 0.05, P < 0.05), but not with the parameters of SRH. Multivariate linear regression analysis demonstrated a significant association between HOMA(IR) and FMD, even after adjustments for covariates, including the use of medication for hypertension. (R(2) = 0.32, beta = -0.29, P = 0.02).
The complication of IR in hypertensive patients without obvious CV disease/risk factors may be related to impaired macrovasculature rather than microvasculature reactivity, apart from the influence of antihypertensive medication on the reactivity of the vasculature and insulin sensitivity.
尽管胰岛素抵抗（IR）被认为与血管功能障碍有关，但IR 与微血管和大血管反应性的关系尚不清楚。本研究旨在阐明在高血压患者中，IR 是否与大血管反应性（肱动脉反应性充血引起的血流介导的血管扩张：FMD）或微血管反应性（激光多普勒血流仪评估的皮肤反应性充血：SRH）更密切相关。
在 75 例连续的高血压患者（61±11 岁）中，无明显心血管（CV）疾病和/或除高血压以外的 CV 疾病危险因素，测量 FMD、SRH 和胰岛素抵抗的稳态模型评估指数（HOMA（IR））。
FMD 与 SRH 的参数之间没有显著的关系。在单变量线性回归分析中，HOMA（IR）与 FMD 呈显著相关性（R²=0.05，P<0.05），但与 SRH 的参数无关。多元线性回归分析显示，即使在调整包括高血压药物治疗在内的混杂因素后，HOMA（IR）与 FMD 之间仍存在显著关联（R²=0.32，β=-0.29，P=0.02）。
在无明显 CV 疾病/危险因素的高血压患者中，IR 的并发症可能与大血管反应性受损有关，而与微血管反应性无关，除了降压药物对血管和胰岛素敏感性的反应的影响。
