Saad M F, Knowler W C, Pettitt D J, Nelson R G, Mott D M, Bennett P H
Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ 85014.
Diabetes. 1990 Nov;39(11):1430-5.
The relationships among blood pressure, obesity, glucose tolerance, and serum insulin concentration were studied in 2873 Pima Indians aged 18-92 yr (mean 37 yr). Age- and sex-adjusted to the Pima population, the prevalence of hypertension (systolic blood pressure greater than or equal to 160 mmHg, diastolic blood pressure greater than or equal to 95 mmHg, or receiving drug treatment) was 7.1% for subjects with normal glucose tolerance compared with 13.0% for subjects with impaired glucose tolerance (IGT) and 19.8% for those with non-insulin-dependent diabetes mellitus (NIDDM) (P less than 0.001). The prevalence ratio of hypertension was 1.8 (95% confidence interval [CI] 1.2-2.5) for IGT and 2.6 (95% CI 2.0-3.2) for NIDDM compared with normal glucose tolerance, controlled for age, sex, and body mass index (BMI). In logistic regression analysis, hypertension was positively related to age, male sex, BMI, glucose tolerance, and fasting but not 2-h postload serum insulin concentration. Among subjects not taking antihypertensive drugs, however, neither fasting nor 2-h postload serum insulin was significantly related to hypertension. Furthermore, in 2033 subjects receiving neither antihypertensive nor antidiabetic drugs, blood pressure was not significantly correlated to fasting insulin concentration, and 2-h postload serum insulin was negatively correlated with diastolic blood pressure. In conclusion, insulin is not significantly related to blood pressure in Pima Indians not receiving antihypertensive drugs. Higher insulin concentrations in drug-treated hypertensive patients might result from the treatment rather than contribute to the pathogenesis of hypertension. Thus, these data do not support a major role for insulin in determining the occurrence of hypertension or regulation of blood pressure in Pima Indians.
对2873名年龄在18至92岁（平均37岁）的皮马印第安人进行了血压、肥胖、糖耐量和血清胰岛素浓度之间关系的研究。根据皮马人群的年龄和性别进行调整后，糖耐量正常的受试者中高血压（收缩压大于或等于160 mmHg，舒张压大于或等于95 mmHg，或接受药物治疗）的患病率为7.1%，而糖耐量受损（IGT）的受试者为13.0%，非胰岛素依赖型糖尿病（NIDDM）患者为19.8%（P<0.001）。与糖耐量正常相比，在控制了年龄、性别和体重指数（BMI）后，IGT的高血压患病率比为1.8（95%置信区间[CI] 1.2 - 2.5），NIDDM为2.6（95% CI 2.0 - 3.2）。在逻辑回归分析中，高血压与年龄、男性、BMI、糖耐量和空腹有关，但与负荷后2小时血清胰岛素浓度无关。然而，在未服用抗高血压药物的受试者中，空腹和负荷后2小时血清胰岛素均与高血压无显著相关性。此外，在2033名既未服用抗高血压药物也未服用抗糖尿病药物的受试者中，血压与空腹胰岛素浓度无显著相关性，负荷后2小时血清胰岛素与舒张压呈负相关。总之，在未服用抗高血压药物的皮马印第安人中，胰岛素与血压无显著相关性。药物治疗的高血压患者中较高的胰岛素浓度可能是治疗的结果，而非导致高血压发病的原因。因此，这些数据不支持胰岛素在皮马印第安人高血压发生或血压调节中起主要作用。
