Žižek B, Žižek D, Bedenčič K, Jerin A, Poredoš P
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Int Angiol. 2013 Aug;32(4):386-93.
Essential hypertension (EH) is often accompanied by hyperinsulinemia/insulin resistance (IR) and deranged adiponectin secretion. IR may in turn be associated with endothelial dysfunction and increased levels of asymmetric dimethylarginine (ADMA). Therefore, we aimed to determine metabolic abnormalities in normotensive offspring of subjects with essential hypertension (familial trait-FT) and to examine their relations to endothelium-dependent vasodilation of the brachial artery (BA).
We included 77 subjects, 38 were normotensive individuals with FT aged 28-39 (mean 33) years and 39 age-matched Controls without FT. Insulin, adiponectin and ADMA plasma levels were determined by radioimmunoassay. Using high-resolution ultrasound, BA diameters at rest and during reactive hyperemia (flow-mediated dilation-FMD) were measured.
Subjects with FT had higher insulin and lower adiponectin levels than controls (13.65±6.70 vs. 7.09±2.20 mE/L; P<0.001 and 13.60±5.98 vs. 17.27±7.17 mg/L respectively; P<0.05). Insulin and adiponectin levels were negatively interrelated (r=-0.33, P=0.003). ADMA levels were comparable in both groups. The study group had worse FMD than Controls (6.11±3.28 vs. 10.20±2.07%; P<0.001). IR was independently associated with FMD (partial R2=0.23, P<0.001).
Increased insulin and decreased adiponectin levels along with endothelial dysfunction are present in normotensive subjects with FT. IR and hypoadiponectinemia are interrelated, but only hyperinsulinemia has an independent adverse influence on endothelial function. Results of our study did not confirm the role of ADMA in pathogenesis of evolving hypertension.
原发性高血压（EH）常伴有高胰岛素血症/胰岛素抵抗（IR）以及脂联素分泌紊乱。IR 继而可能与内皮功能障碍及不对称二甲基精氨酸（ADMA）水平升高有关。因此，我们旨在确定原发性高血压患者（家族性特征-FT）的血压正常后代的代谢异常情况，并研究这些异常与肱动脉（BA）内皮依赖性血管舒张的关系。
我们纳入了 77 名受试者，其中 38 名是年龄在 28 - 39 岁（平均 33 岁）的有 FT 的血压正常个体，39 名是年龄匹配的无 FT 的对照组。采用放射免疫分析法测定胰岛素、脂联素和 ADMA 的血浆水平。使用高分辨率超声测量静息状态下及反应性充血（血流介导的舒张-FMD）时的 BA 直径。
有 FT 的受试者的胰岛素水平高于对照组，脂联素水平低于对照组（分别为 13.65±6.70 与 7.09±2.20 mE/L；P<0.001 以及 13.60±5.98 与 17.27±7.17 mg/L；P<0.05）。胰岛素和脂联素水平呈负相关（r = -0.33，P = 0.003）。两组的 ADMA 水平相当。研究组的 FMD 比对照组差（6.11±3.28 与 10.20±2.07%；P<0.001）。IR 与 FMD 独立相关（偏 R2 = 0.23，P<0.001）。
有 FT 的血压正常受试者存在胰岛素水平升高、脂联素水平降低以及内皮功能障碍。IR 和低脂联素血症相互关联，但只有高胰岛素血症对内皮功能有独立的不良影响。我们的研究结果未证实 ADMA 在高血压发病机制中的作用。
