Ferrannini E, Santoro D, Manicardi V
C.N.R. Institute of Clinical Physiology, University of Pisa, Italy.
Compr Ther. 1989 Nov;15(11):51-8.
Diabetes may be associated with systolic hypertension secondary to atherosclerosis, renal hypertension secondary to diabetic nephropathy, and essential hypertension. The latter is by far the most prevalent, and a wealth of epidemiologic data suggests that such an association is independent of age and obesity. Considerable evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive subjects, whether obese or of normal body weight, are compared to age- and weight-matched normotensive controls, a heightened plasma insulin response to a glucose challenge is found consistently. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the use of the glucose clamp technique coupled with tracer glucose infusion and indirect calorimetry, it can be shown that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal, and is directly correlated with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms--sodium retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and altered muscle fiber composition. Physiologic maneuvers such as caloric restriction in the overweight individual and regular physical exercise can improve tissue sensitivity to insulin; good preliminary evidence shows that these measures can also lower blood pressure in both normotensive and hypertensive individuals. A strong case can therefore be made for the use of physiologic intervention in the treatment of essential hypertension.
糖尿病可能与动脉粥样硬化继发的收缩期高血压、糖尿病肾病继发的肾性高血压以及原发性高血压有关。其中，原发性高血压最为常见，大量流行病学数据表明，这种关联独立于年龄和肥胖因素。大量证据表明，糖尿病与原发性高血压之间的联系是高胰岛素血症。因此，当将高血压患者（无论肥胖与否）与年龄和体重匹配的血压正常对照组进行比较时，始终会发现他们对葡萄糖刺激的血浆胰岛素反应增强。细胞对胰岛素作用的抵抗状态是观察到的高胰岛素血症的基础。通过使用葡萄糖钳夹技术，结合示踪葡萄糖输注和间接测热法，可以证明原发性高血压的胰岛素抵抗位于外周组织（肌肉），仅限于葡萄糖处置的非氧化途径，并且与高血压的严重程度直接相关。胰岛素抵抗与原发性高血压之间关联的原因至少可以从四种一般机制中寻找——钠潴留、交感神经系统活动过度、膜离子转运紊乱以及肌肉纤维组成改变。诸如超重个体的热量限制和定期体育锻炼等生理措施可以提高组织对胰岛素的敏感性；有力的初步证据表明，这些措施还可以降低血压正常和高血压个体的血压。因此，有充分的理由支持在原发性高血压治疗中采用生理干预措施。
