Insulin resistance and hypertension.

In non obese, nondiabetic patients, essential hypertension is associated with an insulin resistance that is peripheral in location and metabolically selective. The correlations between hyperinsulinemia, insulin resistance and blood pressure values do not prove that the relationship is a causal one. Different data support this hypothesis, however, the demonstration in humans that insulin resistance play a central role in the development of essential hypertension and coronary heart disease is still lacking. The relative current failure of coronary heart disease prevention in hypertensive patients may be related to the metabolic side effects of diuretics and beta-blockers. These drugs increase insulin resistance and lipid disorders. Angiotensin-converting enzyme inhibitors and calcium antagonists do not decrease insulin sensitivity neither alter lipid profile. Angiotensin-converting enzyme inhibitors and calcium antagonists have significantly improve compliance to pharmacological therapy, however their use has been associated with a dramatic cost increase and we do not yet know if they would reduce morbidity and mortality as well as or better than older and cheaper antihypertensive agents. Nonpharmacological interventions are usually very effective to reduce insulin resistance and the different cardiovascular risk factors present in most hypertensive patients. To improve patient's compliance to diet and regular exercise we have to develop new strategies.