Mediratta S, Fozailoff A, Frishman W H
Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
J Clin Pharmacol. 1995 Oct;35(10):943-56. doi: 10.1002/j.1552-4604.1995.tb04010.x.
Systemic hypertension, a vascular disease with multiple origins, now is being linked to subtle abnormalities in glucose metabolism, which include insulin resistance and hyperinsulinemia. These conditions often occur together in patients with obesity, noninsulin-dependent diabetes, or both. Hyperinsulinemia and insulin resistance may cause systemic hypertension through multiple mechanisms. Insulin has a salt-retaining effect on the kidney. Also, insulin can augment catecholamine release, increase vascular sensitivity to vasoconstrictor substances, and decrease vascular sensitivity to vasodilator substances. In addition, insulin can increase production of tissue growth factors and help retain sodium and calcium in cells. Insulin resistance in patients can be treated with regular aerobic exercise, weight reduction, and a high-fiber diet. Pharmacologic approaches include hypoglycemic drugs, weight-reducing agents, and certain antihypertensive drugs that may have a favorable impact on both blood pressure and insulin resistance.
系统性高血压是一种具有多种病因的血管疾病，目前被认为与葡萄糖代谢的细微异常有关，这些异常包括胰岛素抵抗和高胰岛素血症。肥胖患者、非胰岛素依赖型糖尿病患者或同时患有这两种疾病的患者常常同时出现这些情况。高胰岛素血症和胰岛素抵抗可能通过多种机制导致系统性高血压。胰岛素对肾脏有保钠作用。此外，胰岛素可增加儿茶酚胺释放，提高血管对血管收缩物质的敏感性，并降低血管对血管舒张物质的敏感性。此外，胰岛素可增加组织生长因子的产生，并有助于细胞内钠和钙的潴留。患者的胰岛素抵抗可以通过规律的有氧运动、减轻体重和高纤维饮食来治疗。药物治疗方法包括降糖药、减肥药以及某些可能对血压和胰岛素抵抗都有有利影响的抗高血压药物。
