Wall U, Bergbrant A, Jern S
Department of Internal Medicine, Ostra University Hospital, Göteborg University, Sweden.
Blood Press. 1996 May;5(3):139-47. doi: 10.3109/08037059609062122.
Recent studies suggest that patients with essential hypertension have impaired glucose tolerance and are hyperinsulinemic compared with normotensive subjects. The aims of the study were (1) to follow blood pressures of 56 young men with borderline hypertension for 5 years, (2) to investigate glucose tolerance in these subjects, and (3) to determine the relation of insulin/glucose metabolism to structural vascular changes and hemodynamic patterns in borderline hypertension.
Thirty-nine young (age 22-34 years) male subjects with borderline hypertension (SBP 140-160 and or DBP 85-95 mmHg initially) and 17 normotensive control subjects (SBP 110-130 and DBP 60-80 mmHg) participated in the study. Blood pressure was measured, a standard oral glucose tolerance test (OGTT) was performed, and glucose, insulin and C-peptide were determined before and 30, 60, 90 and 120 minutes after a standard 75-g glucose load. Post-ischemic forearm vasodilatory responses were examined by plethysmography.
At follow-up, the borderline hypertensives had maintained significantly higher blood pressures than control subjects. Borderline hypertensives also had significantly impaired glucose tolerance compared to control subjects. The insulin response had a somewhat more sluggish descent, but did not differ significantly from the response of normotensives. The C-peptide response pattern resembled that of insulin, but C-peptide was significantly elevated after 120 min. On the whole group level, there were only weak relations of insulin to blood pressure. By contrast, fasting insulin and post-load insulin levels were strongly correlated with body mass index, the waist-hip circumference ratio, triglyceride, and both total and LDL cholesterol. Across the whole group, there were significant correlations between forearm minimal vascular resistance and fasting insulin (r = +0.37 p = 0.007) and insulin area-under-the-curve (r = +0.28 p = 0.044). However, Rmin was even more strongly correlated with body mass index, suggesting that this relationship was related to degree of obesity.
Borderline hypertension in young men is a persistent condition which is associated with impaired glucose tolerance without hyperinsulinemia. This finding suggests that impaired glucose tolerance might be a more primary phenomenon in early hypertension devoid of lipid metabolic aberrations.
近期研究表明，与血压正常的受试者相比，原发性高血压患者存在糖耐量受损和高胰岛素血症。本研究的目的是：（1）对56名轻度高血压青年男性的血压进行5年随访；（2）调查这些受试者的糖耐量；（3）确定胰岛素/葡萄糖代谢与轻度高血压患者血管结构变化及血流动力学模式之间的关系。
39名轻度高血压青年男性（年龄22 - 34岁，初始收缩压140 - 160mmHg和/或舒张压85 - 95mmHg）和17名血压正常的对照受试者（收缩压110 - 130mmHg，舒张压60 - 80mmHg）参与了本研究。测量血压，进行标准口服葡萄糖耐量试验（OGTT），并在给予标准75g葡萄糖负荷前及负荷后30、60、90和120分钟测定血糖、胰岛素和C肽。通过体积描记法检测缺血后前臂血管舒张反应。
随访时，轻度高血压患者的血压仍显著高于对照受试者。与对照受试者相比，轻度高血压患者的糖耐量也显著受损。胰岛素反应的下降略显迟缓，但与血压正常者的反应无显著差异。C肽反应模式与胰岛素相似，但120分钟后C肽显著升高。在整个组水平上，胰岛素与血压之间仅有微弱关系。相比之下，空腹胰岛素和负荷后胰岛素水平与体重指数、腰臀围比、甘油三酯以及总胆固醇和低密度脂蛋白胆固醇均密切相关。在整个组中，前臂最小血管阻力与空腹胰岛素（r = +0.37，p = 0.007）和胰岛素曲线下面积（r = +0.28，p = 0.044）之间存在显著相关性。然而，最小血管阻力与体重指数的相关性更强，表明这种关系与肥胖程度有关。
青年男性的轻度高血压是一种持续性疾病，与糖耐量受损有关，但无高胰岛素血症。这一发现表明，在无脂质代谢异常的早期高血压中，糖耐量受损可能是一种更为原发性的现象。
