Kamide K, Nagano M, Nakano N, Yo Y, Kobayashi R, Rakugi H, Higaki J, Ogihara T
Department of Geriatric Medicine, Osaka University Medical School, Suita, Japan.
Am J Hypertens. 1996 Dec;9(12 Pt 1):1165-71. doi: 10.1016/s0895-7061(96)00263-4.
Hyperinsulinemia or insulin resistance is suggested to play a role in the pathogenesis of hypertension and its target organ diseases. We designed this study to evaluate the role of insulin resistance in cardiac function, cardiac hypertrophy, wall thickness of the common carotid artery, and endothelial function of the brachial artery in essential hypertensive patients without diabetes mellitus. Insulin resistance was evaluated by the constant glucose infusion rate (M value) during the euglycemic-hyperinsulinemic glucose clamp test. In correlation analysis for several indices of glucose metabolism, only M value correlated with left ventricular mass index (LVMI), ratio of peak velocity during atrial contraction to that during early left ventricular filling phase (E/A ratio) and intima-media complex (IMC). In stepwise regression analysis of various risk factors for cardiovascular diseases, only M value and age were dependent factors for LVMI, E/A ratio, and IMC. No indices of glucose metabolism or risk factors for cardiovascular diseases correlated with endothelium-dependent and -independent vasodilation. These results suggest that insulin resistance, but not glucose intolerance and hyperinsulinemia, partly accelerates cardiovascular complications such as left ventricular hypertrophy and wall thickening of the carotid artery in patients with essential hypertension.
高胰岛素血症或胰岛素抵抗被认为在高血压及其靶器官疾病的发病机制中起作用。我们设计了这项研究，以评估胰岛素抵抗在无糖尿病的原发性高血压患者的心功能、心脏肥大、颈总动脉壁厚度和肱动脉内皮功能中的作用。胰岛素抵抗通过正常血糖高胰岛素血症葡萄糖钳夹试验期间的恒定葡萄糖输注率（M值）进行评估。在对几种葡萄糖代谢指标的相关性分析中，只有M值与左心室质量指数（LVMI）、心房收缩期峰值速度与左心室早期充盈期峰值速度之比（E/A比值）以及内膜-中膜复合体（IMC）相关。在对心血管疾病各种危险因素的逐步回归分析中，只有M值和年龄是LVMI、E/A比值和IMC的相关因素。没有葡萄糖代谢指标或心血管疾病危险因素与内皮依赖性和非内皮依赖性血管舒张相关。这些结果表明，在原发性高血压患者中，胰岛素抵抗而非葡萄糖不耐受和高胰岛素血症，部分加速了心血管并发症，如左心室肥厚和颈动脉壁增厚。
