Andersen U B, Dige-Petersen H, Frandsen E K, Ibsen H, Vølund A
Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, Denmark.
J Hypertens. 1997 Oct;15(10):1167-73. doi: 10.1097/00004872-199715100-00015.
Insulin is secreted in regular pulses at intervals of 12-14 min in normal fasting subjects. An abnormal pattern has been found in subjects with non-insulin-dependent diabetes mellitus (NIDDM) and in young individuals predisposed to NIDDM. It has been suggested that there might be a causal relationship between insulin-secretion abnormalities and insulin resistance.
To examine whether insulin-secretion abnormalities are also present in offspring of patients with essential hypertension.
Eleven young (aged 18-35 years) normotensive individuals each of whom had two parents with essential hypertension were compared with 10 age- and sex-matched controls each of whom had two normotensive parents. We verified that diabetes and morbid obesity were absent among the subjects and their parents. We studied basal insulin-secretion patterns during a 60 min period, glucose tolerance by administering an oral glucose-tolerance test, insulin resistance by using an isoglycaemic hyperinsulinaemic clamp and basal plasma catecholamine levels.
Autocorrelation analysis of insulin concentrations showed that the hypertension-prone subjects had a significantly reduced or irregular oscillatory pattern compared with the regular insulin-level oscillations with a period of 12-14 min in control subjects. The hypertension-prone subjects had significantly higher systolic blood pressures and tended to be insulin-resistant.
This is the first evidence of early insulin-secretion abnormalities in young normotensive individuals with a genetic predisposition to essential hypertension, but with a normal glucose tolerance and without a genetic predisposition to NIDDM. Early insulin-secretion abnormalities may be the very first step towards the development of insulin resistance and an important factor initiating the hypertension in hypertension-prone individuals.
在正常空腹受试者中，胰岛素以12 - 14分钟的间隔规律脉冲式分泌。在非胰岛素依赖型糖尿病（NIDDM）患者以及易患NIDDM的年轻人中发现了异常模式。有人提出胰岛素分泌异常与胰岛素抵抗之间可能存在因果关系。
研究原发性高血压患者的后代是否也存在胰岛素分泌异常。
将11名年轻（18 - 35岁）血压正常但父母均患有原发性高血压的个体与10名年龄和性别匹配、父母均血压正常的对照者进行比较。我们证实这些受试者及其父母均无糖尿病和病态肥胖。我们研究了60分钟内的基础胰岛素分泌模式、通过口服葡萄糖耐量试验评估葡萄糖耐量、使用等血糖高胰岛素钳夹技术评估胰岛素抵抗以及基础血浆儿茶酚胺水平。
胰岛素浓度的自相关分析表明，与对照组受试者中周期为12 - 14分钟的规律胰岛素水平振荡相比，易患高血压的受试者的振荡模式明显减少或不规律。易患高血压的受试者收缩压显著更高，且倾向于存在胰岛素抵抗。
这是首次有证据表明，具有原发性高血压遗传易感性但糖耐量正常且无NIDDM遗传易感性的年轻血压正常个体存在早期胰岛素分泌异常。早期胰岛素分泌异常可能是胰岛素抵抗发展的第一步，也是易患高血压个体引发高血压的重要因素。
