Bianchi S, Bigazzi R, Nenci R, Campese V M
Nefrology Unit, Spedali Riuniti, Livorno, Italy.
J Nephrol. 1997 Nov-Dec;10(6):325-33.
Some patients with essential hypertension display hyperinsulinemia and/or insulin resistance. A relationship between hyperinsulinemia and blood pressure has not been conclusively established. Some evidence points to a relationship between hyperinsulinemia and evidence of cardiovascular damage.
In this study, we examined the relationship between insulin secretion in response to an oral glucose load, circadian variation of blood pressure, and evidence of vascular damage, measured by the thickness of the carotid artery and urinary albumin excretion.
Seventy patients with essential hypertension and 35 healthy volunteers were included in the study.
Twenty patients were hyperinsulinemic. Office blood pressure was not different between hypertensive patients with high and those with normal insulin AUC. However, night-time diastolic blood pressure was greater in hypertensive patients with high insulin AUC (93 +/- 2.9 mm Hg) than in those with normal insulin AUC (83.5 +/- 1.7 mm Hg, P < 0.005). The thickness of the carotid artery and urinary albumin excretion were greater (P < 0.05) in patients with high insulin AUC than in patients with normal insulin AUC and normotensive subjects. Insulin AUC was significantly correlated with ambulatory blood pressure, carotid artery thickness, and urine albumin excretion. Multiple regression analysis using insulin AUC as the dependent variable and UAE, triglycerides, body-mass index and office or ambulatory blood pressure as independent variables showed the strongest correlation with urine albumin excretion (P < 0.0001), triglycerides (P < 0.02) and body-mass index (P < 0.07).
These data suggest that in patients with essential hypertension hyperinsulinemia is associated with higher levels of nocturnal blood pressure, and greater evidence of vascular damage.
一些原发性高血压患者表现出高胰岛素血症和/或胰岛素抵抗。高胰岛素血症与血压之间的关系尚未最终确定。一些证据表明高胰岛素血症与心血管损伤证据之间存在关联。
在本研究中，我们研究了口服葡萄糖负荷后胰岛素分泌、血压的昼夜变化以及通过颈动脉厚度和尿白蛋白排泄量测量的血管损伤证据之间的关系。
本研究纳入了70例原发性高血压患者和35名健康志愿者。
20例患者存在高胰岛素血症。胰岛素AUC高的高血压患者与正常的高血压患者的诊室血压无差异。然而，胰岛素AUC高的高血压患者夜间舒张压（93±2.9 mmHg）高于胰岛素AUC正常的患者（83.5±1.7 mmHg，P<0.005）。胰岛素AUC高的患者的颈动脉厚度和尿白蛋白排泄量高于胰岛素AUC正常的患者和血压正常的受试者（P<0.05）。胰岛素AUC与动态血压、颈动脉厚度和尿白蛋白排泄量显著相关。以胰岛素AUC为因变量，以尿白蛋白排泄量、甘油三酯、体重指数和诊室或动态血压为自变量的多元回归分析显示，与尿白蛋白排泄量（P<0.0001）、甘油三酯（P<0.02）和体重指数（P<0.07）的相关性最强。
这些数据表明，在原发性高血压患者中，高胰岛素血症与夜间血压升高以及血管损伤证据增多有关。
