[Hyperinsulinemia and arterial hypertension]

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Metabolic Syndrome

Context:

• Essential hypertension affects approximately 50% of patients with co-occurring insulin resistance.
• Insulin resistance predominantly impacts skeletal muscle's non-oxidative glucose metabolism, specifically glycogen synthesis.
• The kidney's response to insulin suggests a potential, though not primary, role in arterial hypertension pathogenesis.

Purpose:

• To explore the intricate relationship between hyperinsulinemia/insulin resistance and the development of essential hypertension.
• To investigate the role of metabolic disturbances, including lipid status and fibrinolysis, in patients with hyperinsulinemia.
• To review the impact of antihypertensive medications on glucose metabolism and insulin sensitivity.

Summary:

• Around 50% of individuals with essential hypertension exhibit insulin resistance, mainly in skeletal muscle, impairing glucose metabolism.
• While hypertension may contribute to insulin resistance through vascular changes, the absence of hyperinsulinemia in secondary hypertension argues against it being the primary cause.
• Metabolic alterations like dyslipidemia and impaired fibrinolysis associated with hyperinsulinemia significantly increase cardiovascular risk.

Impact:

• Hyperinsulinemia itself is not a standalone risk factor but amplifies cardiovascular disease risk when co-existing with dyslipidemia, hypertension, hyperuricemia, and fibrinolytic disorders.
• Understanding these metabolic links is crucial for comprehensive cardiovascular risk assessment and management in hypertensive patients.
• This research highlights the importance of considering metabolic profiles alongside blood pressure for effective therapeutic strategies.