EPIDEMIOLOGIC, PHYSIOLOGICAL, AND CLINICAL IMPLICATIONS OF HYPERTENSION AND INSULIN-RESISTANCE

Hypertension and dyslipidemia tend to cluster within individuals, and insulin resistance may be the link between these two cardiovascular disease risk factors. However, despite a recognized association between insulin resistance and hypertension, evidence that insulin resistance elevates blood pressure is inconclusive. Insulin has an antinatriuretic effect, stimulates sympathetic nervous system activity, alters ion transport, and stimulates cell growth, all of which may contribute to hypertension. Conversely, there is evidence to suggest that hypertension and vascular disease may contribute to insulin resistance. Clinically, the evaluation and therapy of hypertensive patients should address overall cardiovascular disease risk. Medications currently available for the treatment of hypertension have various effects on insulin sensitivity and dyslipidemia, with thiazide diuretics and beta-blockers having the most detrimental effects.