Hypertension in patients with diabetes mellitus

被引:15
作者
Skyler, JS
Marks, JB
Schneiderman, N
机构
[1] Department of Medicine, University of Miami, Miami, FL
[2] Department of Pediatrics, University of Miami, Miami, FL
[3] Department of Psychology, University of Miami, Miami, FL
关键词
insulin sensitivity; diabetes mellitus; cardiovascular risk; hypertension; dyslipidemia; Syndrome X;
D O I
10.1016/0895-7061(95)00307-X
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Diabetes mellitus and hypertension each confer increased cardiovascular risk. That risk is much greater when the diseases coexist and is further magnified by their frequent association with dyslipidemia and central obesity. Insulin resistance appears to be an important common component to these four entities, whether or not the relationship is truly cause and effect. Increased renal tubule absorption of sodium and increased sympathetic nervous system stimulation from insulin have been said to be the mechanisms by which elevated levels of insulin cause hypertension. However, animal experiments suggest that these are short-term effects only and that long-term insulin may actually increase peripheral blood flow and reduce blood pressure. Experiments in humans suggest that the insulin resistant state in obese patients and type II diabetics is associated with a decrease of the usual vasodilatory effect of insulin. Antihypertensive drugs have differing effects on insulin resistance. Angiotensin converting enzyme inhibitors, alpha-adrenergic blockers, and dihydropyridines appear to improve insulin sensitivity. Other calcium channel blockers appear to be neutral, as is furosemide. Thiazide diuretics, spironolactone, and beta-adrenergic blockers impair insulin sensitivity. The drugs that increase insulin sensitivity also tend to improve dyslipidemia or remain lipid neutral. In contrast, those drugs that tend to impair insulin sensitivity also tend to worsen dyslipidemia.
引用
收藏
页码:S100 / S105
页数:6
相关论文
共 60 条
[1]   RELATIONSHIPS BETWEEN PLASMA-LIPOPROTEIN CONCENTRATIONS AND INSULIN ACTION IN AN OBESE HYPERINSULINEMIC POPULATION [J].
ABBOTT, WGH ;
LILLIOJA, S ;
YOUNG, AA ;
ZAWADZKI, JK ;
YKIJARVINEN, H ;
CHRISTIN, L ;
HOWARD, BV .
DIABETES, 1987, 36 (08) :897-904
[2]   INSULIN INCREASES SYMPATHETIC ACTIVITY BUT NOT BLOOD-PRESSURE IN BORDERLINE HYPERTENSIVE HUMANS [J].
ANDERSON, EA ;
BALON, TW ;
HOFFMAN, RP ;
SINKEY, CA ;
MARK, AL .
HYPERTENSION, 1992, 19 (06) :621-627
[3]   HYPERINSULINEMIA PRODUCES BOTH SYMPATHETIC NEURAL ACTIVATION AND VASODILATION IN NORMAL HUMANS [J].
ANDERSON, EA ;
HOFFMAN, RP ;
BALON, TW ;
SINKEY, CA ;
MARK, AL .
JOURNAL OF CLINICAL INVESTIGATION, 1991, 87 (06) :2246-2252
[4]   INTERACTIONS BETWEEN INSULIN AND NOREPINEPHRINE ON BLOOD-PRESSURE AND INSULIN SENSITIVITY - STUDIES IN LEAN AND OBESE MEN [J].
BARON, AD ;
BRECHTEL, G ;
JOHNSON, A ;
FINEBERG, N ;
HENRY, DP ;
STEINBERG, HO .
JOURNAL OF CLINICAL INVESTIGATION, 1994, 93 (06) :2453-2462
[5]   SKELETAL-MUSCLE BLOOD-FLOW - A POSSIBLE LINK BETWEEN INSULIN RESISTANCE AND BLOOD-PRESSURE [J].
BARON, AD ;
BRECHTELHOOK, G ;
JOHNSON, A ;
HARDIN, D .
HYPERTENSION, 1993, 21 (02) :129-135
[6]   CARDIOVASCULAR ACTIONS OF INSULIN IN HUMANS - IMPLICATIONS FOR INSULIN SENSITIVITY AND VASCULAR TONE [J].
BARON, AD .
BAILLIERES CLINICAL ENDOCRINOLOGY AND METABOLISM, 1993, 7 (04) :961-987
[7]   OBESITY AND INSULIN RESISTANCE IN HUMANS - A DOSE-RESPONSE STUDY [J].
BONADONNA, RC ;
GROOP, L ;
KRAEMER, N ;
FERRANNINI, E ;
DELPRATO, S ;
DEFRONZO, RA .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1990, 39 (05) :452-459
[8]  
BRESSLER P, 1992, DIABETES S1, V41, pA24
[9]   STRESS AND LIPOPROTEIN METABOLISM - MODULATORS AND MECHANISMS [J].
BRINDLEY, DN ;
MCCANN, BS ;
NIAURA, R ;
STONEY, CM ;
SUAREZ, EC .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1993, 42 (09) :3-15
[10]   INSULIN RESISTANCE - A MULTIFACETED SYNDROME RESPONSIBLE FOR NIDDM, OBESITY, HYPERTENSION, DYSLIPIDEMIA, AND ATHEROSCLEROTIC CARDIOVASCULAR-DISEASE [J].
DEFRONZO, RA ;
FERRANNINI, E .
DIABETES CARE, 1991, 14 (03) :173-194