Insulin resistance and hypertension

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Hypertension is frequently associated with decreased insulin sensitivity (3); reduced insulin sensitivity has been observed in normotensive offspring of first-degree relatives of hypertensive patients, independent of obesity (4). Insulin resistance also predates hypertension in normotensive persons. In a prospective investigation of CVD risk factors involving 840 normotensive persons, insulin sensitivity was inversely related to development of hypertension over a 5-yr period (5). This observation has been confirmed in other large studies (6).

There is accumulating data that insulin resistance is associated with abnormalities of the renin-angiotensin system (3,7). For example, the level of insulin resistance in hypertensive persons is influenced by a relatively common polymorphism of the angiotensin-converting enzyme (ACE) gene, their being a significantly greater insulin resistance with the DD geno type (8). Recent evidence suggests that tissue overexpression of the RAS leads to impaired insulin signaling, in part by increasing the generation of reactive oxygen species (3,8). Further, abrogation of the RAS with ACE inhibitor and angiotensin receptor blocking agents has been shown to improve insulin sensitivity in animals and humans (1,8,10).

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