Hypertension and insulin disorders.
Insulin resistance and/or compensatory hyperinsulinemia are associated with hypertension, obesity, dyslipidemia, and glucose intolerance. Insulin resistance and hyperinsulinemia are considered to increase blood pressure through sympathetic nervous system activation, renin-angiotensin system stimulation, and vascular smooth muscle cell proliferation. Leptin, magnesium ions, nitric oxide, endothelin, peroxisome proliferator-activated receptor gamma, and tumor necrosis factor-alpha also modulate blood pressure. Decreasing insulin resistance by lifestyle modification including diet, weight loss, and physical exercise has been shown to reduce blood pressure. Angiotensin-converting enzyme inhibitors have a beneficial effect on insulin resistance. On the other hand, the angiotensin II antagonist, losartan, does not affect insulin sensitivity. The selective alpha1-blockers have a favorable metabolic profile producing increases in insulin sensitivity. A short-acting type calcium channel blocker seems to decrease insulin sensitivity. On the other hand, long-acting type calcium channel blockers improve insulin sensitivity. Thiazide diuretics and most of the beta-blockers decrease insulin sensitivity. Vasodilatory beta-blockers have been reported to improve insulin sensitivity. Use of low-dose diuretics avoids the adverse effects seen with conventional doses.
Imazu
Michinori
M
Division of Internal Medicine, Ajina Tsuchiya Hospital, 4-51-1 Ajina Hatsukaichi, Japan. mimazu@dd.iij4u.or.jp
D000959:Antihypertensive Agents / Q000627:therapeutic use; D006801:Humans; D006946:Hyperinsulinism / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D007333:Insulin Resistance / Q000502:physiology*; D009765:Obesity / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence
D000959:Antihypertensive Agents