To investigate the cellular basis linking hypertension, non-insulin-dependent diabetes melllrus (NIDDM), and obesity, we used 31 P and "F nuclear magnetic resonance spectroscopy to measure intracellular pH (pHJ, free magnesium (M&), and cytosolic free calcium (Ca,) in erythrocytes of obese and NIDDM subjects with and without hypertension. Compared with nonnotensive, nondiabetic controls (Ca^ 25.2 ±1.4 nM; Mg,, 232 ±8 fiM), Cat was elevated in both nonnotensive (36.8±2.7 nM, sig=0.005) and hypertensive (43.4±2.9 nM, sig=0.001) NIDDM subjects, and Mg, was concomitantly suppressed (nonnotensive: 206±ll juM, sig=0.05; hypertensive: 196±8 fiM, sig=0.001). Similar but less striking changes were noted in obese subjects. Values of pH, were significantly lower (sig=0.05) in all hypertensive groups compared with their nonnotensive controls. Continuous relations were observed for all subjects between Ca, and diastolic blood pressure (r=0.649,/7<0.001) and body mass index (r=0-565,p<0.001), between Mg, and diastolic blood pressure (r=-0.563, p<0.001) and fasting blood glucose (r=-0.580, p<0.001), and in diabetics, between pH, and diastolic blood pressure (r= -0.680, p<0.001). Thus, the constellation of elevated Ca, and suppressed Mg, and pH, levels is characteristic of the hypertensive state. These abnormalities of cellular ion handling in whole or in part common to hypertension, diabetes, and obesity may contribute to the pathophysiology of these syndromes and may help to explain their frequent clinical coexistence. (Hypertension 1991;17:951-957) T he long-recognized association of hypertension, obesity, and non-insulin-dependent diabetes mellitus (NIDDM) has received increasing attention.1 In particular, it has been suggested that the insulin resistance and concomitant hyperinsulinemia present in these disease states may represent a metabolic link mediating their increased clinical coincidence.
-3At the cellular level, we previously have reported that levels of intracellular free magnesium (Mgi) are closely related to the height of the blood pressure and to the insulinemic response to glucose loading; the lower the Mg^ the higher the pressure and the greater the peripheral insulin resistance.
-7 Similarly, we found that lower intracellular pH (pHj) values strongly correlated with both blood pressure and hyperinsulinemia. 58 We hypothesized that these