Hyperinsulinemia in normotensive offspring of hypertensive parents.

Abstract

Hyperinsulinemia and insulin resistance have been extensively reported in adult patients with essential hypertension. The aim of this study was to examine serum glucose and insulin levels both in the fasting state and after 0.25 g/kg IV glucose and to relate those findings to the status of intracellular Na + and red blood cell Na + -Li + countertransport in a population of 21 normolipemic normotensive offspring of hypertensive parents (N-EH) and 13 control children without a history of parental essential hypertension or diabetes mellitus matched for age, body mass index, and pubertal stage. Offspring of hypertensive parents presented significantly higher serum insulin levels both after an overnight fast (17.4±1.6 versus 11.6±1.6 fiU/mh in control [mean±SEM], P<.01) and after intravenous glucose than control subjects (insulin area under the curve, 3015±310 and 2057±234 jiU/mL per hour, respectively, P<.01). No relation could be established between the high red blood cell Na + -Li + countertransport (343±22 versus 215±15 /unol/L per hour, N-EH versus control; P<.002) or high intracellular Na + (9.8±0.28 versus 8.7 ±0.36 mEq/L, N-EH versus control) and hyperinsulinemia found in children of hypertensive parents. We conclude that the time precedence of hyperinsulinemia (and possibly insulin resistance) over the appearance of clinical hypertension in a high-risk population further supports the contention that an abnormal insulin action may play a pathogenetic role in essential hypertension. The lack of relation between hyperinsulinemia and red blood cell Na + -Li + countertransport or intracellular Na + suggests that either they are not linked in the causal pathway of hypertension or they are both an untimely product of a third yet undetermined pathogenetic factor.

Treating hypertension while protecting the vulnerable islet in the cardiometabolic syndrome

“…IR and hypertension coexist in rats with genetic IR [13,16,17], suggesting that genetic predisposition contributes to both IR and hypertension [13]. The presence of altered glucose metabolism in normotensive children of parents with hypertension supports this hypothesis [12,13,15]. In addition, some persons with coexisting IR and hypertension have specific metabolic genetic defects [18,19].…”

“…A strong relationship between IR and hypertension has been identified [5,13]. Defective insulin signaling occurs in patients with hypertension, and drug-naive patients with hypertension have greater fasting and postprandial insulin levels than age-and sexmatched normotensive individuals regardless of weight ( Figure 3) [5,[12][13][14][15]. However, there is no link between increased plasma insulin levels and secondary hypertension [12,13].…”

The T8590C Polymorphism of CYP4A11 and 20-Hydroxyeicosatetraenoic Acid in Essential Hypertension

“…34 The sodiumretaining actions of insulin have been implicated in the pathogenesis of salt-sensitive hypertension, independent of obesity. 35 Our data suggest that 1 of the plausible mechanisms underlying the relationships among insulin resistance, salt sensitivity of blood pressure, and essential hypertension is an abnormal synthesis of 20-HETE.…”

The Relationship between Hyperinsulinemia, Hypertension and Progressive Renal Disease

“…The association of hypertension, insulin resistance, and resultant hyperinsulinemia is well established (3)(4)(5)(6)(7)(8)(9)(10)14). In untreated essential hypertensive patients, fasting and postprandial insulin (INS) levels are higher than in normotensive controls, regardless of the BMI, with a direct correlation between plasma INS concentrations and BP.…”