We used the insulin-perfused human forearm model to assess the effects of vasoconstriction induced with norepinephrine on the extraction of glucose in the forearm in two groups of healthy young volunteers. The norepinephrine findings were compared with a previously studied group in which vasoconstriction had been caused by reflex activation of the sympathetic nervous system. The aim of the study was to determine the relative importance of hemodynamic and receptor-mediated mechanisms of insulin resistance. Plasma insulin, arterial and venous glucose samples, and forearm blood flow were measured at 10-minute intervals during a 30-minute baseline, a 60-minute intra-arterial insulin infusion, and during 30 minutes of insulin infusion plus vasoconstriction. Group 1 (n=14) had physiological vasoconstriction induced by inflation of bilateral thigh cuffs to 40 mm Hg to cause pooling of blood in the lower extremities and reflex vasoconstriction in the forearm; group 2 (n=8) had intra-arterial infusion of norepinephrine to achieve the same degree of vasoconstriction as seen with inflation of thigh cuffs in group 1. Subjects in A frequent association of tissue insulin insensitivity and blood pressure in humans has been ob-L. served in several clinical surveys.17 Recent investigations have focused on a possible pressor effect of insulin through sympathetic nervous system tone, 811 an increase in the intravascular volume, 12 -13 or through the effect of insulin on vascular smooth muscle.14 ' 15 It has been speculated that high insulin in insulin-resistant states may cause the increase of blood pressure in hypertension through these various pressor mechanisms. 16 In contrast to the insulinogenic hypothesis of the blood pressure elevation, the infusion of insulin into humans has been repeatedly associated with vasodilation or attenuation of vasoconstrictive stimuli instead of a pressor effect.11 .
1719In a recent review we offered an alternative explanation for the frequent association between elevated blood pressure and insulin resistance. 20 ' 21 We proposed that vascular changes in the microcirculation secondary to long-standing elevations in blood pressure may alter the delivery of insulin and glucose to tissues and may thereby, in part, cause insulin resistance. Our hypothesis suggests that the primary defect may be vascular in nature, from elevation in blood pressure, and not in tissue sensitivity to the effects of insulin. A first step group 3 (n=7) had infusion of intra-arterial norepinephrine to achieve a twofold increase in physiological vasoconstriction. With a physiological decrease in forearm blood flow (group 1), there was a 19% decrease in forearm blood flow resulting in a 23% reduction in glucose uptake in the forearm (P<.03). The same degree of reduction in forearm blood flow with a predominantly a-adrenergic agonist, norepinephrine (group 2), causes much less insulin resistance (a decrease in utilization of 13%) (P