HYPERINSULINEMIA - A LINK BETWEEN HYPERTENSION OBESITY AND GLUCOSE-INTOLERANCE
HYPERINSULINEMIA - A LINK BETWEEN HYPERTENSION OBESITY AND GLUCOSE-INTOLERANCE
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DOI：
10.1172/jci111776
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发表时间：
1985-01-01
影响因子：
15.9
通讯作者：
FUCHS, Z
中科院分区：
文献类型：
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作者：
MODAN, M;HALKIN, H;FUCHS, Z
在随机人群样本(n=2,475)中确定的高血压和葡萄糖耐量异常，从这两种疾病的最轻微水平来看，显示出高度显著的相关性(P<；0.001)，与年龄、性别、肥胖和降压药物的混杂影响无关。与正常耐量相比，高血压的总发生率比为1.48(1.18~1.87)，糖尿病为2.26(1.69~2.84)。总体而言，83.4%的高血压患者要么是糖耐量异常，要么是肥胖，两者都已确立了胰岛素抵抗的条件。在一个有代表性的亚组(n=1241)中，高血压患者的空腹和负荷后胰岛素水平显著升高，与肥胖、糖耐量、年龄和降压药物无关。与血压正常的非肥胖者相比，1小时和2小时胰岛素水平平均增加(MU/L)分别为：单纯高血压12例，单纯肥胖47例，单纯异常52例，3种情况均存在时124例。红细胞Na+浓度(Me/L)的患病率7.0，K+<；92.5，血浆K+.4.5在59名有异常耐力、肥胖和高血压所有组合的个体中，与30名没有这些疾病的个体进行比较。总体而言，前者的88.1%与后者的40.0%至少出现这3个体内阳离子失衡的标志之一(P<；0.001)。胰岛素抵抗和/或高胰岛素血症存在于大多数高血压患者中，构成了肥胖、糖耐量异常和高血压的共同病理生理特征，可能解释了它们之间普遍存在的联系，并可能与高血压患者外周血管阻力增加有关，这可能与细胞内钠浓度升高有关。
Hypertension and glucose intolerance, determined in a random population sample (n = 2475), showed a highly significant (P < 0.001) association from the mildest levels of both conditions, independent of the confounding effects of age, sex, obesity and antihypertensive medications. Summary rate ratios for hypertension were 1.48 (1.18-1.87) in abnormal tolerance and 2.26 (1.69-2.84) in diabetes compared with normal tolerance. Altogether, 83.4% of the hypertensives were either glucose-intolerant or obese, both established insulin-resistant conditions. Fasting and post-load insulin levels in a representative subgroup (n = 1241) were significantly elevated in hypertension independent of obesity, glucose tolerance, age and antihypertensive medications. The mean increment is summed 1 and 2 h insulin levels (mU/l) compared with non-obese normotensives with normal tolerance was 12 for hypertension alone, 47 for obesity alone, 52 for abnormal tolerance alone and 124 when all 3 conditions were present. The prevalence of concentrations (mE/l) of erythrocyte Na+ .gtoreq. 7.0, K+ < 92.5, and plasma K+ .gtoreq. 4.5 in a subsample of 59 individuals with all combinations of abnormal tolerance obesity and hypertension was compared with those in 30 individuals free of these conditions. Altogether, 88.1% of the former vs. 40.0% of the latter group presented at least one of these 3 markers of internal cation imbalance (P < 0.001). Insulin resistance and/or hyperinsulinemia are present in the majority of hypertensives, constitute a common pathophysiologic feature of obesity, glucose intolerance, and hypertension, possibly explaining their ubiquitous association, and may be linked to the increased peripheral vascular resistance of hypertension, which is putatively related to elevated intracellular sodium concentration.