To study the prevalence of insulin resistance in non-diabetes hypertensive subjects

Authors

  • Gurinder Mohan Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Ranjeet Kaur Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Gursimran Singh Nayyar Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Parminder Singh Department of Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20170035

Keywords:

Hypertension, Insulin resistance, Insulin

Abstract

Background: Hypertension is an important medical and public health problem in both developed and developing countries. It is an important risk factor for morbidity and mortality from coronary heart disease, stroke and renal disease. It is well recognized that hypertension coexists in varying degrees with conditions of obesity, insulin resistance/hyperinsulinemia and dyslipidemia, the interrelated metabolic disorders characteristic of metabolic syndrome.

Methods: The study was carried out at Sri Guru Ram Das hospital, Amritsar, Punjab, India. A total of 150 patients were taken, out of which 75 were hypertensive and 75 healthy subjects more than 18 years of age were recruited. Serum insulin concentration was measured using a solid phase enzyme linked immunoassay based on the sandwich principle. Insulin resistance was determined by HOMA-IR (homeostasis model assessment of insulin resistance).

Results: Statistically, the mean fasting serum insulin level was 17.09±8.17 μIu/ml in cases and 9.33±2.67μIU/ml in controls (reference range 2-25 μIU/ml); the difference was statistically significant (P <0.001). The mean value of HOMA-IR in cases was 3.86±1.84 as compared with controls with mean HOMA -IR value of 2.01±0.62. This difference was statistically significant (P <0.001).

Conclusions: Essential hypertension is significantly associated with higher mean fasting insulin levels and insulin resistance. Hyperinsulinemia has a possible role in the pathophysiology of essential hypertension with insulin resistance being the likely predominant mechanism.

References

Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J, eds: Harrison’s Principles of Internal Medicine. 19th edition. New York: McGraw Hill Education; 2015;2:16.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23

Gupta R. Trends in hypertension epidemiology of hypertension in India. J hum hypertens. 2004;18:73-8

Collins R, Peto R, Macmahon S. Blood pressure, stroke, coronary heart disease. Short term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990;335:827-38.

Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37:1595-607.

Defrenzo RA. Insulin and renal sodium handling; clinical implication. Int J Obes. 1981;5(2):93-105.

Rowe JW, Young JB, Minaker KL. Effect of insulin and glucose infusion on symapatthetic nervous system activity in normal man. Diabetes. 1981;30:219-25.

Boller S, Joblin BA, Xu L. From signal transduction to signal interpretation: an alternative model for the molecular function of insulin receptor substrates. Arch Physiol Biochem. 2012;118:148-55.

Landesberg L, Aronne LJ, Beilin LJ. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment a position paper of the obesity society and the American society of hypertension. J Clin Hypertens. 2013;15:14-33.

Olefsky JM, Kolterman OG, Scarlett JA. Insulin action and resistance in obesity and noninsulin-dependent type II diabetes mellitus. Am J Physiol. 1982;243:15-30.

Modan M, Halkin H, Almog S, Lusky A, Eshkol A, Shefi M, et al. Hyperinsulinemia: a link between hypertension, obesity and glucose tolerance. J Clin Invest. 1985;75:809-17.

Bonora E, Zavaroni I, Alpi O, Pezzarossa A, Bruschi F, Dall AE, et al. Relationship between blood pressure and plasma insulin in non-obese and obese non-diabetic subjects. Diabetologia. 1987;30:719-23.

Manicardi V, Cannellini I, Bellodi G, Coscelli C, Ferrannini E. Evidence for an association of high blood pressure and hyperinsulinemia in obese man. J Clin Endocrinol Metab. 1986;62:1302-4.

Stout RW, Bierman EL, Ross R. Effect of insulin on cultured primate arterial smooth muscle cells. Circ Res. 1975;36:319-27.

Trovati M, Massucco P, Anfossi G, Cavalot F, Mularoni E, Mattiello L, et al. Insulin influences the renin-angiotensin-aldosterone systems in humans. Metab Clin Exp. 1989;38:501-3.

Defronzo RA. The effect of insulin on renal sodium metabolism: a review with clinical implications. Diabetologia. 1981;21:165-71.

Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J, eds: Harrison’s Principles of Internal Medicine. 19thedition. New York: McGraw Hill Education; 2015;2:2450.

Judzewitch RG. Drug insulin enzyme immunoassay kit: chronic chlorpropamide therapy of non-insulin dependent diabetes augments basal and stimulated insulin secretions by increasing islet sensitivity to glucose. J Clin End Metab. 2005;55(2):321-8

Ferrannini E, Mari A. How to measure insulin sensitivity. J Hypertension. 1998;16:895-906.

Ikeda Y, Suehiro T, Nakamura T, Kumon Y, Hashimoto K. Clinical significance of the insulin resistance index as assessed by homeostasis model assessment. Endocrine Journal. 2001;48:81-6.

Bonoram E, Targher G, Alberiche M. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23:57-63.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9.

Annaswami R, Selly WE, Roland A. Body fat distribution and insulin regulation in healthy Asian Indian and Caucasian. J Clin Endocrinol Metab. 2001;86:5366-71.

Gupta AK, Jain SK. A study to evaluate surrogate markers of insulin resistance in forty euglycaemic healthy subjects. J Assoc Physicians India. 2004;5:549-53.

Misra A, Vikram KN. Insulin resistance syndrome (metabolic syndrome) and Asian Indians. Curr Sci. 2002;83:1483-96.

Chugh S, Dash RJ, Sialy R. Relationship of insulin resistance and hypertension and body habitus in north Indian subjects with a normal glucose tolerance. Indian J Nephrol. 1996;6:153-61.

Mohan V, Shanthirani S, Deepa R, Premalatha G. Intraurban differences in the prevalence of the metabolic syndrome in southern India- the Chennai urban population. Diabetes Care. 1998;21:967-71.

Mishra A, Kathpalia R, Lau SB, Peshin S. Hyperinsulinaemia in non-obese, non-diabetic subjects with isolated systolic hypertension. Indian Heart J. 1998;50:49-54.

Salagre SB, Itolikar SM, Churiwaia JJ. Prevalence and clinical profile of metabolic syndrome in hypertensive subjects. Journal Association Physicians India. 2016;64:22-4.

Alves LMM, Rigotti AR, Nogueira MS, Cesarino CB, Godoy SD. Metabolic syndrome components in arterial hypertension. Rev Esc Enferm USP. 2012;46(6):1349-54.

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Published

2017-01-23

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Original Research Articles