ReviewRole of Hyperinsulinemia and Insulin Resistance in Hypertension: Metabolic Syndrome Revisited
Section snippets
Epidemiological evidence associating insulin resistance and hyperinsulinemia with hypertension
More than 30 years ago investigators observed that people with high plasma insulin concentration and insulin resistance often had higher BP compared with those with normal insulin levels.12, 13, 14, 15, 16, 17 The majority of people with insulin resistance and hyperinsulinemia also exhibited a cluster of other metabolic abnormalities, including elevated serum triglycerides, dyslipidemia with low HDL and high low-density lipoproteins, among other factors. This “metabolic syndrome” included
Mechanisms That Initiate Hypertension in Obesity and Metabolic Syndrome
The list of additional factors, besides insulin resistance and hyperinsulinemia, that have been postulated to mediate hypertension on obesity/metabolic syndrome is extensive and includes various adipokines from adipose tissue, abnormal gut microbiota, SNS activation, excess antinatriuretic hormones, deficiency of natriuretic hormones, vascular and kidney dysfunction, and other mechanisms that have been previously reviewed.84, 85, 86, 87 For many of these factors, however, clear cause and effect
Conclusions
Obesity/metabolic syndrome is a major risk factor for multiple chronic diseases including CV diseases. Many hypotheses have been proposed to explain how excess adiposity increases SNS activity, impairs kidney function, and elevates BP. One hypothesis that gained traction more than 30 years ago is that hyperinsulinemia and insulin resistance are major contributors to hypertension in people with obesity/metabolic syndrome. This hypothesis is mainly supported by epidemiologic studies showing
Funding Sources
The authors’ research was supported by National Heart, Lung, and Blood Institute (P01 HL51971), National Institute of General Medical Sciences (P20 GM104357 and U54 GM115428), National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK121411 and R00 DK113280), and the American Heart Association.
Disclosures
The authors have no conflicts of interest to disclose.
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