Insulin resistance and hypertension

Abstract

IR has been reported to be associated with elevated blood pressure and hypertension. It is reasonable to postulate that IR is causally related to increased rates of hypertension in IR, especially considering abnormalities in SNS activity, renal salt handling, and endothelial function. Other, albeit indirect, evidence for the causal role of IR in blood pressure elevation comes from studies where improvement in IR resulted in lowering of blood pressure. A likely mechanistic explanation for the association between IR and blood pressure is that adipocyte dysfunction, elevated free fatty acid levels and elevated insulin levels, over time, may adversely affect systems involved in blood pressure regulation. Since the association between IR and elevated blood pressure is not found in all populations, these studies also suggest that, depending on genetic and environmental factors, these IR-induced changes lead eventually to increased blood pressure, or diabetes, or cardiovascular disease, or any combination of these. Of these, the time-dependent effects on blood pressure, even if not detectable in all individuals as a measurable change, may be particularly signifi cant from a population perspective. Importantly, improvement in IR will likely have signifi cant overall benefi cial effects, to prevent or postpone the development of diabetes, hypertension, and cardiovascular disease.