Insulin Resistance in Essential Hypertension

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Abstract
High blood pressure is prevalent in obesity and in diabetes, both conditions with insulin resistance. To test whether hypertension is associated with insulin resistance independently of obesity and glucose intolerance, we measured insulin sensitivity (using the euglycemic insulin-clamp technique), glucose turnover (using [3H]glucose isotope dilution), and whole-body glucose oxidation (using indirect calorimetry) in 13 young subjects (38±2 years [±SEM]) with untreated essential hypertension (165±6/112±3 mm Hg), normal body weight, and normal glucose tolerance. In the postabsorptive state, all measures of glucose metabolism were normal. During steady-state euglycemic hyperinsulinemia (about 60 μU per milliliter), hepatic glucose production and lipolysis were effectively suppressed, and glucose oxidation and potassium disposal were normally stimulated. However, total insulin-induced glucose uptake was markedly impaired (3.80±0.32 vs. 6.31±0.42 mg per minute per kilogram of body weight in 11 age- and weight-matched controls, P<0.001). Thus, reduced nonoxidative glucose disposal (glycogen synthesis and glycolysis) accounted for virtually all the defect in overall glucose uptake (1.19±0.24 vs. 3.34±0.44 mg per minute per kilogram, P<0.001). Total glucose uptake was inversely related to systolic or mean blood pressure (r = 0.76 for both, P<0.001).