Insulin Resistance, Hypertension, and Coronary Heart Disease

Gerald Reaven, MD

Disclosures
In This Article

Conclusion

Patients with high blood pressure, as a group, are insulin resistant, glucose intolerant, hyperinsulinemic, and dyslipidemic, with evidence of endothelial dysfunction. There is substantial evidence supporting the view that insulin resistance and/or compensatory hyperinsulinemia have a role in blood pressure regulation and may predispose a substantial number of individuals to develop high blood pressure. Of greater immediate clinical import is the fact that the abnormalities of glucose, insulin, lipid metabolism, and endothelial dysfunction that exist in substantial numbers of patients with high blood pressure seem to be a consequence of their insulin resistance. These insulin-resistance-associated changes are mainly responsible for the increased CHD morbidity and mortality that characterizes patients with essential hypertension. Given this information, it seems prudent to enlarge the scope of our therapeutic approach to patients with hypertension and to realize that blood pressure lowering is necessary, but not sufficient, if the goal is to reduce CHD in patients with essential hypertension. More succinctly, efforts at global CHD risk reduction must be implemented.

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