Insulin Resistance, Hypertension, and Coronary Heart Disease

Gerald Reaven, MD

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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Reprint Address

Gerald Reaven, MD, Falk CVRC, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5406. E-mail: greaven@cvmed.stanford.edu.

Cite this: Insulin Resistance, Hypertension, and Coronary Heart Disease - Medscape - Jul 01, 2003.

Table I. Mean ( ± SE) Plasma Lipid and Lipoprotein Concentrations in Normotensive Individuals as a Function of Family History of Hypertension
Variable (mmol/L)	Positive Family History	Negative Family History	p Value
Cholesterol (C)	4.80 ± 0.15	4.44 ± 0.12	<0.07
VLDL-C	0.50 ± 0.06	0.23 ± 0.03	<0.001
IDL-C	0.34 ± 0.07	0.21 ± 0.02	<0.08
LDL-C	2.65 ± 0.12	2.54 ± 0.10	NS
HDL-C	1.34 ± 0.06	1.47 ± 0.05	<0.10
VLDL+IDL+LDL-C	3.47 ± 0.14	3.00 ± 0.11	<0.003
Ratio of C/HDL-C	3.84 ± 0.18	3.09 ± 0.11	<0.001
Triglyceride (TG)	1.15 ± 0.07	0.76 ± 0.05	<0.001
VLDL-TG	0.71 ± 0.07	0.40 ± 0.04	<0.001
IDL-TG	0.14 ± 0.02	0.10 ± 0.01	NS
LDL-TG	0.19 ± 0.01	0.16 ± 0.01	<0.05
HDL-TG	0.11 ± 0.01	0.09 ± 0.01	<0.06

Table II. Mean ( ± SE) Lipid and Lipoprotein Concentrations in Hypertensive Subjects With and Without ECG Evidence of Ischemic Changes
Group	Cholesterol (mmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	Cholesterol/ HDL-C (Ratio)	Triglyceride (mmol/L)
Control (n=25)	5.05 ± 0.24	3.11 ± 0.22	1.36 ± 0.08	3.95 ± 0.31	1.16 ± 0.12
Normal ECG (n=24)	4.79 ± 0.19	3.03 ± 0.18	1.28 ± 0.07	4.00 ± 0.25	1.21 ± 0.14
Abnormal ECG (n=29)	5.36 ± 0.18	3.39 ± 0.17	1.10 ± 0.06*	5.04 ± 0.23**	1.81 ± 0.13**

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Insulin Resistance, Hypertension, and Coronary Heart Disease

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