本態性高血圧におけるインスリン感受性の病態的意義インスリン抵抗性群と非インスリン抵抗性群の比較
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Insulin resistance and hyperinsulinemia have been reported to be linked with essential hypertension and it's complications. But a wide ranging variation in insulin sensitivity has been observed in essential hypertensives, indicating that there are insulin resistant and non-resistant essential hypertensives. To clarify the characteristics of insulin resistant essential hypertensives, the euglycemic hyperinsulinemic glucose clamp technique and the 75 g oral glucose tolerance test (OGTT) was applied in 28 normotensives (NT) and 51 essential hypertensives (EHT). Insulin sensitivity was evaluated as M value (metabolic clearance rate of glucose, mg/m2/min). Mean-1SD of M value in NT (145.0 mg/m2/min) was chosen as the cut- off limit for insulin resistance. At this cut-off limit, EHT were divided into two groups; insulin resistant essential hypertensives (EHT-R, M value<145.0 mg/m2/min) and insulin non-resistant essential hypertensives (EHT-N, M value≧145.0mg/m2/min). Blood samples were collected before GC to measure fasting blood sugar (FBS), plasma immunoreactive insulin level (F-IRI), total cholesterol (TC), triglyceride (TG), free fatty acid (FFA), high density lipoprotein-cholesterol (HDL-C), plasma norepinephrine level (PNE) and plasma renin activity (PRA). There was no significant difference between NT, EHT-R and EHT-N in age and body mass index. EHT-R showed significantly lower M value than NT and EHT-N, but no difference was observed between EHT-N and NT. EHT-R showed significantly higher FBS, summation of blood sugar levels during the OGTT and significantly higher F-IRI, summation of insulin levels and value of insulin level at 120 minutes into the OGTT when compared with NT and EHT-N. EHT-R showed higher FFA and TG, and lower HDL-C than the other two groups, but no significant difference was observed in TC between the three groups. PNE was significantly higher in EHT-R than in NT, while no difference was observed between NT and EHT-N. There was no significant difference between the three groups in PRA. In summary, 1) EHT-N showed no difference in glucose and lipid metabolisms compared with NT, 2) in EHT-R, hyperinsulinemia and metabolic disturbance in lipid and glucose were observed, and 3) PNE and F-IRI were higher in EHT-R than in EHT-N and NT. These results suggest that EHT-R might have more risk factors for arteriosclerotic complications than EHT-N. Increased PNE observed in EHT-R, possibly due to increased insulin, might be one of the causes of blood pres sure elevation in this group.
- 札幌医科大学の論文
- 1996-12-01
札幌医科大学 | 論文
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