Insulin resistance in patients with hypertension

Parts of which are impaired glucose tolerance or type 2 DM, AH, dyslipidemia, and atherosclerosis. Although hyperinsulinemia is a well-known independent risk factor for the development of coronary artery disease and atherosclerosis, it has been shown that hyperinsulinemia contributes not only to the development of atherosclerosis, but also to hypertension. Hyperinsulinemia may cause hypertension due to a change in the ratio of cytoplasmic calcium and calcium in vascular smooth muscle cells, which enhances their contractile activity; due to vascular rearrangement, as well as due to the development of atherosclerotic lesions. It was shown that insulin resistance resulting from various receptor disorders, both at the level of the liver,and peripheral tissues (in patients with an insulin-dependent form of type 2 diabetes, there may be a combined defect in the secretion of endogenous insulin), hypertension is supported, which at the same time forms the basis for carbohydrate metabolism disorders due to early violation of muscle tissue sensitivity to the action of insulin.

A number of studies were devoted to studying the direct effect of blood glucose concentration on blood pressure formation, which made it possible to draw conclusions about the dependence of blood pressure in patients with type 2 diabetes on the duration of hypertension and the degree of compensation of diabetes assessed by glycosylated hemoglobin. This dependence is expressed in the following equation:

Systolic blood pressure = 0.83 X1 + 0.68 X2 – 2.57 X3 + 100.8 (r = 0.6),

where X1 is the diastolic blood pressure, X2 is the duration of arterial hypertension, X3 is Hb A1c.

This formula shows that the longer the patient suffers from hypertension, the higher the level of diastolic blood pressure and the worse the compensation of diabetes, the higher the systolic blood pressure.

The weight of the patient, the nature and degree of obesity, age and gender undoubtedly are important for the prediction of the course of these conditions, but a clear mathematical relationship for these factors has not been established.

It was shown that the state of carbohydrate metabolism (glycemia level and other factors) has the greatest influence on the formation of hypertension in patients with diabetes. Insulin resistance and hyperinsulinemia in type 2 diabetes lead to impaired lipid metabolism. The nature of dyslipidemia and hypertriglyceridemia are determined, as was shown, by the type of diabetes mellitus. In type 2 diabetes insulin deficiency causes a decrease in The activity of lipoprotein lipase which leads to hyperlipidemia, hyper- triglyceridemia, lower-cholesterol, disruption of blood lipoprotein spectrum (higher content of atherogenic pre-lipoproteidov and reduce – lipoproteins). In this case, a direct correlation is observed between the level of systolic blood pressure and total blood cholesterol, as well as the levels of immunoreactive insulin, pre – лип-lipoproteids and triglycerides. The above violations make a significant contribution to the risk of developing cardiovascular complications in diabetes and especially in diabetes mellitus type 2.

local_offerevent_note September 3, 2019

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