Insulin resistance and hypertension.

While clinicians have long recognized the apparent increased prevalence of hypertension among diabetics, sophisticated epidemiological analyses begun in the early 1970s have established that hypertensive individuals are more prone to hyperinsulinemia and glucose intolerance than normotensive individuals. Subsequently, the several hypertensinogenic effects of insulin were carefully studied in a number of laboratories. Most recently, the association of these two relatively common cardiovascular risk factors, hypertension and insulin resistance, was broadened to include lipid abnormalities, namely, increased concentrations of very low density lipoprotein triglycerides and decreased concentrations of high density lipoprotein cholesterol. These abnormalities, all of which appear in association more commonly than would be expected by chance, clearly predispose affected individuals to increased cardiovascular risk. This review summarizes our current understanding of the mechanisms underlying the relations between insulin resistance and hypertension and focuses discussion on the role of insulin as a common link between them. It concludes with recommendations, based on today's knowledge, for behavioral and therapeutic interventions aimed at the prevention of increased cardiovascular risk.