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Abstract

Hyperinsulinemia and insulin resistance are frequently claimed to correlate with, and possibly even cause an increase in urinary albumin excretion (UAE) in essential hypertensive patients (EH). The evidence on this topic is controversial, however, and to achieve a better understanding of this still unsettled issue, we evaluated the behaviour of UAE in EH characterised by markedly different degrees of insulin resistance (IR).

123 glucose-tolerant (2-hr plasma glucose <140mg/dl following a 75g glucose load), mild-moderate, never treated hypertensive males were screened. 88 were normotriglyceridemic (NTG, serum triglycerides, TG>170 mg/dl, 50±11yrs, BP: 150±16/94±13 mmHg) and 35 had elevated TG (HTG, serum triglycerides, TG>170 mg/dl, 49±9yrs, BP:150±13/94±10 mmHg), a typical phenotype of the IR syndrome. Evaluation variables were urine albumin excretion (UAE, the mean of 3 overnight collections, immunonephelometry), fasting plasma glucose (GLUC), serum insulin (INS)to derive the HOMA index (fasting insulin (μU/ml)/[22.5 x e-ln (glucose [mmol/L))as a measure of insulin sensitivity, as well as circulating lipids, BMI, left ventricular mass index (LVMI, 2D echocardiography).

As a result of the selection procedure, TG were much higher in HTG than NTG (249[52] vs 119 [23] mg/dl). Correspondingly, HDL cholesterol was lower (39±10 vs 49±12 mg/dl, p<0.001, fasting INS higher (14.6 [6.1] vs 9.7 [5.6] mU/ml, p=0.001)and GLUC superimposable (97±8 vs 98±8mg/dl). As a consequence, the HOMA index was almost twofold higher in HTG (4.2[2.2] vs 2.7 [1.4], p=0.005), but, in spite of an evidently impaired insulin sensitivity, UAE was closely superimposable between the HTG and NTG subgroups (8.7 [10] vs 8.8 [10] [mug/min). LDL cholesterol (128±39 vs 134±43 mg/dl), BMI (27.4±2.5 vs 26.8±2.9 Kg/m2) and LVMI (57±12 vs 57±13 g/m2) did not differ.

UAE was unequivocally dissociated from hyperinsulinemia and IR in these glucose-tolerant essential hypertensive patients with hypertriglyceridemia and a markedly impaired insulin sensitivity. An increased UAE is unlikely to represent a correlate of the underlying IR status.

albuminuria, insulin resistance, hypertriglyceridemia
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© American Journal of Hypertension, Ltd. 2001
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