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Diabetes Care 30:e107 2007
DOI: 10.2337/dc07-1344
© 2007 by the American Diabetes Association
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Online Letters: Comments and Responses

Insulin Resistance and Hyperinsulinemia Are Related to Plasma Aldosterone Levels in Hypertensive Patients

Response to Perciaccante et al.

GianLuca Colussi, MD, Cristiana Catena, MD, PHD, Roberta Lapenna, MD, Elisa Nadalini, MD, Alessandra Chiuch, MD and Leonardo A. Sechi, MD

From the Division of Internal Medicine, Hypertension and Diabetes Unit, Department of Experimental and Clinical Pathology and Medicine, University of Udine, Udine, Italy

Address correspondence to Leonardo A. Sechi, MD, Clinica Medica, University of Udine, Department of Experimental and Clinical Pathology and Medicine (DPMSC), Piazzale S. Maria della Misericordia, 1, 33100 Udine, Italy. E-mail: sechi{at}uniud.it

Perciaccante et al. (1) commented on our article (2) and underlined the relevance that an activated autonomic nervous system might have as a potential link between insulin resistance and hypertension. The possibility that sympathetic hyperactivity contributes to the prohypertensive action of insulin resistance and hyperinsulinemia was suggested more than 25 years ago (3). Initial studies had shown that acute insulin infusion increases plasma norepinephrine (NE) levels even when plasma glucose concentration is maintained constant (4) and that overfeeding-induced hyperinsulinemia increases NE turnover (5). Additionally, muscle sympathetic nerve activity had been shown to increase in a dose-dependent manner during a hyperinsulinemic-euglycemic clamp (6), and, more recently, an association between a nondipper status as a reflection of an unbalanced autonomic nervous system and more prominent insulin resistance has been reported in essential hypertension (7).

These findings were challenged by large population studies in which no significant association was found between plasma NE and insulin sensitivity (8). We investigated the relationship between the sympathetic nervous system and parameters of glucose metabolism in 77 patients with essential hypertension; however, we did not observe a relationship between urinary NE and both fasting and postglucose load plasma insulin and C-peptide (9).

Thus, we agree that multiple pathophysiological mechanisms, possibly including sympathetic hyperactivity, might be involved in the development and maintenance of hypertension in subjects with insulin resistance (10).

References

  1. Perciaccante A, Fiorentini A, Valente R, Di Stefano A, Tubani L: Insulin resistance and hyperinsulinemia are related to plasma aldosterone levels in hypertensive patients (Letter). Diabetes Care 30:e106, 2007. DOI:10.2337/dc07-1176[Free Full Text]
  2. Colussi G, Catena C, Lapenna R, Nadalini E, Chiuch A, Sechi LA: Insulin resistance and hyperinsulinemia are related to plasma aldosterone levels in hypertensive patients. Diabetes Care 30:2349–2354, 2007[Abstract/Free Full Text]
  3. De Fronzo RA: The effect of insulin on renal sodium metabolism: a review with clinical implications. Diabetologia 21:161–171, 1981[Medline]
  4. Rowe JW, Young JB, Minaker KL, Stevens Al, Pallotta J, Landsberg L: Effect of insulin and glucose infusions on sympathetic nervous system in normal man. Diabetes 30:219–225, 1981[Medline]
  5. Young JB, Landsberg L: Stimulation of the sympathetic nervous system during sucrose feeding. Nature 269:615–617, 1977[Medline]
  6. Anderson EA, Hoffman RP, Balon TW, Sinkey CA, Mark AL: Hyperinsulinemia produces both sympathetic neural activation and vasodilation in normal humans. J Clin Invest 87:2246–2252, 1991[Medline]
  7. Della Mea P, Lupia M, Bandolin V, Guzzon S, Sonino N, Vettor R, Fallo F: Adiponectin, insulin resistance, and left ventricular structure in dipper and nondipper essential hypertensive patients. Am J Hypertens 18:30–35, 2005[Medline]
  8. Clausen JO, Ibsen H, Dige-Petersen H, Borch-Johnsen K, Pedersen O: The importance of adrenaline, insulin and insulin sensitivity as determinants of blood pressure in young Danes. J Hypertens 13:499–505, 1995[Medline]
  9. Sechi LA, Catena C, Zingaro L, De Carli S, Bartoli E: Hypertension and abnormalities of carbohydrate metabolism: possibile role of the sympathetic nervous system. Am J Hypertens 10:678–682, 1997[Medline]
  10. Sechi LA, Bartoli E: Mechanisms of insulin resistance leading to hypertension: what we can learn from experimental models. J Investig Med 45:238–251, 1997[Medline]

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This Article
Right arrow Extract Freely available
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