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

¹Division of Internal Medicine, Hypertension and Diabetes Unit, Department of Experimental and Clinical Pathology and Medicine, University of Udine, 33100 Udine, Italy

sechi{at}uniud.it

ABSTRACT

Objective.: Association between aldosterone and insulin resistance has been demonstrated in obesity, primary aldosteronism, and in blacks with the metabolic syndrome. The aim of this study was to evaluate the relationship of plasma aldosterone with insulin sensitivity in white subjects.

Research Design and Methods.: In 356 patients with essential hypertension and 102 normotensive controls of comparable age and BMI, we measured, after discontinuation of treatment, plasma active renin, aldosterone, cortisol, glucose, insulin, and C-peptide levels, and calculated markers of insulin sensitivity. Direct assessment of insulin sensitivity was obtained in a subset of 64 hypertensive patients by a hyperinsulinemic clamp.

Results.: Hypertensive patients had significantly greater fasting plasma insulin and C-peptide concentrations, and HOMA index than normotensive controls. Positive association with increasing plasma aldosterone concentrations was demonstrated for plasma glucose, insulin, C-peptide, and HOMA. Assessment of insulin sensitivity by the clamp showed significant decrease of the metabolic clearance rate (MCR) of glucose with increasing aldosterone levels. Significant correlations were found between plasma aldosterone and plasma insulin, and C-peptide levels, HOMA, and glucose MCR. Blood pressure and plasma potassium, plasma cortisol, and renin levels, but not BMI, were also directly correlated with plasma aldosterone. Multiple regression analysis showed that HOMA, together with plasma potassium, cortisol, and renin levels, was independently correlated with plasma aldosterone.

Conclusions.: This study demonstrates a direct relationship between aldosterone, insulin resistance, and hyperinsulinemia in white subjects. In patients with hypertension this relationship might contribute to maintenance of high blood pressure and increase cardiovascular risk.

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