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(Hypertension. 1998;31:632-636.)
© 1998 American Heart Association, Inc.

Scientific Contributions

Vasodilation With Sodium Nitroprusside Does Not Improve Insulin Action in Essential Hypertension

Andrea Natali; Alfredo Quiñones Galvan; Neda Pecori; Giovanna Sanna; Elena Toschi; ; Ele Ferrannini

From the Metabolism Unit of the CNR Institute of Clinical Physiology and the Department of Internal Medicine, University of Pisa, Pisa, Italy.

Correspondence to Dr Andrea Natali, CNR Institute of Clinical Physiology, Via Savi, 8, 56100 Pisa, Italy. E-mail pisamet{at}po.ifc.pi.cnr.it

Abstract—The vasodilation induced by systemic insulin infusion is mediated by nitric oxide and is impaired both in obese subjects and patients with essential hypertension. Whether this vascular defect explains the metabolic resistance to insulin action is uncertain. In 8 overweight male patients with essential hypertension, we used the double forearm (ie, infused versus control) technique, combined with the euglycemic hyperinsulinemic clamp, to test whether sustained vasodilation (induced by intra-arterial sodium nitroprusside infusion) improves insulin-mediated glucose uptake. During the clamp, whole-body glucose disposal rose to 24.4±2.9 µmol · min^-1 · kg^-1. Forearm blood flow in the control forearm was stable (3.1±0.4 versus 2.9±0.3 mL · min^-1 · dL^-1), while in the infused forearm it increased from 3.4±0.5 to 10.6±1.3 mL · min^-1 · dL^-1 in response to sodium nitroprusside. During insulin administration, tissue glucose extraction rose from 2±1% to 21±4% (P<.001) in the control forearm and from 2±1% to 8±3% in the infused forearm (P<.02 versus baseline for both); the calculated net glucose uptake reached similar plateaus in the two forearms (3.5±0.7 versus 3.7±0.6 µmol · min^-1 · kg^-1, control versus infused, P=.6). We conclude that in overweight male patients with essential hypertension, increasing forearm perfusion with sodium nitroprusside does not attenuate the insulin resistance of forearm tissues.

Key Words: hypertension, essential • insulin resistance • sodium nitroprusside • forearm

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