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(Hypertension. 2008;51:e30.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Cardiovascular Autonomic Dysfunction as a Link Between Insulin Resistance and Nocturnal Blood Pressure Elevation

Internal Medicine, "San Giovanni Decollato-Andosilla" Hospital, Civita Castellana, Italy

To the Editor:

I read with interest the article by Lurbe et al¹ on the relationship between insulin resistance and the ambulatory blood pressure components in obese children and adolescents. The authors have observed that nocturnal systolic blood pressure and heart rate were significantly higher in subjects in the highest homeostasis model assessment index tertile. They conclude that the increased nocturnal blood pressure and heart rate associated with hyperinsulinemia may contribute to heightened cardiovascular risk associated with this condition. I agree with the authors, and I want suggest cardiovascular autonomic function as a possible link between insulin resistance and increased nocturnal blood pressure.

This hypothesis is supported by several pieces of evidence. Scherrer and Sartori² have observed that hyperinsulinemia activates the central sympathetic drive. Several studies performed by spectral analysis of heart rate variability have shown sympathetic hyperactivity in insulin-resistant subjects with normoglycemia.^3,4 In a previous study performed in adult subjects, Perciaccante et al⁵ have reported a relationship between insulin resistance and cardiovascular autonomic dysfunction, characterized by an impaired circadian rhythm of heart rate variability with a sympathetic hyperactivity at nighttime. Moreover, the authors have reported that this hyperactivity of sympathetic component at nighttime (evaluated by heart rate variability analysis in the frequency domain as low frequency expressed in normalized units and the low frequency:high frequency ratio) is correlated with the highest homeostasis model assessment index.

I conclude that insulin resistance has an impact on nocturnal blood pressure and heart rate, and this may be because of the effect of the insulin resistance on the cardiovascular autonomic activity.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 
1. Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual MJ, Redon J. Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescent. Hypertension. 2008; 51: 635–641.[Abstract/Free Full Text]

2. Scherrer U, Sartori C. Insulin as a vascular and sympathoexcitatory hormone. Implications for blood pressure regulation, insulin sensitivity and cardiovascular morbidity. Circulation. 1997; 96: 4104–4114.[Abstract/Free Full Text]

3. Laitinen T, Vauhkonen IK, Niskanen LK, Hartikainen JE, Lansimies EA, Uusitupa MI, Laakso M. Power spectral analysis of heart rate variability during hyperinsulinemia in nondiabetic offspring of type 2 diabetic patients: evidence for possible early autonomic dysfunction in insulin-resistant subjects. Diabetes. 1999; 48: 1295–1299.[Abstract]

4. Pikkujamsa SM, Huikuri HV, Airaksinen KE, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Kesaniemi YA. Heart rate variability and baroreflex sensitivity in hypertensive subjects with and without metabolic features of insulin resistance syndrome. Am J Hypertens. 1998; 11: 523–531.[CrossRef][Medline] [Order article via Infotrieve]

5. Perciaccante A, Fiorentini A, Paris A, Serra P, Tubani L. Circadian rhythm of the autonomic nervous system in insulin resistant subjects with normoglycemia, impaired fasting glycemia, impaired glucose tolerance, type 2 diabetes mellitus. BMC Cardiovasc Disord. 2006; 2: 6: 19–28.

This article has been cited by other articles:

				E. Lurbe Response to Cardiovascular Autonomic Dysfunction as a Link Between Insulin Resistance and Nocturnal Blood Pressure Elevation Hypertension, April 1, 2008; 51(4): e31 - e31. [Full Text] [PDF]

This Article Extract Full Text (PDF) All Versions of this Article: 51/4/e30    most recent HYPERTENSIONAHA.108.110361v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Perciaccante, A. Search for Related Content PubMed PubMed Citation Articles by Perciaccante, A. Related Collections Obesity