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(Hypertension. 1998;32:243-248.)
© 1998 American Heart Association, Inc.

Scientific Contributions

Insulin Resistance and the Effect of Insulin on Blood Pressure in Essential Hypertension

Tim Heise; Kai Magnusson; Lutz Heinemann; ; Peter T. Sawicki

From the Department of Metabolic Diseases and Nutrition, Heinrich-Heine University, Düsseldorf, Germany (WHO Collaborating Center for Diabetes).

Abstract—The aim of this study was to investigate the effect of 2 weeks of insulin administration on blood pressure and to simultaneously measure insulin sensitivity and insulin-induced vasodilatation in obese hypertensive patients. In a prospective, randomized, double-blind, crossover study (study 1), 23 obese, untreated, nondiabetic, hypertensive patients received either neutral protamine Hagedorn (NPH) insulin (0.3 U/kg body wt per day) or placebo subcutaneously for 2 weeks (washout period, 2 weeks). Office and 24-hour blood pressure values were measured at the beginning and end of each treatment period. In an open-label study (study 2), 8 obese hypertensive patients and 10 healthy control subjects underwent a 3-step hyperinsulinemic, euglycemic glucose clamp (step 1, 0.5; step 2, 2.5; step 3, 5.0 mU · kg^-1 · min^-1 [120 minutes each]). Leg blood flow (LBF) was measured by venous occlusion plethysmography. Insulin administration decreased mean±SD office blood pressure from 131±13 to 128±12 mm Hg (placebo, 132±13 and 132±13 mm Hg; P<0.05 between final examinations) and mean±SD 24-hour blood pressure by -3.3±6.9 mm Hg (placebo, +0.7±4.6 mm Hg; P<0.05). Insulin infusion increased LBF significantly in the healthy controls but not in obese insulin-resistant hypertensive subjects. Obese hypertensive patients are resistant to the effects of insulin with regard to both glucose uptake and vasodilatation. Administration of insulin exerts a small blood pressure–lowering effect in these patients. These data strongly argue against the postulated pressor action of insulin in essential hypertension.

Key Words: insulin • insulin resistance • hypertension, essential • blood flow • vasodilation

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