[NATAP] Insulin resistance common in men with treated hypertension

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Insulin resistance common in men with treated hypertension

By Will Boggs, MD

NEW YORK (Reuters Health) - Insulin resistance is common among men with treated hypertension, but conventional risk factors do not reliably diagnosis the condition, UK researchers report.

"This sub-group of patients with hypertension is likely to benefit from targeted treatment," Dr. Mobin Mohteshamzadeh from Royal Liverpool University Hospital told Reuters Health.

Dr. Mohteshamzadeh and colleagues investigated the frequency of insulin resistance among treated 106 hypertensive men who were considered to have a high risk of cardiovascular disease and 18 healthy controls.

Twenty-one of the 106 patients were insulin resistant, 36 were insulin sensitive, and 49 fell into an intermediate group, the authors report. Mean blood pressure did not differ in the three groups.

Body mass index, triglyceride levels, and glucose levels were higher and HDL cholesterol levels were lower in the insulin-resistant group than in the insulin-sensitive group, the researchers note, but there was substantial overlap between the groups.

"Only the plasma glucose identified a useful number of insulin-resistant patients," the investigators write, "and even in this case only one-third of affected patients were detected."

During 3 years of follow-up, two patients in the insulin-resistant group and one patient in the intermediate group were diagnosed with type 2 diabetes, the results indicate. None of the insulin-sensitive patients developed diabetes.

"One may argue that patients with hypertension and insulin resistance are at increased risk of cardiovascular disease and as such should be treated to the same [blood pressure] targets as patients with diabetes mellitus," Dr. Mohteshamzadeh said. "Unfortunately, as yet we cannot back this up with outcome data."

"Patients with hypertension and insulin resistance are likely to need multiple drugs to control their blood pressure and the question is which drugs," Dr. Mohteshamzadeh said. "We know some drugs have been associated with an increased incidence of diabetes mellitus and as such perhaps these drugs should be avoided in these patients."

"The next question is what happens when we use agents to improve insulin resistance over and above blood pressure control, such as thiazolidines, metformin, and modern antihypertensive agents," Dr. Mohteshamzadeh added. "There are some on-going studies that will hopefully shed light on this matter."

The findings are published in the April issue of the American Journal of Hypertension.

Am J Hypertens 2005;18:452-456.