Summary
We have investigated the hypothesis that insulin is a causal and independent risk factor for blood pressure elevation in humans by comparing pre- and post-operative blood pressure values of 34 consecutive patients with histologically-confirmed diagnosis of insulinoma and 34 age- and sex-matched control patients. In patients with insulinoma hypoglycaemic symptoms were present for 18 (9–36) months. (Values are given as median and 95% confidence interval or mean and SD). After removal of insulinoma fasting plasma insulin levels decreased from 22 (16–28) mU/l to 11 (6–20) mU/l (p<0.003) and minimal fasting plasma glucose concentrations increased from 2.5 (2.0–3.0) to 4.4 (4.2–5.7) mmol/l (p<0.002) while blood pressure values remained unchanged. Body mass index before operation was comparable between the groups: 25.5 (5.4) kg/m2 in insulinoma patients and 24.8 (4.7) kg/m2 in control subjects. Pre-operative and post-operative blood pressure values did not differ between the groups, being (systolic/diastolic) 133 (18)/82 (9) mm Hg in insulinoma patients and 128 (15)/78 (10) mm Hg in control subjects before and 129 (19)/80 (10) mm Hg and 125 (11)/76 (7) after surgery. Chronic hyperinsulinaemia in patients with insulinoma is not associated with a detectable elevation of blood pressure values. Correction of hyperinsulinaemia after surgery for insulinoma does not result in blood pressure changes. These results argue against the hypothesis that insulin is an independent causal factor in the development of essential hypertension in humans.
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References
Ferrannini E, Buzzigoli G, Bonadonna R et al. (1987) Insulin resistance in essential hypertension. N Engl J Med 317: 350–357
Modan M, Halkin L, Almog S et al. (1985) Hyperinsulinemia — A link between hypertension obesity and glucose intolerance. J Clin Invest 75: 805–817
Laakso M, Sarlund H, Mykkänen L (1989) Essential hypertension and insulin resistance in non-insulin-dependent diabetes. Eur J Clin Invest 19: 518–526
Reaven PD, Hoffman BB (1987) A role for insulin in the aetiology and course of hypertension? Lancet II: 435–436
Troisi RJ, Weiss ST, Parker DR, Sparrow D, Young JB, Landsberg L (1991) Relation of obesity and diet to sympathetic nervous system activity. Hypertension 17: 669–677
DeFronzo RA, Goldberg M, Agnus Z (1976) The effects of glucose and insulin in renal electrolyte transport. J Clin Invest 58: 83–90
Rocchini AP, Katch V, Kveselis D et al. (1989) Insulin and renal sodium retention in obese adolescents. Hypertension 14: 367–374
Halkin H, Modan M, Shefi M, Almog S (1988) Altered erythrocyte and plasma sodium and potassium in hypertension, a facet of hyperinsulinemia. Hypertension 11: 71–77
Dean JD, Jones CJH, Hutchison SJ, Peters JR, Henderson AH (1991) Hyperinsulinaemia and microvascular angina (“syndrome X”). Lancet II: 456–457
Krotkiewski M, Mandroukas K, Sjostrom L, Sullivan L, Wetterauist H, Bjorntorp P (1979) Effects of long-term physical training on body fat, metabolism and blood pressure in obesity. Metabolism 28: 650–658
Landsberg L (1987) Insulin and hypertension: lessons from obesity. N Engl J Med 317: 378–379
Alexander WD, Oake RJ (1977) The effect of insulin on vascular reactivity to norepinephrine in diabetes. Diabetes 26: 611–614
Hall JE, Coleman TG, Mizelle HL (1989) Does chronic hyperinsulinemia cause hypertension? Am J Hypertens 2: 171–173
Berger M, Bordi C, Cüppers HJ et al. (1983) Functional and morphologic characterisation of human insulinomas. Diabetes 32: 921–931
Zar JH (1984) Biostatistical analysis, 2nd edn. Prentice Hall, New Jersey, pp 134–137
Nankervis A, Proitto J, Aitken P, Alford F (1985) Hyperinsulinaemia and insulin insensitivity: studies in subjects with insulinoma. Diabetologia 28: 427–431
Tsutsu N, Nunoi K, Kodama T, Nomiyama R, Iwase M, Fujishima M (1990) Lack of association between blood pressure and insulin in patients with insulinoma. J Hypertens 8: 479–482
Swislocki AL, Hoffman BB, Reaven GM (1989) Insulin resistance, glucose intolerance and hyperinsulinemia in patients with hypertension. Am J Hypertens 2: 419–423
Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A (1987) Altering reaction and rise in blood pressure during measurement by physician and nurse. Hypertension 9: 209–215
Hall JE, Brands MW, Kivlighn SD et al. (1990) Chronic hyperinsulinemia and blood pressure. Interactions with catecholamines? Hypertension 15: 519–527
Mbanya JCN, Thomas TH, Wilkinson R, Alberti KGMM, Taylor R (1988) Hypertension and hyperinsulinemia: a relation in diabetes but not essential hypertension. Lancet I: 733–734
Saad MF, Lillioja S, Nyomba BL et al. (1991) Racial differences in the relation between blood pressure and insulin resistance. N Engl J Med 324: 733–739
Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett PH (1990) Insulin and hypertension. Relationship to obesity and glucose intolerance in Pima Indians. Diabetes 39: 1430–1435
Mathias CJ, da Costa DF, Fosbraey P, Christensen NJ, Bannister P (1987) Hypotensive and sedative effects of insulin in autonomic failure. Br Med J 295: 161–163
Sowes JR, Khoury S, Standley P, Zemel P, Zemel M (1991) Mechanisms of hypertension in diabetes. Am J Hypertens 4: 177–182
Paolisso G, De Riu S, Marrazzo G, Verza M, Varricchio M, D'Onofria F (1991) Insulin resistance and hyperinsulinemia in patients with chronic heart failure. Metabolism 40: 972–977
Jaspan JB, Mako ME, Kuzuya H, Blix P, Horwitz DL, Rubenstein AH (1977) Abnormalities in circulating beta cell peptide in chronic renal failure: comparison of C-peptide, pro-insulin and insulin. J Clin Endocrinol Metab 45: 441–445
Stout RW (1977) The relationship of abnormal circulating insulin levels to atherosclerosis. Atherosclerosis 27: 1–13
Thomas BJ, Jarrett RJ, Keen H, Ruskin HJ (1982) Relation of habitual diet to fasting plasma insulin concentrations and the insulin response to oral glucose. Hum Nutr Clin Nutr 36: 49–56
Björntorp P, de Jounge K, Sjöstrom L, Sullivan L (1970) The effect of physical training on insulin production in obesity. Metabolism 19: 631–638
Peiris AN, Mueller RA, Smith GA, Struve MF, Kissebah AH (1986) Splanchnic insulin metabolism in obesity: influence of body fat distribution. J Clin Invest 78: 1648–1657
Cigolini M, Seidel JC, Charzewska J et al. (1991) Fasting serum insulin in relation to fat distribution, serum lipid profile and blood pressure in European women: the European fat distribution study. Metabolism 8: 781–787
Hales CN, Barker DJP, Clark PMS et al. (1991) Fetal and infant growth and impaired glucose tolerance at age 64. Br Med J 303: 1019–1922
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Sawicki, P.T., Heinemann, L., Starke, A. et al. Hyperinsulinaemia is not linked with blood pressure elevation in patients with insulinoma. Diabetologia 35, 649–652 (1992). https://doi.org/10.1007/BF00400257
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DOI: https://doi.org/10.1007/BF00400257