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The Renin Angiotensin Aldosterone System and Insulin Resistance in Humans

  • Hypertension and the Kidney (RM Carey and A Mimran, Section Editors)
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Abstract

Alterations in the renin angiotensin aldosterone system (RAAS) contribute to the underlying pathophysiology of insulin resistance in humans; however, individual differences in the treatment response of insulin resistance to RAAS blockade persist. Thus, understanding inter-individual differences in the relationship between the RAAS and insulin resistance may provide insights into improved personalized treatments and improved outcomes. The effects of the systemic RAAS on blood pressure regulation and glucose metabolism have been studied extensively; however, recent discoveries on the influence of local tissue RAAS in the skeletal muscle, heart, vasculature, adipocytes, and pancreas have led to an improved understanding of how activated tissue RAAS influences the development of insulin resistance and diabetes in humans. Angiotensin II (ANGII) is the predominant RAAS component contributing to insulin resistance; however, other players such as aldosterone, renin, and ACE2 are also involved. This review examines the role of local ANGII activity on insulin resistance development in skeletal muscle, adipocytes, and pancreas, followed by a discussion of the other RAAS components implicated in insulin resistance, including ACE2, Ang1-7, renin, and aldosterone.

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  1. Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave., Boston, MA, 02115, USA

    Patricia C. Underwood & Gail K. Adler

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  1. Patricia C. Underwood
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  2. Gail K. Adler
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Correspondence to Gail K. Adler.

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This work is supported by NIH/NHLBI K24HL103845 (Adler, PI) and NIH/NINR F32NR013318 (Underwood, PI).

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Underwood, P.C., Adler, G.K. The Renin Angiotensin Aldosterone System and Insulin Resistance in Humans. Curr Hypertens Rep 15, 59–70 (2013). https://doi.org/10.1007/s11906-012-0323-2

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