Does insulin resistance play a role in the pathogenesis and clinical course of patients with hypertension?

Introduction Essential hypertension is a multifactorial disease, and it is unlikely that any given abnormality will prove to be the ‘cause’ of this syndrome. Rather, a number of abnormalities are likely to predispose individuals to develop high blood pressure. In this context, recent evidence has raised the likelihood that resistance to insulin-mediated glucose uptake and/or compensatory hyperinsulinaemia may play such a role. It seems even more likely that abnormalities of glucose, insulin and lipoprotein metabolism have a profound effect on the clinical course of patients with high blood pressure. In this chapter an attempt will be made to review both these issues by addressing the following four questions. Do insulin resistance and its associated metabolic abnormalities exist in patients with essential hypertension? Do insulin resistance and/or compensatory hyperinsulinaemia play a role in the regulation of blood pressure? What are the pathophysiological mechanisms that might serve as the link between insulin resistance and essential hypertension? And finally, is there a relationship between insulin resistance and/or its consequences and the clinical course of individuals with high blood pressure?