Insulin Resistance the Hinge Between Hypertension and Type 2 Diabetes
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Insulin Resistance the Hinge Between Hypertension and Type 2 Diabetes Costantino Mancusi1 · Raffaele Izzo1 · Giuseppe di Gioia1 · Maria Angela Losi1 · Emanuele Barbato1 · Carmine Morisco1 Received: 25 July 2020 / Accepted: 5 September 2020 © The Author(s) 2020
Abstract Epidemiological studies have documented a high incidence of diabetes in hypertensive patients.Insulin resistance is defined as a less than expected biologic response to a given concentration of the hormone and plays a pivotal role in the pathogenesis of diabetes. However, over the last decades, it became evident that insulin resistance is not merely a metabolic abnormality, but is a complex and multifaceted syndrome that can also affect blood pressure homeostasis. The dysregulation of neurohumoral and neuro-immune systems is involved in the pathophysiology of both insulin resistance and hypertension. These mechanisms induce a chronic low grade of inflammation that interferes with insulin signalling transduction. Molecular abnormalities associated with insulin resistance include the defects of insulin receptor structure, number, binding affinity, and/or signalling capacity. For instance, hyperglycaemia impairs insulin signalling through the generation of reactive oxygen species, which abrogate insulin-induced tyrosine autophosphorylation of the insulin receptor. Additional mechanisms have been described as responsible for the inhibition of insulin signalling, including proteasome-mediated degradation of insulin receptor substrate 1/2, phosphatase-mediated dephosphorylation and kinase-mediated serine/threonine phosphorylation of both insulin receptor and insulin receptor substrates. Insulin resistance plays a key role also in the pathogenesis and progression of hypertension-induced target organ damage, like left ventricular hypertrophy, atherosclerosis and chronic kidney disease. Altogether these abnormalities significantly contribute to the increase the risk of developing type 2 diabetes. Keywords Cardiovascular risk · Left ventricular hypertrophy · Atherosclerosis · Microalbuminuria · Vascular inflammation
1 Essential Hypertension and Type 2 Diabetes the Link Essential hypertension is characterised by both hemodynamic and metabolic abnormalities. Epidemiological studies have documented a high incidence of diabetes in hypertensive patients. The Women’s Health Study [1] showed that in healthy, middle-aged women, blood pressure (BP), and BP progression are strong and independent predictors of incident type 2 diabetes (T2D). Similarly, the Monitoring Trends and Determinants on Cardiovascular Diseases/Cooperative Health Research in the Region of Augsburg Cohort Study [2] showed that high normal BP, as well as, established hypertension * Carmine Morisco [email protected] 1
Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini n. 5, 80131 Naples, Italy
were strongly and independently related to the development of an incident T2Din men. However, in women only established hypertension sig
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