Nocturnal blood pressure elevation is related to adrenomedullary hyperactivity, but not to hyperinsulinemia, in nonobese normoalbuminuric type 1 diabetes
| Autor: | Wolfgang Kerner, D Look, S Gromeier, T Kohlmann, Annette Peters |
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| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty Ambulatory blood pressure Adolescent Epinephrine Endocrinology Diabetes and Metabolism medicine.medical_treatment Clinical Biochemistry Biochemistry Body Mass Index chemistry.chemical_compound Norepinephrine Endocrinology Internal medicine Diabetes mellitus Hyperinsulinemia medicine Albuminuria Humans Insulin Aldosterone Type 1 diabetes business.industry Biochemistry (medical) medicine.disease Circadian Rhythm Blood pressure Diabetes Mellitus Type 1 chemistry Adrenal Medulla Hypertension Multivariate Analysis Female business Hyperinsulinism |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 81(2) |
| ISSN: | 0021-972X |
| Popis: | We tested the hypothesis that insulin is an independent risk factor for elevated blood pressure. As our model we selected type 1 diabetes with peripheral circulatory hyperinsulinemia induced by sc insulin treatment. In 15 nonobese normoalbuminuric patients with type 1 diabetes (23.7 +/- 0.8 yr old) and in 15 healthy controls matched for age, sex, and body weight, ambulatory blood pressure was recorded over 24 h. The areas under the curve of free insulin (605 +/- 135 vs. 275 +/- 35 pmol/L.h; P = 0.03) and basal plasma epinephrine concentrations were higher (170 +/- 10 vs. 130 +/- 10 pmol/L; P = 0.02), and the basal aldosterone level was lower (220 +/- 40 vs. 410 +/- 50 pmol/L; P = 0.009) in the patients. The nocturnal decline in systolic blood pressure was less pronounced (13 +/- 1 vs. 19 +/- 2 mm Hg; P = 0.007) in the patients. Multivariate adjustment (r2 = 0.75; P = 0.0002) showed an effect of basal plasma epinephrine and norepinephrine levels and body mass index on the mean nocturnal systolic blood pressure, but showed no effect of age, sex, hemoglobin A1c, aldosterone, or, in particular, insulin. We found a blunted nocturnal fall in blood pressure in nonobese, normoalbuminuric type 1 diabetic patients. These patients showed increased adrenomedullary activity, and this predominantly contributed to the blood pressure alterations. We also found hyperinsulinemia in these patients, but, after controlling for covariates, blood pressure was independent of the insulin level. |
| Databáze: | OpenAIRE |
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