THE RELATIONSHIP BETWEEN INSULIN RESISTANCE OF ESSENTIAL HYPERTENSION AND RENIN - ANGIOTENSIN - SYSTEM

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1 II PI3K Akt Glut4 ARB ACEI ARB ACEI RAS PI3K R544 A THE RELATIONSHIP BETWEEN INSULIN RESISTANCE OF ESSENTIAL HYPERTENSION AND RENIN - ANGIOTENSIN - SYSTEM WANG Hui YAN Zhao - li HU Kang - hong Inner Monogolia Medical College Hohhot China Abstract Recently Insulin resistance is found in essential hypertension patients and parts of hypertensive animal models. During the course of primary hypertension development angiotensin II promotes insulin resistance involving the approach of PI3K which plays an important role in the Akt and Glut4 of insulin downstream pathway influences the application of glucose and results in insulin resistance. This paper demonstrate the possible mechanism of ARB and ACEI of improving insulin resistance of hypertension patients from basical and clinical aspects providing evidence for the improvement of insulin resistance by ARB and ACEI in clinical works. Key words essential hypertension insulin resistance RAS system Phosphoinositide 3 - Kinase Z E - mail aliceyzl@ 126. com

2 essential hypertension EH 2 IR RAS 2. 1 IR RAS insulin resistance IR IR - renin - angiotensin - system RAS IR RAS IR RAS IR RAS IR IR 1 spontaneously hypertensive rats SHR EH EH IR IR IR SHR EH high insulin RAS IR RAS HIS IR 1966 Welborn 1 5 EH angiotensinogen AGT Ⅱ 2 angiotensin Ⅱ AngⅡ Ⅱ1 angiotensin receptorⅡ type 1 AT1 R RAS EH IR IR IR 58. 0% impaired glucose tolerance IGT 2-6 interleukin - 6 IL α tumor necrosis IR 95. 2% IR 3 factor - α TNF - α IR IR 4 6 RAS adiponection IR 80% 7 Xu ZG 8 Zucker IGT IR AT1mRNA Losartan Losartan IR AngⅡ

3 82 RAS PI3K PI PIP PIP2 PIP 9 PIP2 PIP RAS Akt Glut4 IR RAS SHR AngⅡ IR AT1R IR AngⅡ IR 1 IR 5 RAS AngⅡ IR IR angiotensin converting enzyme inhibitor ACEI anigotensinⅡ receptor blocker ARB Glut mg / kg d HDL - C IR SHR 16 RAS AngⅡ NO IR AngⅡ IR ARB AT1 AngⅡ Ang insulin receptor substrate IRS PI3K IR 17 RAS Ⅱ AT2 / Akt 4 candesartan glucose transporter 4 Glut4 β 18 / IRS - 1 RAS 11 PI3K RAS IRS - l Tyr - Xl - X2 - ACEI Met PI3K p85α

4 ACEI IR 1989 ~ 2001 RAS A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension 1989 the Captopril Prevention Project ACEI CAPPP 1999 ARB IR RAS a subanalysis of the Captopril Prevention Project 2001 Heart Outcome Prevention Evaluation HOPE Welborn TA Breckenridge A Rubinstein AH et al. Serum 14% ~ 34% - insulin in essential hypertension and in peripheral vascular diseases J. Lancet ACEI ARB RAS LIFE 2. HOPE VALUE RAS IR IR LIFE Losartan Intervention 3 Solymoss BC Marcil M ChaourM et al. Fasting hyperin- for Endpoint Reduction in Hypertension Study sulinism insulin resistance syndrome and coronary artery VALUE Outcomes in hypertensive patients at high risk of cardiovascular risk treated with regimens based on Valsartan or amlodipine The disease in men and women J. Am J Cardiol J VALUE randomised trial LIFE 5. SHR RAS J % 25% VALUE 6 Dandona P Aljada A Chaudhuri A et al. Metabolic syndrome a Comprehensive Perspective based on interactions 16. 4% 13. 1% between obesity diabetes and inflammation J. Cireulation % ARB IR 7 Saitoh S. Insulin resistance and renin - angiotensin - aldos ONTAR- - terone system J. Nippon Rinsho GET 734 ARB ACEI 8 Xu ZG Lanting L Vaziri ND et al. Up regulation of angio IR RAS RAS IR 24 IR J tensin Ⅱ type 1 receptor inflammatory mediators and en-

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