IAJPS 2017, 4 (04), 950-954 Muhammad Iqbal Shah et al ISSN 2349-7750

CODEN (USA): IAJPBB ISSN: 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES
http://doi.org/10.5281/zenodo.557103

Available online at: http://www.iajps.com Research Article

CROSS-SECTIONAL ANALYSIS OF INTER-RELATIONSHIP BETWEEN

INSULIN RESISTANCE AND HYPERTENSION AMONG PATIENTS AT
LIAQUAT UNIVERSITY HOSPITAL
Muhammad Iqbal Shah1*, Abdul Ghaffar Memon 2, Sohail Ahmed Almani3,
Aatir H. Rajput4, Muhammad Muneeb5 and Syed Jehangir6.
1, 2, 3, 4 and 5
Liaquat University Hospital
1,3
Department of Medicine, Liaquat University of Medical & Health Sciences, Jamshoro
2
Department of Cardiology, Liaquat University of Medical & Health Sciences, Jamshoro
Received: 08 April 2017 Accepted: 20 April 2017
Abstract:
Background:
Insulin resistance and hypertension often stem from the same genotypic and phenotypic phenomenon. It is well established that a sedentary
lifestyle, and a plentiful diet rich in sodium and energy are the likely culprits that over the years have contributed to the rise of both ailments.
However, the inter-relationship too is worthy of exploration.
Objective:
This research hopes to study the inter-relationship between insulin resistance and hypertension among patients by eyeing the co-presentation of
both diseases in patients and by evaluating the time elapsed in diagnosis of each disease to assess which disease preceded the other.
Methods:
This observational was carried out on patients presenting at the medicine outpatient department of Liaquat University Hospital with a joint
complaint of insulin resistance and hypertension from 1st Dec 2015 to 10th February 2016. Data was collected using an interview based
structured questionnaire administered to the patients after taking written informed consent. The data was analyzed in SPSS v. 16.0.
Results:
During the course of the study, a total of 248 patients presented with the complaint of insulin resistance, 356 patients presented with the
complaint of hypertension. While 136 patients presented with a joint complaint of insulin resistance and hypertension. Majority (70.588%) of the
patients reportedly developed insulin resistance prior to developing hypertension. The chief complaint of 120 (88.24%) of the patients was insulin
resistance. 42 (30.88%) of the patients, despite suffering from hypertension, were not taking treatment.
Conclusion:
The inter-relationship of both diseases is marked. For every 10 patients suffering from insulin resistance, 3.7 suffered from hypertension as well.
While for every 10 patients suffering from hypertension, 2.8 suffered from insulin resistance as well. Thus patients suffering from insulin
resistance are more likely to be hypertensives.
Keywords: Insulin resistance, Hypertension, Cardiac comorbidities, Diabetes and Insulin.
Corresponding author:
Muhammad Iqbal Shah, QR code
Department of Medicine,
Liaquat University of Medical & Health Sciences,
Jamshoro
Email: muhammadiqbalshah22@gmail.com
Contact Number: 0300-3034963
Please cite this article in press as Muhammad Iqbal Shah et al, Cross-Sectional Analysis of Inter-Relationship
between Insulin Resistance and Hypertension among Patients at Liaquat University Hospital , Indo Am. J.
Pharm. Sci, 2017; 4(04).

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INTRODUCTION: lesser quantity of researches gauged resistance to

For nearly 4 decades now, presence of insulin directly, majorly in little groups of individuals
hyperinsulinemia in normo-glycemic individuals with but with incoherent results too[10]. (Pollare T, 1990
hypertension is seen often in clinical practice. More and Mattiason 1992). In this article, we discuss the
often than not, such patients are ought to become inter-relation between insulin resistance and
insulin resistant[1]. Ferrannini too established this by hypertension at an out-patient department of a large
revealing that slender individuals with hypertension tertiary acre hospital catering to the needs of patients
living in predominantly white regions had lesser from a diverse sociodemographic background.
insulin-controlled glucose clearance as compared to
normal controls[2]. Thus the belief, that insulin METHODOLOGY
resistance and/or insulin alone may play an important This observational was carried out on patients
factor in the hypertension pathogenesis[3]. Many presenting at the medicine outpatient department of
researchers have explored the matter and Reaven GM Liaquat University Hospital with a joint complaint of
has shown that Insulin is capable of stimulating the insulin resistance and hypertension from 1st Dec 2015
sympathetic nervous system, hiking up the retention to 10th February 2016. Data was collected using an
of sodium by kidneys, controlling transport of interview based structured questionnaire
cations, and inducing hypertrophy of vascular smooth administered to the patients after taking written
muscles[4]. It is conceivable that through associated informed consent. Queries were made about patients
compensating hyperinsulinemia, insulin resistance bio data, sociodemographic and educational
participates in the hypertension pathogenesis by variables, complaints of patient, duration of disease
solely this or other such mechanisms. Regardless, and order of disease developed across a given period
short-term insulin injection was discovered to be a of time. Insulin resistance was diagnosed on the basis
hypotensive vasodilator instead of an effective of poor response to insulin therapy by the help of
hypertension inducing agent[5]. Oral Glucose Tolerance Test and serial Fasting Blood
In order to settle these conflicting interpretations, it Sugar tests. The data was analyzed in SPSS v. 16.0.
was proposed that resistance to insulin may cause RESULTS
hypertension due to hampered vasodilation induced During the course of the study, a total of 248 patients
by insulin and an upset between its depressor and presented with the complaint of insulin resistance,
pressor effects[6,7]. Even though a vast quantity of 356 patients presented with the complaint of
researches investigated the inter-relationship between hypertension. While 136 patients presented with a
hypertension (blood pressure) and insulinemia, the joint complaint of insulin resistance and
evidence has been incoherent with few claiming hypertension.
marked and others insignificant, or no link[8,9]. A

Fig 1: Incidence of presentation of hypertension was more common than insulin resistance. However, a
greater propensity was seen among patients suffering from insulin resistance to develop hypertension.

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 IAJPS 2017, 4 (04), 950-954 Muhammad Iqbal Shah et al ISSN 2349-7750

Majority (70.588%) of the patients reportedly developed insulin resistance prior to developing hypertension.

Fig 2: In addition to greater propensity of patients suffering from insulin resistance to develop hypertension,
it was seen that patients suffering from both diseases simultaneously, more often than not initially developed
insulin resistance prior to developing hypertension.

The chief complaint of 120 (88.24%) of the patients was insulin resistance. 42 (30.88%) of the patients, despite
suffering from hypertension, were not taking treatment.

Fig 3: The chief complaint, as regarded by the patients themselves was Insulin resistance in many of the
subjects suffering from both the diseases. This may be due to the symptoms of insulin resistance since they
affect health related quality of life (HRQoL) to a greater extent.

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The inter-relationship of both diseases is marked. For every 10 patients suffering from insulin resistance, 3.7
suffered from hypertension as well. While for every 10 patients suffering from hypertension, 2.8 suffered from
insulin resistance as well.

Fig 4: The probability of the disease development is shown above and it indicates that patients suffering from
insulin resistance are more likely to be hypertensives.

DISCUSSION: Hispanic females. Research in African Americans,

The link between insulinemia and resistance to Hispanics, Nauruans, Pima Indians, and Asian
insulin and hypertension is conflicting, at best. subjects exhibited an insignificant or a total lack of
However, a few researches claimed that resistance to association. (Heisa T, 1998). Even in NHW, the link
insulin and/or hyperinsulinemia were markedly between blood pressure and insulinemia was
linked to hypertension, others claim only an incoherent with a few of the researches claiming a
insignificant or a total lack of less marked link.
association[7].(Ferrannini, 1997 and Mattiason I, The pathway via which resistance to insulin is linked
1992). Our data adds to the pool of this literature, to hypertension and blood pressure is unknown. It is
some significant findings that may prove to be an believed that resistance to insulin may lead to
essential building block for further interventionist hypertension via compensating hyperinsulinemia.3
research. (Reaven GM, 1987). Insulin has been revealed to up-
It is noteworthy, yet, that many antihypertensive surge the sympathetic nervous system, hike sodium
drugs may further aggravate resistance to insulin retention by kidneys, modulate transport of cations,
(Coates PA, 1995) and that we may not gauge the and bring about hypertrophy of vascular smooth
effect of medication due to the observation, non- muscle.
descriptive nature of the research. In addition to that, The results do not second the belief since insulin had
the amount of individuals suffering from no independent relation with hypertension or blood
hypertension but not receiving drugs (due to pressure. The fact that insulin could lessen blood
symptoms that are less worrying) was too little to pressure markedly in diabetics suffering from
allow investigation of the results individually. neuropathy (autonomic) has been known for many
The inter-relationship between hypertension and years. (Paife M, 1986). Furthermore, administering
resistance to insulin seems to differ between insulin to people (regardless of whether they suffer
ethnicities in foreign evidence based researches. from diabetes) does not lead to a hike in blood
Almost all research exhibiting a marked link between pressure in absence of hypoglycemia. However, it is
blood pressure and insulin are carried out in non-

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 IAJPS 2017, 4 (04), 950-954 Muhammad Iqbal Shah et al ISSN 2349-7750

possible that it is the hike in blood pressure may be for insulin resistance. J Clin Invest. 1990;85:1844
due to resistance to the vasodilator effect of insulin. 1852.
Moreover, resistance to insulin has been linked to 7.Ferrannini E, Natali A, Capaldo B, Lehtovira M,
reduced endothelium-dependent vasodilatation, Jacob S, Yki-Ja rvinen H, for the European Group
which may be responsible for hiking up the blood for the Study of Insulin Resistance (EGIR). Insulin
pressure. Meanwhile, the link between hypertension resistance, hyperinsulinemia, and blood pressure.
and resistance to insulin may not be as simple as we Role of age and obesity. Hypertension.
perceive and rather, they may not be associated 1997;30:11441149.
directly through pathways of an acquired or inherited 8.Manicardi V, Camellini L, Bellodi G, Coscelli C,
nature. Ferrannini E. Evidence for an association of high
While on one hand, increased adrenergic tone could blood pressure and hyperinsulinemia in obese men. J
bring about a hike in resistance to insulin and a hike Clin Endocrinol Metab. 1986;62:13021304.
in blood pressure on the other. Racial and ethnic 9.Manolio TA, Savage PJ, Burke GL, Liu K,
disparities in the activity of sympathetic nervous Wagenknecht LE, Sidney S, Jacobs DR Jr., Roseman
system may shed light on the contrasting inter- JM, Donahue RP, Oberman A. Association of fasting
relationship of resistance to insulin and blood insulin with blood pressure and lipids in young
pressure. A hike in the inflammatory markers levels adults: The CARDIA study. Arteriosclerosis.
such as tumor necrosis factor may play an important 1990;10:430436.
role in resistance to insulin and dysfunction of the 10.Pollare T, Lithell H, Berne C. Insulin resistance is
endothelium and trigger the inter-relationship a characteristic feature of primary hypertension
between hypertension and resistance to insulin. independent of obesity. Metabolism. 1990;39: 167
174
CONCLUSION:
This study concludes that the inter-relationship of
both diseases is marked. For every 10 patients
suffering from insulin resistance, 3.7 suffered from
hypertension as well. While for every 10 patients
suffering from hypertension, 2.8 suffered from
insulin resistance as well. Thus patients suffering
from insulin resistance are more likely to be
hypertensives.

REFERENCES:
1.Welborn TA, Breckenridge A, Rubinstein AH,
Dollery CT, Fraser TR. Serum insulin in essential
hypertension and in peripheral vascular disease.
Lancet. 1996;1:13361337.
2.Ferrannini E, Buzzigoli G, Bonadonna R, Giorico
MA, Oleggini M, Graziadei L, Pedrinelli R, Brandi
L, Bevilacqua S. Insulin resistance in essential
hypertension. N Engl J Med. 1987;317:350357.
3.Reaven GM, Hoffman BB. A role for insulin in the
aetiology and course of hypertension. Lancet.
1987;2:435436.
4.Reaven GM, Lithell H, Landsberg L. Hypertension
and associated metabolic abnormalitiesthe role of
insulin resistance and the sympathoadrenal system. N
Engl J Med. 1996;334:374381.
5.Creager MA, Liang C-S, Coffman JD. Beta
adrenergic-mediated vasodilator response to insulin
in the human forearm. J Pharmacol Exp Ther.
1985;235:709714.
6.Laakso M, Edelman SV, Brechtel G, Baron AD.
Decreased effect of insulin to stimulate skeletal
muscle blood flow in obese men: a novel mechanism

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