Insulin resistance and reduced nocturnal fall of blood pressure as risk factors for atherosclerosis in salt sensitive hypertension

Recent studies reported that salt sensitive [SS] hypertensive models are more susceptible to atherosclerotic complications than non-salt sensitive [NSS], and some other studies showed that a link may exist between salt sensitivity, reduced nocturnal fall of blood pressure and insulin resistance. The aim of the present study was to confirm these findings and to study the possible role of insulin resistance and reduced nocturnal fall of blood pressure in the suspected increase of atherosclerotic complications in SS hyertensive patients. This study was carried out on 26 patients with essential hypertension classified as 12 SS and 14 NSS. SS patients were at a significantly higher risk of being non-dippers than NSS [OR=11, 95% CI=1.35-114.75] and there was a significant negative correlation between salt sensitivity index [SSI] and nocturnal fall of blood pressure during high salt intake [r=-0.61, p<0.001]. Moreover, there was a significant positive correlation between SSI and both insulin resistance index [IRI] and insulin level during high salt intake [r=0.623, p<0.001 and r=0.621, p<0.001 respectively] and a significant negative correlation between nocturnal fall of blood pressure and both IRI and insulin level during high salt intake [r=0.517, p<0.01 and r=-0.486, p<0.05 respectively]. Nocturnal fall of blood pressure was preserved in SS patients during low salt intake and IRI and insulin level were significantly lower in SS patients during low salt intake compared to that during high salt intake [3.57 +/- 1.02 versus 5.64 +/- 1.67 and 15.92 +/- 3.82 micro lU/mL versus 23.5 +/- 5.99 micro lU/mL]. Carotid intima-media thickness [IMT] was significantly higher in SS patients compared to NSS [0.84 +/- 0.21 mm versus 0.65 +/- 0.16 mm] [p<0.05] and there was a significant positive correlation between carotid IMT and both IRI and insulin level [r=0.773, p<0.001 and r=0.700, p<0.001 respectively] and a significant negative correlation between carotid IMT and nocturnal fall of blood pressure [r=-0530, p<0.01]. It was concluded that insulin resistance, salt induced increase in blood pressure and reduced nocturnal fall of blood pressure are associated with each other in patients with essential hypertension. Insulin resistance and reduced nocturnal fall of blood pressure are closely related to atherosclerotic complications in hypertensive patients and are implicated, at least in part, in the increased atherosclerotic complications in SS patients. Dietary salt restriction can cause improvement of insulin sensitivity in SS patients and shift of circadian blood pressure rhythm from a non-dipper to dipper pattern

Insulin and glutamic acid decarboxylase antibodies in chronic hepatitis [C] patients with diabetes mellitus

Diabetes mellitus is associated more with HCV chronic liver disease than in the general population and in the other types of chronic liver disease. The increased incidence of diabetes in HCV patients might be related to an autoimmune process produced by the virus or the virus itself has a cytopathic effect on the pancreatic beta clells. The aim of this work was to study the plasma basal insulin level and the seropositivity against glutamic acid decarboxylase [GADA] - an islet cell cytoplasmic antigen. Patients: the study was carried out on 45 patients categorized into 3 equal groups. Group I included 15 diabetic patient with HCV chronic liver disease, Group II included 15 diabetic patients with chronic liver disease which is not related to HCV, Group III included 15 non diabetic patients with HCV chronic liver disease. All patients were selected to be matched regarding age, sex and sevirity of liver disease. The results showed that basal insulin level [22.4 +/- 23.1 micro IU/ml in group I, 21.6 +/- 23.8 micro IU/ml in group II, and 8.8 +/- 6.4 micro IU/ml in group III] were significantly higher in the diabetic patients [GI and GII] compared to the non diabetic [GIII] [P<0.01]. The insulin resistance index as calculated by HOMA equation [9.6 +/- 7.9 in group I, 9.2 +/- 10.3 in group II and 2.4 +/- 1.2 in group III], were also significantly higher in the diabetic groups [p < 0.01]. Seropositivity for [GADA] was 9/15 [60%] of patients of groups I and III and 3/15 [20%] of patients of group II. We concluded that diabetes mellitus associated with HCV chronic liver disease in characterized hyperinsulinaemia and increased insulin resistance. There may be a role of autoimmunity in the pathogenesis of diabetes in HCV chronic liver disease. Follow up of the non diabetic HCV patients with positive GADA for development of diabetes is recommended