Elevated serum insulin levels in patients with essential hypertension and microalbuminuria.

Hyperinsulinemia, insulin resistance, or both have been described in patients with essential hypertension. Previous work from our laboratory has shown that in hypertensive patients with microalbuminuria, dyslipidemia and abnormal patterns in the diurnal variations of blood pressure are frequently associated. Whether hyperinsulinemia and microalbuminuria are directly related has not been determined. To test this possibility, we measured the plasma insulin response to an oral glucose load in 25 patients with or without microalbuminuria and 20 normotensive control subjects. Serum lipid profile and 24-hour ambulatory blood pressure were obtained. In the hypertensive patients as a group, the plasma insulin response to glucose (evaluated as the insulin area under the curve) was significantly enhanced compared with a group of 20 normotensive healthy control subjects (46,311 +/- 3745 and 27,557 +/- 2563 pmol/L x 2 hours, P < .01). When the hypertensive patients were subdivided according to their albumin excretion rate, the microalbuminuric patients had significantly higher plasma glucose (969 +/- 45.2 versus 762 +/- 28.7 mmol/L x 2 hours, P < .01) and insulin (59,172 +/- 5964 versus 37,737 +/- 3422 pmol/L x 2 hours, P < .01) area under the curve values. In addition, a significant direct correlation was found to exist between insulin area under the curve and the urinary albumin excretion rate (r = .63, P < .001). Serum levels of lipoprotein(a) were significantly greater (P < .01) in patients with than in those without microalbuminuria and in control subjects. Furthermore, daytime diastolic blood pressure and nighttime systolic and diastolic blood pressure values were greater in patients with than in those without microalbuminuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent epidemic hepatitis A associated with consumption of raw shellfish, probably controlled through public health measures.

Between April 1984 and January 1985, in the Italian seaport of Livorno, the annual incidence of serologically confirmed acute hepatitis A doubled to 46 per 100,000 population. The exposure histories of each of 75 jaundiced subjects with serologically confirmed hepatitis A were compared with up to four, randomly chosen-, age-, sex-, and neighborhood-matched controls. Illness was strongly associated with consumption of raw mussels and clams within six weeks of onset of illness. When the two thirds of the subjects who had been exposed were classified according to the frequency with which they had recently consumed any type of raw shellfish, there was a clear dose-response relation. In February 1985, comprehensive control measures were introduced and the annual incidence of hepatitis A fell to 2.3 per 100,000 population, a 10-fold decrease from the preepidemic period.