such women by oral contraceptive administration ( Skouby, Andersen, Saurbrey, Kuhl, 1987).
Women with hypertension during the third trimester of pregnancy have been shown to have hyperinsulinemia in response to an oral glucose tolerance test, in comparison to normotensive control women ( Bauman, Maimen, & Lauger, 1988). Both groups of women had similar normal glucose tolerance curves, and had equivalent circulating levels of placental lactogen, thought to be one factor conferring the insulin resistance of pregnancy. Thus, gestational hypertension, like gestational diabetes, appears to be associated with an even greater degree of insulin resistance than that normally seen in pregnancy.
The evidence relating elevated blood pressure to reduced insulin sensitivity has been reviewed. It is important to note that when there is reduced sensitivity to the glucoregulatory effects of insulin, hyperinsulinemia ensues. In contrast to the reduced sensitivity to the glucoregulatory effects of insulin, there may be preservation of sensitivity to other effects of insulin. Thus, hyperinsulinemia may result in increased stimulation of pathways that contribute to maintenance of blood pressure, and consequently raise such pressure. The pathways involved in regulation of blood pressure are complex and multifactorial. Thus, much further investigation is required to provide further insights and definition to the mechanisms involved in insulin's effects on blood pressure. Concomitantly, such studies may also better explain the nature of the "chronic high risk factor syndrome," one of the most important public health problems in the world today.
This chapter was supported by grant #P01-HL-36588 from the National Institutes of Health, U.S. Public Health Service.
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