Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 67–70
Contents lists available at ScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx
Original Article
Correlated analysis and pathological study on insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients Hua Zhi, Hongbin Wang *, Tao Li, Fumin Pin Department of Cardiology, Affiliated Hospital of Hebei Engineering University, PR China
A R T I C L E I N F O
A B S T R A C T
Keywords: Insulin resistance Cardiovascular endocrine hormone Hypertension
Aims: The correlated analysis and pathological study on insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients was investigated by clinical observation and physical experiments in my hospital. Materials and methods: Randomly enrolled 300 subjects seen at hospital from January 2011 to January 2013, which included 150 hypertension patients and 150 non-hypertension of healthy people, while 150 cases of hypertension patients as the experimental group, 150 cases of healthy people without hypertension acts as the control group. The t-PA of serum (plasma), activity of PAI, ANP, IS, ET were determined in this 300 subjects, and it studied on the correlation and pathological effect between insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients. Results: The levels of PAI, ANP, ET are apparently higher in hypertension patients than in healthy control group (p < 0.05), while the t-PA, IS are obviously lower in hypertensive patients than in healthy control group (p > 0.05). Conclusion: This study has shown that there is a significant correlation and pathological effect between insulin resistance and cardiovascular endocrine hormone in hypertensive patients, and which plays an important role in genesis and development of hypertension in elderly people. ß 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
1. Introduction Under the gradual development of social economy, people’s living conditions have a great improvement. Recent years, the number of hypertensive patients is increasing. Of which is the main patients group of middle-aged and elderly people, and also it is a kind of common disease [1–5]. Domestic and foreign research showed that insulin resistance (IR) [3–8], tissue Plasminogen Activator (t-PA), Plasminogen Activator Inhibitor activity (PAI) was closely related to hypertension, coronary heart disease. However, the research of relationship between IR and Atrial Natriuretic Peptide (ANP), Endothelin (ET), Angiotensin I (AI) was rarely reported in the pathogenesis of hypertension disease. It is a critical study of how to effective treat and explore the pathogenesis of elderly hypertension disease. Therefore, it is further to understand the etiology and pathogenesis, in order to
* Corresponding author at: Cong Tai Road 81#, Cong Tai District, Handan, Hebei Province 056029, PR China. Tel.: +86 0310 8572189. E-mail address: [email protected] (H. Wang). http://dx.doi.org/10.1016/j.dsx.2015.02.013 1871-4021/ß 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
find better treatments. Therefore, the aim of this paper is that we selected from January 2011 to January 2011 in our hospital for treatment of 150 cases of hypertension patients and 150 patients without hypertension health people, and it analyzed the inspection data of these two groups. 2. Materials and methods 2.1. Clinical data Three hundred subjects were selected from January 2011 to January 2011 in our hospital for treatment, including 150 cases of hypertension patients and 150 patients without hypertension health people, and analyze the inspection data of these two groups, the former acts as experimental group, the latter acts as control group. Among the 150 cases of hypertension patients, the male is 90, female is 60, the age is from 55 to 80, average is 65 7, body mass index (BMI) is 22.19 3.8, blood pressure (SBP/DBP) is 156 19/ 94 11 mmHg. The 150 patients without hypertension control group, the male is 95, female is 55, and the age is from 53 to 82, average is 66 5, body mass index (BMI) [7,9] is 21.47 2.9, blood
H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 67–70
68
Table 1 Comparison of cardiovascular endocrine hormone between experimental and control group (y¯ s, n = 300). Groups Experimental group Control group
n
BMI
G (mmol/L) *
t-PA (IU/ml)
150
22.19 3.80
6.12 1.30
1.68 0.32
150
21.47 2.90
4.33 1.70
2.04 0.33
*
PAI (IU/L)
ANP (pg/ml) *
11.81 2.3
62.37 35.4
9.91 2.5
39.17 15.2
**
IS (mU/L)
ISI
14.72 7.37 12.31 2.90
*
ET (pg/ml) *
AI (ng/ml/h) *
-6.61 0.07
79.36 20.6
-7.01 0.08
52.31 22.9
0.72 0.31 0.76 0.35
*
p < 0.05. ** p < 0.01. BMI, body mass index; G, glycemic index; t-PA, tissue plasminogen activator; PAI, plasminogen activator inhibitor activity; ANP, atrial natriuretic peptide; IS, insulin; ISI, insulin sensitivity index; ET, endothelin; AI, angiotensin I.
pressure (SBP/DBP) is 156 21/92 11 mmHg (shown in Table 1). All the cardiac function is normal, and the two groups are comparable. 2.2. Method Elderly hypertension group had the medical history, physical examination and laboratory tests, with the exception of diabetes and endocrine diseases, liver, kidney, recent not taking drugs which affect blood pressure, blood glucose, blood lipids and platelet function. Healthy comparison group is also checked by the medical history, physical examination [10–13], electrocardiogram, chest x line, blood biochemical examination [14], and no organic disease. Specimen collection: empty stomach venous blood extraction and determination of plasma (serum) t-PA, PAI, glycemic index (G), insulin (IS), insulin sensitivity index (ISI) and the level of ANP, AI. 2.3. Statistical analysis Statistical Package for Social Sciences (SPSS 18.0 Package Facility, SPSS Inc., IL, USA) was used for data support and analysis, t-tests [3–15], analysis of variance (ANOVA), and chi-square analyses were used to assess potential differences in demographic and clinical variables between groups. Data is showed mean standard (y¯ s). The t-tests is used to comparison of data difference, p < 0.05 is significant. 3. Results 3.1. Cardiovascular endocrine hormone Comparison results of cardiovascular endocrine hormone between experimental and control group are shown in Table 1. The element of BMI in experimental group is 22.19 3.80 while the control group is 21.47 2.90, and the glycemic index is 6.12 1.30 mmol/L obviously higher than control group (4.33 1.70 mmol/L). As the test result of t-PA is 1.68 0.32 IU/ml in experimental group, while the control group is 2.04 0.33 IU/ml obviously higher than experimental group (p < 0.05 is significant). And the level of PAI in experimental group (11.81 2.3 IU/L) is significantly higher than control group (9.91 2.5 IU/L), the index of ANP level is 62.37 35.4 pg/ml in experimental group obviously higher than control group (39.17 15.2 pg/ml), p < 0.01 is significant in statistical analysis [11,13]. With the level of IS in experimental group is 14.72 7.37 mU/L, the control group is 12.31 2.90 mU/L.
The ET level is 79.36 20.6 pg/ml in experimental group, and control group is 52.31 22.9 pg/ml, and angiotensin I (AI) is 0.72 0.31 ng/ml/h in experimental group, while the control group is 0.76 0.35 ng/ml/h. Among these influence index of t-PA, PAI, glycemic index (G), insulin (IS), insulin sensitivity index (ISI) and the level of ANP, AI, it is helpful to find the key factor [15] which affect insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients. And the detailed blood lipid level is shown in Table 2. 3.2. Blood lipid level A recent published study [12–16] provided evidence suggesting that C-reactive protein better predicts cardiovascular events than LDL-C alone, whereas using both LDL-C and C-reactive protein values allows an even more accurate measure of cardiovascular risk. Although endothelial cell dysfunction occurs with individual components of the insulin resistance syndrome (i.e., hypertension, low levels of HDL-C, etc.), it also occurs with only modest alterations in these risk factors in the presence of insulin resistance. Data in comparison of blood lipid between experimental group and control group is shown in Table 2. The results show that TG, TC, LDL-C in experimental group is obviously higher than control group, the p < 0.05 is significant difference. The detailed result of TG in experimental group is 2.28 0.27 mmol/L, while the level of TG is 1.63 0.31 mmol/L in control group. And the total cholesterol (TC) is 4.85 0.81 mmol/L in experimental group, the level of TC is 4.13 0.56 mmol/L in control group. However, the level of HDL-C in experimental group is similar with control group, it is not significant difference. The level of insulin in hypertension patients are significantly higher than healthy people, its lipid metabolism is not normal accompanied with hyperinsulinemia. This may be related to the body and which is not sensitive to insulin, leading to resistance to lipolysis function abate [17], glucose utilization obstacle, the decomposition of lipid increasing. Therefore, the free fatty acid increased and lipid metabolism disorders can also promote the hypertension formation. 3.3. C-peptide and insulin releasing The level of C peptide is a good indicator to reflect the insulin B cell in hypertension patients. However, the detailed result of comparison of C peptide and insulin releasing is shown in Table 3.
Table 2 Comparison of blood lipid between experimental group and control group (y¯ s, n = 300). Groups
n
TG (mmol/L)
TC (mmol/L)
LDL-C (mmol/L)
HDL-C (mmol/L)
Experimental group Control group
150 150
2.28 0.27* 1.63 0.31
4.85 0.81* 4.13 0.56
2.37 0.73* 1.86 0.81
1.33 0.28 1.24 0.31
* p < 0.05. TG, triglycerides; TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol.
H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 67–70 Table 3 Comparison of C peptide and insulin releasing (y¯ s, n = 300). Various parameter
Experimental group
Control group
Insulin (pmol/L) 0h 2h 5h
112.38 26.31* 402.41 104.35* 336.34 102.38*
78.12 18.27 296.68 117.16 199.81 85.35
0.63 0.31 1.55 0.47* 1.38 0.36
0.66 0.22 1.67 0.51 1.46 0.39
BMI in experimental group. And the ANP is 0.15 in experimental group, while the r-value of ANP is 0.12 in control group. The related indicator within ET, AI, AII of r-value are also higher than control group, and which act as an important evidence to affect insulin sensitivity in hypertension patients.
4. Discussion
C peptide (nmol/L) 0h 2h 5h
178.31 89.47*
IN/CP *
69
115.19 72.03
p < 0.05, comparison with control group.
From the various parameter of insulin and C peptide, we can see that the insulin releasing with the 0 h is 112.38 26.31 pmol/L in experimental group and obviously higher than control group, with increasing to 2 h the insulin releasing to 402.41 104.35 pmol/L in experimental group is also higher than control group. The level of IN/CP is 178.31 89.47 pmol/L in experimental group and obviously higher than control group (p < 0.05 is significant difference). Next part of multiple linear regression of ISI is studied and plotted in Table 4. The influence factor include ANP, AII, ET, IN, and to study the b, F and p-value.
4.1. The sensitivity of insulin According to the previous work of sensitivity of insulin, the cardiovascular endocrine hormone can reduce insulin sensitivity of the aged diabetes mellitus (DM) patients, which is probably the one of the important pathogenetic mechanisms of aged DM patients. Insulin resistance is an important component of pathophysiological processes that underlies the development of type II diabetes [2,18]. Therefore, it is likely to play a role in development of other conditions such as dyslipidemia, hypertension and atherosclerosis. Insulin resistance can be defined as an attenuated effect of defined amounts of insulin in target tissues. As we know that the sensitivity of insulin associated with cardiovascular endocrine hormone within some potential factors such as ANP, ET, t-PA and AI, etc. Among the hypertension patients with cardiovascular endocrine hormone can affect the level of insulin resistance. 4.2. Pathological analysis
3.4. Multiple linear regression of ISI Influence factor of multiple linear regression filter to ISI is shown in Table 4, the analysis results show that ANP, AII, ET and 1 h level of insulin releasing are the main factor to affect insulin sensitivity index (ISI), the detailed data of F-value of ANP is 6.39 (p = 0.004) and obviously affect the insulin sensitivity. And also the AII, ET are 2.38, 2.34 (p = 0.034, 0.037), respectively. 3.5. Correlation analysis of r-value Correlation analysis on ISI and related indicator (r-value) are shown in Table 5. The results show that the r-value of related indicator in experimental group is obviously higher than control group. Table 5 of correlation analysis on ISI is shown that BMI related r-value in experimental group is 0.53, while related r-value in control group is 0.32, which is a high correlation between ISI and
In recent years, cardiovascular endocrine hormone and IR is gradually to be concerned by medical workers [19,20], and who think that insulin work through the variety of ways of sympathetic nervous system, renin angiotensin aldosterone system, blood pressure reflection, kidney water sodium retention, endothelial cells and ion transmembrane transport. The mRNA expression [21] of vascular smooth muscle cells is promoted by insulin, and increase angiotensin, leading to higher reactivity of AII. It suggests that high levels of insulin can activate the activation of vascular local renin angiotensin aldosterone system. Therefore, which increase the excitability of sympatheticadrenaline system, in the condition of high levels of insulin, combination with subcutaneous insulin receptor, activate collaterals glycine kinase, stimulate the mRNA expression of ET and increase the secretion of ET synthesis, these process are interactional in hypertension patients.
5. Conclusion Table 4 Influence factor of multiple linear regression filter to ISI. Projects ANP AII ET IN
b 1.36 0.92 0.047 0.063
x
F
P-value
1.018 1.126 0.083 0.062
6.39 2.38 2.34 2.72
0.004 0.034 0.037 0.031
Table 5 Correlation analysis on ISI and related indicator (r-value). Experimental group BMI ANP ET AI AII
0.53 0.15 0.33 0.38 0.51
Control group 0.32 0.12 0.14 0.16 0.20
In this article, the influencing factors are analyzed by Multiple Linear Regression. And IR is closely related to the cardiovascular endocrine hormone, we found that DM with cardiovascular diseases is not a coincidence, but it may be causal and promote each other, the mechanism of molecular level is still need to further research. The results of this study have shown that there is a significant correlation and pathological effect between insulin resistance and cardiovascular endocrine hormone in hypertensive patients, the ANP, AI, ET t-PA are the significant influence factors, which plays an important role in genesis and development of hypertension in elderly people. Acknowledgement This study was supported by the Department of Cardiology, Affiliated Hospital of Hebei Engineering University.
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H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 67–70
Conflict of interest: The authors have no conflicts of interest or financial disclosures.
References [1] Shen DC, Shkieh SM, Fuh MM, et al. Resistance to insulin stimulated glucose uptake in patients with hypertension. J CIin Endocrinal Metab 1988;63(3):580. [2] Arner P. Insulin resistance in type 2 diabetes – role of the adipokines. Curr Mol Med 2005;5:333–9. [3] Wong SP, Huda M, English P, Bargiotta A, Wilding JPH, Johnson A, et al. Adipokines and the insulin resistance syndrome in familial partial lipodystrophy caused by a mutation in lamin A/C. Diabetologia 2005;48:2641–9. [4] Yang X, Jansson PA, Nagaev I, Jack MM, Carvalho E, Sunnerhagen KS, et al. Evidence of impaired adipogenesis in insulin resistance. Biochem Biophys Res Commun 2004;317:1045–51. [5] Colao A, Di SC, Savanelli MC, De LM, Lombardi G. Beginning to end: cardiovascular implications of growth hormone (GH) deficiency and GH therapy. Growth Horm IGF Res 2006;16:S41–8. [6] Hana V, Silha JV, Justova V, Lacinova Z, Stepan JJ, Murphy LJ. The effects of GH replacement in adult GH-deficient patients: changes in body composition without concomitant changes in the adipokines and insulin resistance. Clin Endocrinol (Oxf) 2004;60:442–50. [7] Wu LY, Juan CC, Hwang LS, Hsu YP, Ho PH, Ho LT. Green tea supplementation ameliorates insulin resistance and increases glucose transporter IV content in a fructose-fed rat model. Eur J Nutr 2004;43:116–24. [8] Addison S, Stas S, Hayden MR, Sowers JR. Insulin resistance and blood pressure. Curr Hypertens Rep 2008;10:319–25. [9] Stolzenberg-Solomon RZ, Graubard BI, Chari S, Limburg P, Taylor PR, Virtamo J, et al. Insulin, glucose, insulin resistance, and pancreatic cancer in male smokers. J Am Med Assoc 2005;294:2872–8. [10] Abbasi F, Farin HMF, Mamendola C, McGraw L, McLaughlin T, Reaven GM. Pioglitazone administration decreases cardiovascular disease risk factors in insulin-resistant smokers. Metab Clin Exp 2008;57:1108–14.
[11] Fagerberg B, Hulten LM, Hulthe J. Plasma ghrelin, body fat, insulin resistance, and smoking in clinically healthy men: the atherosclerosis and insulin resistance study. Metabolism 2003;52:1460–3. [12] Hirsso P, Laakso M, Matilainen V, Hiltunen L, Rajala U, Jokelainen J, et al. Association of insulin resistance linked diseases and hair loss in elderly men. Finnish population-based study. Cent Eur J Public Health 2006;14:78–81. [13] Cagnacci A, Ferrari S, Tirelli A, Zanin R, Volpe A. Insulin sensitivity and lipid metabolism with oral contraceptives containing chlormadinone acetate or desogestrel: a randomized trial. Contraception 2009;79:111–6. [14] Godsland IF, Walton C, Felton C, Proudler A, Patel A, Wynn V. Insulin resistance, secretion, and metabolism in users of oral contraceptives. J Clin Endocrinol Metab 1992;74:64–70. [15] Ong KK, Diderholm B, Salzano G, Wingate D, Hughes IA, MacDougall J, et al. Pregnancy insulin, glucose, and BMI contribute to birth outcomes in nondiabetic mothers. Diabetes Care 2008;31:2193–7. [16] Falorni A, Bini V, Cabiati G, Papi F, Arzano S, Celi F, et al. Serum levels of type I procollagen C-terminal peptide, insulin-like growth factor-I (IGF-I), and IGF binding protein-3 in obese children and adolescents: relationship to gender, pubertal development, growth, insulin, and nutritional status. Metabolism 1997;46:862–71. [17] Yang SW, Yu JS. Relationship of insulin-like growth factor-I, insulin-like growth factor binding protein-3, insulin, growth hormone in cord blood and maternal factors with birth height and birthweight. Pediatr Int 2000;42: 31–6. [18] Holmes MD, Pollak MN, Willett WC, Hankinson SE. Dietary correlates of plasma insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations. Cancer Epidemiol Biomark Prev 2002;11:852–61. [19] Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Diagnosis and classification of diabetes mellitus, provisional report of a WHO consultation. Diabet Med 1998;15:539–53. [20] Takebayashi K, Suetsugu M, Wakabayashi S, Aso Y, Inukai T. Association between plasma visfatin and vascular endothelial function in patients with type 2 diabetes mellitus. Metab Clin Exp 2007;56:451–8. [21] Berndt J, Kloting N, Kralisch S, Kovacs P, Fasshauer M, Schon MR, et al. Plasma visfatin concentrations and fat depot-specific mRNA expression in humans. Diabetes 2005;54:2911–6.
Contents lists available at ScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx
Original Article
Correlated analysis and pathological study on insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients Hua Zhi, Hongbin Wang *, Tao Li, Fumin Pin Department of Cardiology, Affiliated Hospital of Hebei Engineering University, PR China
A R T I C L E I N F O
A B S T R A C T
Keywords: Insulin resistance Cardiovascular endocrine hormone Hypertension
Aims: The correlated analysis and pathological study on insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients was investigated by clinical observation and physical experiments in my hospital. Materials and methods: Randomly enrolled 300 subjects seen at hospital from January 2011 to January 2013, which included 150 hypertension patients and 150 non-hypertension of healthy people, while 150 cases of hypertension patients as the experimental group, 150 cases of healthy people without hypertension acts as the control group. The t-PA of serum (plasma), activity of PAI, ANP, IS, ET were determined in this 300 subjects, and it studied on the correlation and pathological effect between insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients. Results: The levels of PAI, ANP, ET are apparently higher in hypertension patients than in healthy control group (p < 0.05), while the t-PA, IS are obviously lower in hypertensive patients than in healthy control group (p > 0.05). Conclusion: This study has shown that there is a significant correlation and pathological effect between insulin resistance and cardiovascular endocrine hormone in hypertensive patients, and which plays an important role in genesis and development of hypertension in elderly people. ß 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
1. Introduction Under the gradual development of social economy, people’s living conditions have a great improvement. Recent years, the number of hypertensive patients is increasing. Of which is the main patients group of middle-aged and elderly people, and also it is a kind of common disease [1–5]. Domestic and foreign research showed that insulin resistance (IR) [3–8], tissue Plasminogen Activator (t-PA), Plasminogen Activator Inhibitor activity (PAI) was closely related to hypertension, coronary heart disease. However, the research of relationship between IR and Atrial Natriuretic Peptide (ANP), Endothelin (ET), Angiotensin I (AI) was rarely reported in the pathogenesis of hypertension disease. It is a critical study of how to effective treat and explore the pathogenesis of elderly hypertension disease. Therefore, it is further to understand the etiology and pathogenesis, in order to
* Corresponding author at: Cong Tai Road 81#, Cong Tai District, Handan, Hebei Province 056029, PR China. Tel.: +86 0310 8572189. E-mail address: [email protected] (H. Wang). http://dx.doi.org/10.1016/j.dsx.2015.02.013 1871-4021/ß 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
find better treatments. Therefore, the aim of this paper is that we selected from January 2011 to January 2011 in our hospital for treatment of 150 cases of hypertension patients and 150 patients without hypertension health people, and it analyzed the inspection data of these two groups. 2. Materials and methods 2.1. Clinical data Three hundred subjects were selected from January 2011 to January 2011 in our hospital for treatment, including 150 cases of hypertension patients and 150 patients without hypertension health people, and analyze the inspection data of these two groups, the former acts as experimental group, the latter acts as control group. Among the 150 cases of hypertension patients, the male is 90, female is 60, the age is from 55 to 80, average is 65 7, body mass index (BMI) is 22.19 3.8, blood pressure (SBP/DBP) is 156 19/ 94 11 mmHg. The 150 patients without hypertension control group, the male is 95, female is 55, and the age is from 53 to 82, average is 66 5, body mass index (BMI) [7,9] is 21.47 2.9, blood
H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 67–70
68
Table 1 Comparison of cardiovascular endocrine hormone between experimental and control group (y¯ s, n = 300). Groups Experimental group Control group
n
BMI
G (mmol/L) *
t-PA (IU/ml)
150
22.19 3.80
6.12 1.30
1.68 0.32
150
21.47 2.90
4.33 1.70
2.04 0.33
*
PAI (IU/L)
ANP (pg/ml) *
11.81 2.3
62.37 35.4
9.91 2.5
39.17 15.2
**
IS (mU/L)
ISI
14.72 7.37 12.31 2.90
*
ET (pg/ml) *
AI (ng/ml/h) *
-6.61 0.07
79.36 20.6
-7.01 0.08
52.31 22.9
0.72 0.31 0.76 0.35
*
p < 0.05. ** p < 0.01. BMI, body mass index; G, glycemic index; t-PA, tissue plasminogen activator; PAI, plasminogen activator inhibitor activity; ANP, atrial natriuretic peptide; IS, insulin; ISI, insulin sensitivity index; ET, endothelin; AI, angiotensin I.
pressure (SBP/DBP) is 156 21/92 11 mmHg (shown in Table 1). All the cardiac function is normal, and the two groups are comparable. 2.2. Method Elderly hypertension group had the medical history, physical examination and laboratory tests, with the exception of diabetes and endocrine diseases, liver, kidney, recent not taking drugs which affect blood pressure, blood glucose, blood lipids and platelet function. Healthy comparison group is also checked by the medical history, physical examination [10–13], electrocardiogram, chest x line, blood biochemical examination [14], and no organic disease. Specimen collection: empty stomach venous blood extraction and determination of plasma (serum) t-PA, PAI, glycemic index (G), insulin (IS), insulin sensitivity index (ISI) and the level of ANP, AI. 2.3. Statistical analysis Statistical Package for Social Sciences (SPSS 18.0 Package Facility, SPSS Inc., IL, USA) was used for data support and analysis, t-tests [3–15], analysis of variance (ANOVA), and chi-square analyses were used to assess potential differences in demographic and clinical variables between groups. Data is showed mean standard (y¯ s). The t-tests is used to comparison of data difference, p < 0.05 is significant. 3. Results 3.1. Cardiovascular endocrine hormone Comparison results of cardiovascular endocrine hormone between experimental and control group are shown in Table 1. The element of BMI in experimental group is 22.19 3.80 while the control group is 21.47 2.90, and the glycemic index is 6.12 1.30 mmol/L obviously higher than control group (4.33 1.70 mmol/L). As the test result of t-PA is 1.68 0.32 IU/ml in experimental group, while the control group is 2.04 0.33 IU/ml obviously higher than experimental group (p < 0.05 is significant). And the level of PAI in experimental group (11.81 2.3 IU/L) is significantly higher than control group (9.91 2.5 IU/L), the index of ANP level is 62.37 35.4 pg/ml in experimental group obviously higher than control group (39.17 15.2 pg/ml), p < 0.01 is significant in statistical analysis [11,13]. With the level of IS in experimental group is 14.72 7.37 mU/L, the control group is 12.31 2.90 mU/L.
The ET level is 79.36 20.6 pg/ml in experimental group, and control group is 52.31 22.9 pg/ml, and angiotensin I (AI) is 0.72 0.31 ng/ml/h in experimental group, while the control group is 0.76 0.35 ng/ml/h. Among these influence index of t-PA, PAI, glycemic index (G), insulin (IS), insulin sensitivity index (ISI) and the level of ANP, AI, it is helpful to find the key factor [15] which affect insulin resistance and cardiovascular endocrine hormone in elderly hypertension patients. And the detailed blood lipid level is shown in Table 2. 3.2. Blood lipid level A recent published study [12–16] provided evidence suggesting that C-reactive protein better predicts cardiovascular events than LDL-C alone, whereas using both LDL-C and C-reactive protein values allows an even more accurate measure of cardiovascular risk. Although endothelial cell dysfunction occurs with individual components of the insulin resistance syndrome (i.e., hypertension, low levels of HDL-C, etc.), it also occurs with only modest alterations in these risk factors in the presence of insulin resistance. Data in comparison of blood lipid between experimental group and control group is shown in Table 2. The results show that TG, TC, LDL-C in experimental group is obviously higher than control group, the p < 0.05 is significant difference. The detailed result of TG in experimental group is 2.28 0.27 mmol/L, while the level of TG is 1.63 0.31 mmol/L in control group. And the total cholesterol (TC) is 4.85 0.81 mmol/L in experimental group, the level of TC is 4.13 0.56 mmol/L in control group. However, the level of HDL-C in experimental group is similar with control group, it is not significant difference. The level of insulin in hypertension patients are significantly higher than healthy people, its lipid metabolism is not normal accompanied with hyperinsulinemia. This may be related to the body and which is not sensitive to insulin, leading to resistance to lipolysis function abate [17], glucose utilization obstacle, the decomposition of lipid increasing. Therefore, the free fatty acid increased and lipid metabolism disorders can also promote the hypertension formation. 3.3. C-peptide and insulin releasing The level of C peptide is a good indicator to reflect the insulin B cell in hypertension patients. However, the detailed result of comparison of C peptide and insulin releasing is shown in Table 3.
Table 2 Comparison of blood lipid between experimental group and control group (y¯ s, n = 300). Groups
n
TG (mmol/L)
TC (mmol/L)
LDL-C (mmol/L)
HDL-C (mmol/L)
Experimental group Control group
150 150
2.28 0.27* 1.63 0.31
4.85 0.81* 4.13 0.56
2.37 0.73* 1.86 0.81
1.33 0.28 1.24 0.31
* p < 0.05. TG, triglycerides; TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol.
H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 67–70 Table 3 Comparison of C peptide and insulin releasing (y¯ s, n = 300). Various parameter
Experimental group
Control group
Insulin (pmol/L) 0h 2h 5h
112.38 26.31* 402.41 104.35* 336.34 102.38*
78.12 18.27 296.68 117.16 199.81 85.35
0.63 0.31 1.55 0.47* 1.38 0.36
0.66 0.22 1.67 0.51 1.46 0.39
BMI in experimental group. And the ANP is 0.15 in experimental group, while the r-value of ANP is 0.12 in control group. The related indicator within ET, AI, AII of r-value are also higher than control group, and which act as an important evidence to affect insulin sensitivity in hypertension patients.
4. Discussion
C peptide (nmol/L) 0h 2h 5h
178.31 89.47*
IN/CP *
69
115.19 72.03
p < 0.05, comparison with control group.
From the various parameter of insulin and C peptide, we can see that the insulin releasing with the 0 h is 112.38 26.31 pmol/L in experimental group and obviously higher than control group, with increasing to 2 h the insulin releasing to 402.41 104.35 pmol/L in experimental group is also higher than control group. The level of IN/CP is 178.31 89.47 pmol/L in experimental group and obviously higher than control group (p < 0.05 is significant difference). Next part of multiple linear regression of ISI is studied and plotted in Table 4. The influence factor include ANP, AII, ET, IN, and to study the b, F and p-value.
4.1. The sensitivity of insulin According to the previous work of sensitivity of insulin, the cardiovascular endocrine hormone can reduce insulin sensitivity of the aged diabetes mellitus (DM) patients, which is probably the one of the important pathogenetic mechanisms of aged DM patients. Insulin resistance is an important component of pathophysiological processes that underlies the development of type II diabetes [2,18]. Therefore, it is likely to play a role in development of other conditions such as dyslipidemia, hypertension and atherosclerosis. Insulin resistance can be defined as an attenuated effect of defined amounts of insulin in target tissues. As we know that the sensitivity of insulin associated with cardiovascular endocrine hormone within some potential factors such as ANP, ET, t-PA and AI, etc. Among the hypertension patients with cardiovascular endocrine hormone can affect the level of insulin resistance. 4.2. Pathological analysis
3.4. Multiple linear regression of ISI Influence factor of multiple linear regression filter to ISI is shown in Table 4, the analysis results show that ANP, AII, ET and 1 h level of insulin releasing are the main factor to affect insulin sensitivity index (ISI), the detailed data of F-value of ANP is 6.39 (p = 0.004) and obviously affect the insulin sensitivity. And also the AII, ET are 2.38, 2.34 (p = 0.034, 0.037), respectively. 3.5. Correlation analysis of r-value Correlation analysis on ISI and related indicator (r-value) are shown in Table 5. The results show that the r-value of related indicator in experimental group is obviously higher than control group. Table 5 of correlation analysis on ISI is shown that BMI related r-value in experimental group is 0.53, while related r-value in control group is 0.32, which is a high correlation between ISI and
In recent years, cardiovascular endocrine hormone and IR is gradually to be concerned by medical workers [19,20], and who think that insulin work through the variety of ways of sympathetic nervous system, renin angiotensin aldosterone system, blood pressure reflection, kidney water sodium retention, endothelial cells and ion transmembrane transport. The mRNA expression [21] of vascular smooth muscle cells is promoted by insulin, and increase angiotensin, leading to higher reactivity of AII. It suggests that high levels of insulin can activate the activation of vascular local renin angiotensin aldosterone system. Therefore, which increase the excitability of sympatheticadrenaline system, in the condition of high levels of insulin, combination with subcutaneous insulin receptor, activate collaterals glycine kinase, stimulate the mRNA expression of ET and increase the secretion of ET synthesis, these process are interactional in hypertension patients.
5. Conclusion Table 4 Influence factor of multiple linear regression filter to ISI. Projects ANP AII ET IN
b 1.36 0.92 0.047 0.063
x
F
P-value
1.018 1.126 0.083 0.062
6.39 2.38 2.34 2.72
0.004 0.034 0.037 0.031
Table 5 Correlation analysis on ISI and related indicator (r-value). Experimental group BMI ANP ET AI AII
0.53 0.15 0.33 0.38 0.51
Control group 0.32 0.12 0.14 0.16 0.20
In this article, the influencing factors are analyzed by Multiple Linear Regression. And IR is closely related to the cardiovascular endocrine hormone, we found that DM with cardiovascular diseases is not a coincidence, but it may be causal and promote each other, the mechanism of molecular level is still need to further research. The results of this study have shown that there is a significant correlation and pathological effect between insulin resistance and cardiovascular endocrine hormone in hypertensive patients, the ANP, AI, ET t-PA are the significant influence factors, which plays an important role in genesis and development of hypertension in elderly people. Acknowledgement This study was supported by the Department of Cardiology, Affiliated Hospital of Hebei Engineering University.
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Conflict of interest: The authors have no conflicts of interest or financial disclosures.
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