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Contents lists available at ScienceDirect

Diabetes & Metabolic SyndrRevie

jo ur n al h o mep ag e: www .e1. Introduction

Under the gradual development of social economy, peoplesliving conditions have a great improvement. Recent years, thenumber of hypertensive patients is increasing. Of which is the mainpatients group of middle-aged and elderly people, and also it is akind of common disease [15].

Domestic and foreign research showed that insulin resistance(IR) [38], tissue Plasminogen Activator (t-PA), PlasminogenActivator Inhibitor activity (PAI) was closely related to hyperten-sion, coronary heart disease. However, the research of relationshipbetween IR and Atrial Natriuretic Peptide (ANP), Endothelin (ET),Angiotensin I (AI) was rarely reported in the pathogenesis ofhypertension disease.

It is a critical study of how to effective treat and explore thepathogenesis of elderly hypertension disease. Therefore, it isfurther to understand the etiology and pathogenesis, in order to

nd better treatments. Therefore, the aim of this paper is that weselected from January 2011 to January 2011 in our hospital fortreatment of 150 cases of hypertension patients and 150 patientswithout hypertension health people, and it analyzed the inspectiondata of these two groups.

2. Materials and methods

2.1. Clinical data

Three hundred subjects were selected from January 2011 toJanuary 2011 in our hospital for treatment, including 150 cases ofhypertension patients and 150 patients without hypertensionhealth people, and analyze the inspection data of these two groups,the former acts as experimental group, the latter acts as controlgroup.

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 massindex (BMI) is 22.19 3.8, blood pressure (SBP/DBP) is 156 19/94 11 mmHg. The 150 patients without hypertension controlgroup, 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

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 signicant 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.

2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

* Corresponding author at: Cong Tai Road 81#, Cong Tai District, Handan, Hebei

Province 056029, PR China. Tel.: +86 0310 8572189.

E-mail address: hongbinw222@126.com (H. Wang).

http://dx.doi.org/10.1016/j.dsx.2015.02.013

1871-4021/ 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.Original Article

Correlated analysis and pathological stucardiovascular endocrine hormone in e

Hua Zhi, Hongbin Wang *, Tao Li, Fumin Pin

Department of Cardiology, Afliated Hospital of Hebei Engineering University, PR Chin

A R T I C L E I N F O

Keywords:

Insulin resistance

Cardiovascular endocrine hormone

Hypertension

A B S T R A C T

Aims: The correlated analy

hormone in elderly hyp

experiments in my hospit

Materials and methods: Ray on insulin resistance anderly hypertension patients

and pathological study on insulin resistance and cardiovascular endocrine

nsion patients was investigated by clinical observation and physical

mly enrolled 300 subjects seen at hospital from January 2011 to January

ome: Clinical Research &wsl sev ier . c om / loc ate /d s x

Table 1Comparison of cardiovascular endocrine hormone between experimental and control group (y s, n = 300).

Groups n BMI G (mmol/L) t-PA (IU/ml) PAI (IU/L) ANP (pg/ml) IS (mU/L) ISI ET (pg/ml) AI (ng/ml/h)

Experimental

group

150 22.19 3.80 6.12 1.30* 1.68 0.32* 11.81 2.3* 62.37 35.4** 14.72 7.37* -6.61 0.07* 79.36 20.6* 0.72 0.31

Control group 150 21.47 2.90 4.33 1.70 2.04 0.33 9.91 2.5 39.17 15.2 12.31 2.90 -7.01 0.08 52.31 22.9 0.76 0.35* p < 0.05.** p < 0.01.

asm

H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 677068pressure (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, physicalexamination and laboratory tests, with the exception of diabetesand endocrine diseases, liver, kidney, recent not taking drugswhich affect blood pressure, blood glucose, blood lipids andplatelet function. Healthy comparison group is also checked by themedical history, physical examination [1013], electrocardiogram,chest x line, blood biochemical examination [14], and no organicdisease. Specimen collection: empty stomach venous bloodextraction 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 PackageFacility, SPSS Inc., IL, USA) was used for data support and analysis,t-tests [315], analysis of variance (ANOVA), and chi-squareanalyses were used to assess potential differences in demographicand clinical variables between groups. Data is showed mean standard (y s). The t-tests is used to comparison of datadifference, p < 0.05 is signicant.

3. Results

3.1. Cardiovascular endocrine hormone

Comparison results of cardiovascular endocrine hormonebetween experimental and control group are shown in Table 1.The element of BMI in experimental group is 22.19 3.80 while thecontrol group is 21.47 2.90, and the glycemic index is6.12 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/mlin experimental group, while the control group is 2.04 0.33 IU/mlobviously higher than experimental group (p < 0.05 is signicant).And the level of PAI in experimental group (11.81 2.3 IU/L) issignicantly higher than control group (9.91 2.5 IU/L), the index of

BMI, body mass index; G, glycemic index; t-PA, tissue plasminogen activator; PAI, pl

insulin sensitivity index; ET, endothelin; AI, angiotensin I.ANP level is 62.37 35.4 pg/ml in experimental group obviouslyhigher than control group (39.17 15.2 pg/ml), p < 0.01 is signicantin statistical analysis [11,13]. With the level of IS in experimentalgroup is 14.72 7.37 mU/L, the control group is 12.31 2.90 mU/L.

Table 2Comparison of blood lipid between experimental group and control group (y s, n = 30

Groups n TG (mmol/L)

Experimental group 150 2.28 0.27*Control group 150 1.63 0.31 * p < 0.05.

TG, triglycerides; TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; HDLThe ET level is 79.36 20.6 pg/ml in experimental group, andcontrol group is 52.31 22.9 pg/ml, and angiotensin I (AI) is0.72 0.31 ng/ml/h in experimental group, while the control groupis 0.76 0.35 ng/ml/h. Among these inuence index of t-PA, PAI,glycemic index (G), insulin (IS), insulin sensitivity index (ISI) and thelevel of ANP, AI, it is helpful to nd the key factor [15] which affectinsulin resistance and cardiovascular endocrine hormone in elderlyhypertension patients. And the detailed blood lipid level is shown inTable 2.

3.2. Blood lipid level

A recent published study [1216] provided evidence suggestingthat C-reactive protein better predicts cardiovascular events thanLDL-C alone, whereas using both LDL-C and C-reactive proteinvalues allows an even more accurate measure of cardiovascularrisk. Although endothelial cell dysfunction occurs with individualcomponents of the insulin resistance syndrome (i.e., hypertension,low levels of HDL-C, etc.), it also occurs with only modestalterations in these risk factors in the presence of insulinresistance.

Data in comparison of blood lipid between experimental groupand control group is shown in Table 2. The results show that TG, TC,LDL-C in experimental group is obviously higher than controlgroup, the p < 0.05 is signicant difference. The detailed result ofTG in experimental group is 2.28 0.27 mmol/L, while the level ofTG 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 is4.13 0.56 mmol/L in control group. However, the level of HDL-C inexperimental group is similar with control group, it is not signicantdifference.

The level of insulin in hypertension patients are signicantlyhigher than healthy people, its lipid metabolism is not normalaccompanied with hyperinsulinemia. This may be related to thebody and which is not sensitive to insulin, leading to resistance tolipolysis function abate [17], glucose utilization obstacle, thedecomposition of lipid increasing. Therefore, the free fatty acidincreased and lipid metabolism disorders can also promote thehypertension formation.

3.3. C-peptide and insulin releasing

inogen activator inhibitor activity; ANP, atrial natriuretic peptide; IS, insulin; ISI,The level of C peptide is a good indicator to reect the insulin Bcell in hypertension patients. However, the detailed result ofcomparison of C peptide and insulin releasing is shown in Table 3.

0).

TC (mmol/L) LDL-C (mmol/L) HDL-C (mmol/L)

4.85 0.81* 2.37 0.73* 1.33 0.284.13 0.56 1.86 0.81 1.24 0.31

-C, high density lipoprotein cholesterol.

From the various parameter of insulin and C peptide, we can seethat the insulin releasing with the 0 h is 112.38 26.31 pmol/Lin experimental group and obviously higher than control

Table 3Comparison of C peptide and insulin releasing (y s, n = 300).

Various parameter Experimental group Control group

Insulin (pmol/L)

0 h 112.38 26.31* 78.12 18.272 h 402.41 104.35* 296.68 117.165 h 336.34 102.38* 199.81 85.35

C peptide (nmol/L)

0 h 0.63 0.31 0.66 0.222 h 1.55 0.47* 1.67 0.515 h 1.38 0.36 1.46 0.39

IN/CP 178.31 89.47* 115.19 72.03* p < 0.05, comparison with control group.

H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 6770 69group, with increasing to 2 h the insulin releasing to402.41 104.35 pmol/L in experimental group is also higher thancontrol group. The level of IN/CP is 178.31 89.47 pmol/L inexperimental group and obviously higher than control group(p < 0.05 is signicant difference).

Next part of multiple linear regression of ISI is studied andplotted in Table 4. The inuence factor include ANP, AII, ET, IN, andto study the b, F and p-value.

3.4. Multiple linear regression of ISI

Inuence factor of multiple linear regression lter to ISI isshown in Table 4, the analysis results show that ANP, AII, ET and 1 hlevel of insulin releasing are the main factor to affect insulinsensitivity index (ISI), the detailed data of F-value of ANP is 6.39(p = 0.004) and obviously affect the insulin sensitivity. And also theAII, 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) areshown in Table 5. The results show that the r-value of relatedindicator in experimental group is obviously higher than controlgroup.

Table 5 of correlation analysis on ISI is shown that BMI relatedr-value in experimental group is 0.53, while related r-value incontrol group is 0.32, which is a high correlation between ISI and

Table 4

Inuence factor of multiple linear regression lter to ISI.

Projects b x F P-value

ANP 1.36 1.018 6.39 0.004AII 0.92 1.126 2.38 0.034

ET 0.047 0.083 2.34 0.037

IN 0.063 0.062 2.72 0.031

Table 5Correlation analysis on ISI and related indicator (r-value).

Experimental group Control group

BMI 0.53 0.32

ANP 0.15 0.12ET 0.33 0.14

AI 0.38 0.16

AII 0.51 0.20BMI in experimental group. And the ANP is 0.15 in experimentalgroup, while the r-value of ANP is 0.12 in control group. Therelated indicator within ET, AI, AII of r-value are also higher thancontrol group, and which act as an important evidence to affectinsulin sensitivity in hypertension patients.

4. Discussion

4.1. The sensitivity of insulin

According to the previous work of sensitivity of insulin, thecardiovascular endocrine hormone can reduce insulin sensitivity ofthe aged diabetes mellitus (DM) patients, which is probably theone of the important pathogenetic mechanisms of aged DMpatients. Insulin resistance is an important component ofpathophysiological processes that underlies the development oftype II diabetes [2,18]. Therefore, it is likely to play a role indevelopment of other conditions such as dyslipidemia, hyperten-sion and atherosclerosis. Insulin resistance can be dened as anattenuated effect of dened amounts of insulin in target tissues.

As we know that the sensitivity of insulin associated withcardiovascular endocrine hormone within some potential factorssuch as ANP, ET, t-PA and AI, etc. Among the hypertension patientswith cardiovascular endocrine hormone can affect the level ofinsulin resistance.

4.2. Pathological analysis

In recent years, cardiovascular endocrine hormone and IR isgradually to be concerned by medical workers [19,20], and whothink that insulin work through the variety of ways of sympatheticnervous system, renin angiotensin aldosterone system, bloodpressure reection, kidney water sodium retention, endothelialcells and ion transmembrane transport.

The mRNA expression [21] of vascular smooth muscle cells ispromoted by insulin, and increase angiotensin, leading to higherreactivity of AII. It suggests that high levels of insulin can activatethe activation of vascular local renin angiotensin aldosteronesystem. Therefore, which increase the excitability of sympathetic-adrenaline system, in the condition of high levels of insulin,combination with subcutaneous insulin receptor, activate collat-erals glycine kinase, stimulate the mRNA expression of ET andincrease the secretion of ET synthesis, these process areinteractional in hypertension patients.

5. Conclusion

In this article, the inuencing factors are analyzed by MultipleLinear Regression. And IR is closely related to the cardiovascularendocrine hormone, we found that DM with cardiovasculardiseases is not a coincidence, but it may be causal and promoteeach other, the mechanism of molecular level is still need to furtherresearch.

The results of this study have shown that there is a signicantcorrelation and pathological effect between insulin resistance andcardiovascular endocrine hormone in hypertensive patients, theANP, AI, ET t-PA are the signicant inuence factors, which plays animportant role in genesis and development of hypertension inelderly people.

Acknowledgement

This study was supported by the Department of Cardiology,Afliated Hospital of Hebei Engineering University.

Conict of interest: The authors have no conicts of interest ornancial disclosures.

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H. Zhi et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 677070

Correlated analysis and pathological study on insulin resistance and cardiovascular endocrine hormone in elderly hypertens...1 Introduction2 Materials and methods2.1 Clinical data2.2 Method2.3 Statistical analysis

3 Results3.1 Cardiovascular endocrine hormone3.2 Blood lipid level3.3 C-peptide and insulin releasing3.4 Multiple linear regression of ISI3.5 Correlation analysis of r-value

4 Discussion4.1 The sensitivity of insulin4.2 Pathological analysis

5 ConclusionAcknowledgementReferences