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RESISTENCIA A INSULINA E HIPERTENSAO ARTERIAL
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RESISTENCIA A INSULINA E HIPERTENSAO ARTERIAL

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Conforme solicitado, o artigo seria uma revisão do que surgiu sobre este assunto após a publicação de artigo anterior, no Am J Hypertens, sobre resistência à insulina e fatores de risco cardiovasculares em hipertensos. A idéia é comentar vários trabalhos realizados.
dacostalima9_n1810.jpg Autor:
Nereida Kilza Da Costa Lima
Columnista Experta de SIIC

Institución:
Universidade de São Paulo


Artículos publicados por Nereida Kilza Da Costa Lima
Recepción del artículo
4 de Octubre, 2010
Aprobación
20 de Diciembre, 2010
Primera edición
24 de Junio, 2011
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
A primeira síndrome que agregou resistência à insulina (RI), intolerância à glicose, hiperinsulinemia, aumento de triglicérides, redução do HDL (lipoproteína de alta densidade) e hipertensão arterial, denominada Síndrome X, foi proposta (propuesta) por Gerald M. Reaven, em 1988. Muitos estudos comprovaram que esta síndrome está associada a elevado risco (riesgo) cardiovascular. Recentemente, evidenciamos que cerca de 50% dos pacientes com hipertensão primária são resistentes à insulina, tanto tratados como não tratados. Os indivíduos hipertensos com RI tinham índice de massa corpórea, níveis de triglicérides, glicemia e insulinemia maiores, com HDL mais baixo (bajo). Este subgrupo de pacientes com hipertensão está, provavelmente, sob maior (bajo mayor) risco cardiovascular. No entanto (Sin embargo), a ligação (unión) entre RI e hipertensão não ocorre só (no ocurre solo) em indivíduos com sobrepeso ou obesidade. Voluntários do sexo masculino, magros, hipertensos não tratados, com a mesma composição corporal e perfil lipídico, apresentaram maiores RI e hiperinsulinemia. Alguns estudos demonstraram que a RI pode predizer (puede predecir) morte e eventos cardiovasculares independentemente de fatores (factores) de risco tradicionais. É importante aprender a controlar a RI, principalmente em indivíduos com alto risco cardiovascular. Intervenções no estilo de vida podem reduzir a RI, apesar de ela persistir em pacientes hipertensos, quando comparados aos (cuando comparados con los) normotensos. Talvez sejam (sean) necessárias intervenções dietéticas mais específicas neste grupo. A abordagem (El abordaje) farmacológica é uma perspectiva para tratar a RI, mas serão necessários estudos prospectivos que nos mostrem benefícios no risco cardiovascular.

Palabras clave
hipertensão arterial, resistência à insulina, risco cardiovascular, hipertensión arterial, resistencia a la insulina, riesgo cardiovascular


Artículo completo

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Extensión:  +/-4.54 páginas impresas en papel A4
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Abstract
The first syndrome that put together insulin resistance (IR), glucose intolerance, hyperinsulinemia, an increased plasma concentration of triglyceride, a decreased plasma concentration of HDL (high density lipoprotein) cholesterol, and hypertension, named Syndrome X, was proposed by Gerald M. Reaven, in 1988. Many studies proved that this syndrome is associated to a high cardiovascular risk. Recently, we showed that approximately 50% of patients with essential hypertension are insulin resistant, both treated and untreated ones. The hypertensive individuals with RI had higher body mass index, triglyceride concentration, and glucose and insulin levels, with lower HDL. Probably, this subset of hypertensive patients is at greatest cardiovascular risk. However, the link between IR and arterial hypertension does not occur only in individuals with overweight or obesity. Untreated, young, lean hypertensive male volunteers, with the same body composition and lipid profile of normotensive controls, had IR and hyperinsulinemia. Some studies showed that RI can predict death and cardiovascular events independently of traditional cardiovascular risk factor. It is important to learn to control IR, mainly in high cardiovascular risk patients. Lifestyle interventions can reduce IR, although it persists in hypertensive patients when compared to normotensive ones. Maybe more specific dietary interventions should be conducted in this group. The pharmacological approach is a perspective to treat RI, nevertheless it will be necessary prospective studies that show us benefits on cardiovascular risk.

Key words
arterial hypertension, insulin resistance, cardiovascular risk


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología, Diabetología
Relacionadas: Atención Primaria, Cuidados Intensivos, Diagnóstico por Laboratorio, Educación Médica, Endocrinología y Metabolismo, Farmacología, Geriatría, Medicina Familiar, Medicina Farmacéutica, Medicina Interna



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Enviar correspondencia a:
Nereida Kilsa Da Costa Lima, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Clínica Médica, 14048-900, Av. Bandeirantes, 3900, San Pablo, Brasil
Patrocinio y reconocimiento:
ao Professor GM Reaven pela oportunidade de aprender com este grande mestre e à CAPES pela Bolsa de Pós-Doutorado (2007-2008).
Bibliografía del artículo
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