AACE: Insulin Not Sodium Plays a Major Role in Hypertension

Insulin rather than salt is the major driver of hypertension, according to an analysis of data from a study. In the study, obese patients consuming a high saturated fat diet increased daily sodium intake from less than 2 grams a day to more than 20 grams a day. But they also lost an average of 5.5 kg-or about 5% of their total body weight-in six weeks.

"At the same time there were dramatic and significant reductions in fasting insulin and in mean arterial pressure," reported James H. Hays, M.D., of the Christiana Care Health Services in Newark, Del., at the American Association of Clinical Endocrinologists meeting here today.

Dr. Hays said the finding strongly suggests that "we need to stop paying so much attention to sodium and pay much more attention to fasting insulin."

The patients in the trial were all put on a very high fat diet-50% of calories consumed came from saturated fat sources "mostly flesh of mammals," he said. And were told to avoid starch. There was, however, no caloric restriction. "These were free range humans who could consume as much as they liked," he said.

Dr. Hays and colleagues previously reported in the Mayo Clinic Proceedings that the patients achieved significant improvements in a number of cardiovascular risk factors, including reductions in total triglycerides, triglycerides, very low density lipoprotein (vLDL), and vLDL particle size. Additionally, while LDL and HDL concentrations were unchanged, there were significant increases in HDL and LDL particle size.

Among the findings reported last week:

· After six weeks, average fasting blood glucose was 98.3 mg/dL ±9.3 mg/dL down from 106.1 mg/dL ±9.3 17.7 mg/dL (P<0.05).
· At baseline, average fasting insulin was 21.3± 12.2 microunits/ml, after six weeks it declined to 14.8 mu/ml± 5.7 mu/ml (P<0.05).
· Mean arterial pressure decreased by an average of 5.5 mm Hg from 96 mm Hg at baseline to 88.5 mm Hg after six weeks of the high fat diet (P<0.05).

The patients in the study "were all very high risk at baseline and were all taking a number of medications including a number of antihypertensive drugs," he said. "By the end of the study some patients were able to stop drug therapy and others were able to reduce their doses."

Dr. Hays said it is also possible that the real key to the success of these patients is the rapid weight loss. "It all comes back to obesity," he said. Asked whether a similar weight loss achieved with a restricted calorie diet or a low fat diet could produce the same results, he agreed that it could.

Asked to explain the rapid weight loss observed in the high fat study, he said that satiety is a factor. "Steak at every meal sounds good, but it gets old."

He said, however, that although he was once "pretty close to a vegetarian, I do believe in this diet (high fat, red meat) and I do follow it myself."

Abdul-Rahman, M et al "A High-Fat Diet in Obese Patients Induces Weight Loss, Leads to Improved Insulin Resistance, and Lowers Systolic Blood Pressure Despite Marked Increase in Dietary Sodium Intake" Abstract 201 Endocr Pract 2006 12

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