THE ROLE OF INSULIN RESISTANCE IN THE DEVELOPMENT OF ENDOTHELIAL DYSFUNCTION IN ESSENTIAL HYPERTENSION IN YOUNG PATIENTS

Ivanytska T. A., Kazakov Yu. M., Guminsky Ju. I.

LITERATURE REVIEWS

Scentific article

Insulin resistance (IR) manifests itself as a disturbed biological response of peripheral tissues of an organism to the effect of endogenous or exogenous insulin. The modern presentation of IP is not limited to parameters that characterize only the metabolism of carbohydrates, but also takes into account changes in the exchange of fats, proteins, endothelial cell function, and gene expression. Endothelial dysfunction is characterized by predominance of vasoconstriction, adhesion of leukocytes, readiness for thrombotic formation. The presence of factors of cardiovascular risk, such as hypertension, hyperglycemia, hypercholesterolemia, changes the structural and functional state of the endothelial cells. According to modern views, along with dyslipidemia, oxidative stress, endothelial dysfunction and inflammation are the basis for the development and progression of atherosclerosis, which is an emerging pathogenetic factor in the development of cardiovascular diseases (CVD). Essential hypertension is the most common type of CVD, which is the main cause of early disability and death throughout the world. Recent studies have shown that hyperactivity of the renin-angiotensin-aldosterone system plays an important role in the development of IR, which is a major component of the metabolic syndrome (MS). Normally, insulin has a vascular protective effect by activating the enzyme phosphatidyl-3-kinase (PI3-K) in endothelial cells and microvessels. This leads to the expression of the endothelial NO-synthetase gene, the release of endogenous NO c and insulin-induced vasodilation. A specific disorder in the PI3K-dependent insulin signaling forms a link between insulin resistance and endothelial dysfunction (ED), indicating the affinity of metabolic diseases, in particular metabolic syndrome and cardiovascular diseases in insulin-resistant conditions. IP, an excellent symptom of metabolic syndrome, worsens the vascular response and increases cardiovascular risk. The combination of insulin resistance and endothelial dysfunction in pathological disorders contributes to the violation of NO-dependent vasodilatation, cellular glucose uptake, oxidative stress and inflammation, leading to atherosclerosis. On the one hand, insulin stimulates the production of endothelial NO, an important vasodilator, which has an antiaggregation effect and limits the growth of smooth muscle cells in the blood vessels, but on the other – indirectly stimulates the release of endothelin-1, a powerful vasoconstrictor. Thus, the effect of insulin resistance on the development of endothelial dysfunction is still uneven and requires further research. Particular attention should be paid to signs of insulin resistance and endothelial dysfunction in young people, since in this way it is possible to more effectively prevent the development of CVS and metabolic syndrome. ED is at the intersection of the two largest epidemics of civilization – essential hypertension and metabolic syndrome, the main feature of which is insulin resistance. The role of insulin resistance in endothelial dysfunction development is still controversial, so there is a need for further study of this problem, especially among young patients with hypertension.

insulin resistance, endothelial dysfunction, arterial hypertension, young age.

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«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 44-48 pages, index UDK 616.12-008.331.1:616.379-008:64

10.29254/2077-4214-2019-2-2-151-44-48