Salt-sensitivity is associated with a hyperinsulinaemic and hyperglycaemic response to atrial natriuretic peptide infusion in human essential hypertension

Summary To evaluate the influence of salt-sensitivity on the plasma insulin and glucose response to infusion of ANP, we studied 22 men with essential hypertension, who were between 40 and 60 years old. After 1 month under normal Na⁺ intake (120 mmol Na⁺ per day), patients were randomly assigned to receive either ANP (0.04 g · kg^–1 · min^–1) (n=15) or vehicle (50 ml saline) (n=7) over a 60-min period, while in the supine position. Plasma insulin and glucose were measured at time –60, 0, 20, 40, 60, 120, 180, 240 min. Ten days after ANP infusion, blood pressure sensitivity to changes in di etary salt intake was assessed according to a randomized double-blind crossover protocol. Patients were classified into two groups either salt-sensitive (n=8) or salt-resistant (n=7). Our results showed that plasma insulin and glucose did not change during ANP infusion in both groups. However, both plasma insulin (from 75.6 ± 45.1 pmol/l at 60 min to 121.2 ± 48.6 pmol/l at 240 min, p <0.05 vs time 0) and glucose levels (from 4.86 ± 0.73 mmol/l at 60 min to 6.56 ± 1.03 mmol/l at 240 min, p <0.01 vs time 0) rose after discontinuation of ANP in salt-sensitive patients, but did not change at all in salt-resistant patients. In conclusion, this randomized vehicle-controlled study demonstrates that plasma insulin and glucose levels increase in salt-sensitive hypertensive patients after the infusion of ANP. The increase of plasma insulin levels observed after ANP discontinuation, if occurring under physiologic conditions, could influence the blood pressure sensitivity to dietary Na⁺ intake.Abbrevations ANP Atrial natriuretic peptide - NIDDM non-insulin dependent diabetes mellitus