Editorial Comment Metabolic Abnormalities of Hypertension A Lesson in Complexity

In this issue, Reaven and coworkers1 report oncarbohydrate and lipid abnormalities in yetanother experimental model of hypertension, the Dahl rat. Whether salt-sensitive or salt-resistant, animals of this strain are hyperinsulinemic and dys-lipidemic. This finding strengthens the contention that in essential hypertension, metabolic disorders such as reduced glucose tolerance, dyslipidemia, and hyperinsulinemia/insulin resistance are inherent fea-tures rather than incidental findings. To what extent does this concept apply to human essential hypertension? The notion that in patients with high blood pressure, both carbohydrate intoler-ance and lipid changes are more frequent than expected on the basis of chance alone is not new and emerges consistently from shrewd clinical observa-tion. More or less consciously, however, clinician