Figure 3.

The proposed interplay between insulin resistance induced vascular dysfunction, salt sensitivity of blood pressure (SSBP) and hypertension. Insulin resistance is associated with decreased nitric oxide (NO) production due to decreased activity of PI3K and increased endothelin-1 (ET-1) production due to increased mitogen-activated protein kinase (MAPK) activity, which results in vasoconstriction in precapillary arterioles. Decreased vascular endothelial growth factor (VEGF) and angiogenesis also causes capillary rarefaction. Evidence suggests that SSBP, which strongly correlates with hypertension, is associated with increased availability of ET-1. Increased ET-1, in turn, may contribute to the development of insulin resistance via the action of ET_B receptor in adipose tissue. Vascular dysfunction caused by insulin resistance and possibly SSBP leads to hypertension and its clinical manifestations. The figure created with BioRender.com.