Cardiovascular Risk in Patients with Prehypertension and the Metabolic Syndrome
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Prehypertension (pHTN) and metabolic syndrome (MetS) are both lifestyle diseases that are potentiated by increased adiposity, as both disease processes are closely related to weight. In the case of pHTN, increased adiposity causes dysregulation of the renin-angiotensin-aldosterone-system (RAAS) as well as adipokine- and leptin-associated increases in adrenergic tone. In MetS, excess weight potentiates hyperglycemia and insulin resistance which causes positive feedback into the RAAS system, activates an inflammatory cascade that potentiates atherosclerosis, and causes lipid dysregulation which together contribute to cardiovascular disease, especially coronary heart disease (CHD) and heart failure (HF). The relationship with all-cause mortality is not as clear-cut in part because of some protective effects associated with the obesity paradox in chronic diseases such as CHD and HF. However, in healthy populations, the absence of excess weight and its associated effects on prehypertension and MetS are associated with a longer absolute and disease-free lifespan.
KeywordsMetabolic syndrome Obesity Prehypertension Heart failure Insulin resistance
Body mass index
Coronary heart disease
Diastolic blood pressure
European Society of Hypertension
European Society of Cardiology
Free fatty acid
Joint National Committee
The metabolic syndrome
National Cholesterol Education Program
National Health and Nutrition Examination Survey
Reactive oxygen species
The Reasons for Geographic and Racial Differences in Stroke Study
Systolic blood pressure
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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