Abstract
Arterial hypertension is often part of a larger constellation of anthropometric and metabolic abnormalities that includes abdominal (or visceral) obesity, characteristic dyslipidemia (low high-density lipoprotein cholesterol and high triglyceride levels), glucose intolerance, insulin resistance, and hyperuricemia. Using National Cholesterol Education Program Adult Treatment Panel III criteria, prevalence is higher than in the general population and the metabolic syndrome can be found in as many as one third of patients. Among hypertensives with metabolic syndrome, a high prevalence of hypertension-induced target-organ damage and a poor prognostic value has been described. Dietary advice and lifestyle changes should be strongly recommended and prompt pharmacologic treatment is required to control high blood pressure and to reduce risk. The impact of particular antihypertensive drugs on other components of the metabolic syndrome is an important clinical issue with consequences for the success of treatment.
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References and Recommended Reading
Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.
Balkau B, Charles MA: Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999, 16:683–689.
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.
Genest J, Frohlich J, Fodor G, McPherson R, et al.: Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update. CMAJ 2003, 169:921–924.
International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome[article online], 2005. Available at: http://www.idf.org/webdata/docs/metac_syndrome_def.pdf. Accessed January 2007.
Carr DB, Utzschneider KM, Hull RL, et al.: Intraabdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment panel III criteria for the metabolic syndrome. Diabetes 2004, 53:2087–2097.
Pouliot MC, Després JP, Lemieux S, et al.: Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994, 73:460–468.
Grundy SM, Brewer Jr BH, Cleeman JI, et al.: Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation 2004, 109:433–438.
Muntner P, He J, Chen J, et al.: Prevalence of non-traditional cardiovascular disease risk factors among persons with impaired fasting glucose, impaired glucose tolerance, diabetes, and the metabolic syndrome: analysis of the Third National Health and Nutrition Examination Survey (NHANES III). Ann Epidemiol 2004, 14:686–695.
Isomaa B, Almgren P, Tuomi T, et al.: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689.
Alexander CM, Landsman PB, Teutssch SM, Haffner SM: Third National Health and Nutrition Examination Survey (NHANES III); National Cholesterol Education Program (NCEP): NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary herat disease among NHANES III participants age 50 years and older. Diabetes 2003, 52:1210–1214.
Bog-Hansen E, Lindblad U, Gullberg B, et al.: Metabolic disorders associated with uncontrolled hypertension. Diabetes Obes Metab 2003, 5:379–387.
Mancia G, Parati G, Borghi C, et al.: Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study. J Hypertens 2006, 24:837–843.
Leoncini G, Ratto E, Viazzi F, et al.: Metabolic syndrome is associated with early signs of organ damage in nondiabetic, hypertensive patients. J Intern Med 2005, 257:454–460.
Navarro J, Redón J, Cea-Calvo L, et al.: Metabolic syndrome, organ damage and cardiovascular disease in hypertension. The ERIC-HTA study. Blood Pressure, In press.
Rahmouni K, Correia MLG, Haynes WG, Mark AL: Obesity-associated hypertension. New insights into mechanisms. Hypertension 2005, 45:9–14.
Cuspidi C, Meani S, Fusi V, et al.: Prevalence and correlates of left atrial enlargement in essential hypertension: role of ventricular geometry and the metabolic syndrome: the Evaluation of Target Organ Damage in Hypertension study. J Hypertens 2005, 23:875–882.
Schillaci G, Pirro M, Pucci G, et al.: Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women. Hypertension 2006, 47:881–886.
Palaniappan L, Carnethon M, Fortmann SP: Association between microalbuminuria and the metabolic syndrome: NHANES III. Am J Hypertens 2003, 16:952–958.
Thompson PD, Buchner D, Pina IL, et al.: Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003, 107:3109–3116.
Bianchi S, Bigazzi R, Valtriani C, et al.: Elevated serum insulin levels in patients with essential hypertension and microalbuminuria. Hypertension 1994, 23(Part 1):681–687.
Scuteri A, Najjar SS, Muller DC, et al.: Metabolic syndrome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004, 43:1388–1395.
Kawamoto R, Tomita H, Oka Y, et al.: Metabolic syndrome amplifies the LDL-cholesterol associated increases in carotid atherosclerosis. Intern Med 2005, 44:1232–1238.
Safar ME, Thomas F, Blacher J, et al.: Metabolic syndrome and age-related progression of aortic stiffness. J Am Coll Cardiol 2006, 47:72–75.
Jeppesen J, Hein HO, Suadicani P, Gynterberg F: Low triglycerides-high high-density lipoprotein cholesterol and risk of ischemic heart disease. Arch Intern Med 2001, 161:361–366.
Schillaci G, Pirro M, Vaudo G, et al.: Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol 2004, 43:1817–1822.
Onat A, Hergenc G, Sari I, et al.: Dyslipidemic hypertension: distinctive features and cardiovascular risk in a prospective population-based study. Am J Hypertens 2005, 18:409–416.
Dekker JM, Girman C, Rhodes T, et al.: Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn study. Circulation 2005, 112:666–673.
Mancia G, Bombelli M, Corrao G, et al.: Metabolic syndrome in the pressioni arteriose monitorate e loro associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension 2007, 49:40–47
Czoski-Murray C, Warren E, Chilcott J, et al.: Clinical effectiveness and cost-effectiveness of pioglitazone and rosiglitazone in the treatment of type 2 diabetes: a systematic review and economic evaluation. Health Technol Assess 2004, 8:1–91.
Van Gaal LF, Peiffer F: New approaches for the management of patients with multiple cardiometabolic risk factors. J Endocrinol Invest 2006, 29(3 Suppl):83–89.
Pacher P, Batkai S, Kunos G: The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 2006, 58:389–462.
Van Gaal LF, Rissanen AM, Scheen AJ, et al.: Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 2005, 365:1389–1397.
Despres JP, Golay A, Sjostrom L, et al.: Effects of rim on abant on metabolic risk factors in over weight patients with dyslipidemia. N Engl J Med 2005, 353:2121–2134.
European Society of Hypertension-European Society of Cardiology Guidelines Committee: 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21:1011–1053.
Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.
American Diabetes Association: Clinical Practice Recommendations 2005. Diabetes Care 2005, 28(Suppl 1):S1–S79.
Lithell H: Hypertension and hyperlipidemia. A review. Am J Hypertens 1993, 6(11 Pt 2):303S–308S.
Mancia G, Grassi G, Zanchetti A: New-onset diabetes and antihypertensive drugs. J Hypertens 2006, 24:3–10.
Bakris G, Molitch M, Hewkin A, et al.: Differences in glucose tolerance between fixed-dose antihypertensive drug combinations in people with metabolic syndrome. Diabetes Care 2006, 29:2592–2597.
McTavish D, Campoli-Richards D, Sorkin EM: Carvedilol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 1993, 45:232–258.
Tzemos N, Lim PO, MacDonald TM: Nebivolol reverses endothelial dysfunction in essential hypertension: a randomized, double-blind, crossover study. Circulation 2001, 104:S11–S14.
Bakris GL, Fonseca V, Katholi RE, et al.: Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 2004, 292:2227–2236.
Horiuchi M, Mogi M, Iwai M: Signaling crosstalk angiotensin II receptor subtypes and insulin. Endocr J 2006, 53:1–5.
Heart Outcomes Prevention Evaluation Study Investigators: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000, 342:145–153.
Julius S, Kjeldsen SE, Weber M, et al.: Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004, 363:2022–2031.
DREAM (Diabetes Reduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators, Gerstein HC, Yusuf S, Bosch J, et al.: Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 2006, 368:1096–1105
Benson SC, Pershadsingh HA, Ho CI, et al.: Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPA Rgamma-modulating activity. Hypertension 2004, 43:993–1002.
Di Filippo C, Lampa E, Tufariello E, et al.: Effects of irbesartan on the growth and differentiation of adipocytes in obese zucker rats. Obes Res 2005, 13:1909–1914.
Ridker PM, Danielson E, Rifai N, Glynn RJ, Val-MARC Investigators: Valsartan, blood pressure reduction, and C-reactive protein: primary report of the Val-MARC trial. Hypertension 2006, 48:73–79.
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Redon, J., Cífková, R. The metabolic syndrome in hypertension: Diagnostic and therapeutic implications. Current Science Inc 9, 305–313 (2007). https://doi.org/10.1007/s11906-007-0056-9
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DOI: https://doi.org/10.1007/s11906-007-0056-9