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Hypertension and the Metabolic syndrome

Hypertension is a very common condition which frequently remains undiagnosed until relatively late in its course, leading to a variety of other life-threatening conditions, like kidney damage and heart failure. It is a very prominent feature of the metabolic syndrome, present in up to 85% of patients. In the context of global cardiovascular risk, metabolic syndrome is indeed a high risk condition, involving obesity, dyslipidemia, hypertension and diabetes. In spite of controversy surrounding its definition and etiology, the metabolic syndrome represents a useful and simple clinical concept which allows earlier detection of type2 diabetes and cardiovascular disease. The establishment of hypertension as a component of the syndrome has enabled more insight into the condition and allowed earlier detection and treatment. Hypertension is associated with the laboratory and anthropometric findings linked to the metabolic syndrome. Insulin resistance and central obesity, recognized as the main factors involved in the pathophysiology of the metabolic syndrome, contribute to increased blood pressure, which further promotes vascular damage in cardiac, renal, and brain tissue. Insulin resistance and the resulting hyperinsulinemia induce blood pressure elevation by activation of sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS) with a consequential sodium retention and volume expansion, endothelial dysfunction and alteration in renal function. Visceral fat, in comparison to subcutaneous tissue, represents a metabolically active organ, strongly related to insulin sensitivity. Moderating the secretion of various adipocytokines like leptin, adiponectin, plasminogen activator inhibitor 1 (PAI-1), tumor necrosis factor alfa (TNF-alfa), interleukin-6 (IL-6), resistin, it is associated with the processes of inflammation, endothelial dysfunction, hypertension and atherogenesis. One of the proposed mechanisms by which hypertension is linked with central obesity includes sympathetic nervous system overactivation. Therapeutic approach to patients with hypertension and metabolic syndrome include changes in the unhealthy lifestyle which aggravates the underlying pathology. This treatment includes sodium restriction, alcohol and calorie restriction, smoking cessation, weight reduction, increased physical activity. However, it is often not sufficient to obtain the target values of blood pressure, especially in patients with type 2 diabetes. Between pharmacological agents, a particular emphasis is placed on the RAAS blockade with ACE inhibitors and angiotensin II receptor blockers, and central sympatholytic agents which exert additional beneficial effects.

hypertension; metabolic syndrome; insulin resistance; visceral obesity

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