Scientific Council of the European Society of Hypertension. The metabolic syndrome in hypertension: European society of hypertension position statement. J Hypertens

University of Valencia and CIBER 06/03 Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
Journal of Hypertension (Impact Factor: 4.72). 11/2008; 26(10):1891-900. DOI: 10.1097/HJH.0b013e328302ca38
Source: PubMed


The metabolic syndrome considerably increases the risk of cardiovascular and renal events in hypertension. It has been associated with a wide range of classical and new cardiovascular risk factors as well as with early signs of subclinical cardiovascular and renal damage. Obesity and insulin resistance, beside a constellation of independent factors, which include molecules of hepatic, vascular, and immunologic origin with proinflammatory properties, have been implicated in the pathogenesis. The close relationships among the different components of the syndrome and their associated disturbances make it difficult to understand what the underlying causes and consequences are. At each of these key points, insulin resistance and obesity/proinflammatory molecules, interaction of demographics, lifestyle, genetic factors, and environmental fetal programming results in the final phenotype. High prevalence of end-organ damage and poor prognosis has been demonstrated in a large number of cross-sectional and a few number of prospective studies. The objective of treatment is both to reduce the high risk of a cardiovascular or a renal event and to prevent the much greater chance that metabolic syndrome patients have to develop type 2 diabetes or hypertension. Treatment consists in the opposition to the underlying mechanisms of the metabolic syndrome, adopting lifestyle interventions that effectively reduce visceral obesity with or without the use of drugs that oppose the development of insulin resistance or body weight gain. Treatment of the individual components of the syndrome is also necessary. Concerning blood pressure control, it should be based on lifestyle changes, diet, and physical exercise, which allows for weight reduction and improves muscular blood flow. When antihypertensive drugs are necessary, angiotensin-converting enzyme inhibitors, angiotensin II-AT1 receptor blockers, or even calcium channel blockers are preferable over diuretics and classical beta-blockers in monotherapy, if no compelling indications are present for its use. If a combination of drugs is required, low-dose diuretics can be used. A combination of thiazide diuretics and beta-blockers should be avoided.

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Available from: Krzysztof Narkiewicz
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    • "Elevated levels of WHR, BMI, FPG, TC, and TG were reportedly responsible for the progression of pre-HTN stage to HTN stage1 [17]. Thus, the treatment of the individual components of the syndrome and improvement of modifiable risk factors may be necessary to reduce the triad of obesity, MS, and high BP [19]. Pre-HTN is not a disease category but will identify individuals at high risk of developing hypertension, for adequate intervention to prevent or delay the development of the disease. "
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    • "Studying regional sympathetic activity in obese subjects was found an excess of noradrenaline in relation to the kidneys as a key organ of cardiovascular homeostasis. Both obesity and hypertension lead to the development of left ventricular hypertrophy and subsequent diastolic dysfunction (Redon et al., 2008). Adipose tissue is through several mechanisms, directly integrated into the pathogenesis of hypertension. "

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    • "The role of physical activity for treatment of hypertension is wellknown [4–6]. Aerobic exercise has shown to be associated with reduction of systolic blood pressure (SBP) by 3.84 mm Hg and diastolic blood pressure (DBP) by 2.58 mm Hg in a meta-analysis examining large data from 54 randomized controlled trials [4]. "
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    ABSTRACT: Obesity has become a global epidemic over the past few decades because of unhealthy dietary habits and reduced physical activity. Hypertension and diabetes are quite common among obese individuals and there is a linear relationship between the degree of obesity and these diseases. Lifestyle interventions like dietary modifications and regular exercise are still important and safe first-line measures for treatment. Recently, bariatric surgery has emerged as an important and very effective treatment option for obese individuals especially in those with comorbidities like hypertension and diabetes. Though there are few effective drugs for the management of obesity, their efficacy is only modest, and they should always be combined with lifestyle interventions for optimal benefit. In this paper we aim to outline the non-pharmacological measures for the management of hypertension and diabetes in obesity.
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