Skip to main content
Log in

Update on the metabolic syndrome: Hypertension

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The presence of the metabolic syndrome identifies an individual at increased risk for diabetes, cardiovascular disease, and early mortality. However, the increased risk may vary by the absence or presence of hypertension. Current guidelines for the management of high blood pressure in the metabolic syndrome emphasize lifestyle modification as a first-line strategy. Pharmacologic treatment of elevated blood pressure in the metabolic syndrome may be necessary in the presence of other cardiovascular risk factors or to achieve adequate blood pressure control. Currently, there is no consensus as to which antihypertensive therapy should be used to treat hypertension in patients with the metabolic syndrome; it remains unclear whether achieving tight blood pressure control should outweigh the potential for development of glucose intolerance. Future research must focus on this issue given the high prevalence of the syndrome among hypertensive patients and high rates of progression to diabetes among those with the metabolic syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. Available at http://www.idf.org/webdata/docs/MetS_def_update2006.pdf. Accessed October 2008.

  2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): 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) final report. Circulation 2002, 106:3143–3421.

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. Einhorn D, Reaven GM, Cobin RH, et al.: American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003, 9:237–252.

    PubMed  Google Scholar 

  5. Grundy SM, Cleeman JI, Daniels SR, et al.: Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005, 112:2735–2752.

    Article  PubMed  Google Scholar 

  6. Ford ES, Giles WH, Mokdad AH: Increasing prevalence of the metabolic syndrome among US adults. Diabetes Care 2004, 27:2444–2449.

    Article  PubMed  Google Scholar 

  7. Fields LE, Burt VL, Cutler JA, et al.: The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 2004, 44:398–404.

    Article  PubMed  CAS  Google Scholar 

  8. Vasan RS, Beiser A, Seshadri S, et al.: Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart Study. JAMA 2002, 287:1003–1010.

    Article  PubMed  Google Scholar 

  9. McNeill AM, Rosamond WD, Girman CJ, et al.: The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005, 28:385–390.

    Article  PubMed  Google Scholar 

  10. Vaidya D, Szklo M, Liu K, et al.: Defining the metabolic syndrome construct: Multi-Ethnic Study of Atherosclerosis (MESA) cross-sectional analysis. Diabetes Care 2007, 30:2086–2090.

    Article  PubMed  Google Scholar 

  11. Rutter MK, Meigs JB, Sullivan LM, et al.: Insulin resistance, the metabolic syndrome, and incident cardiovascular events in the Framingham Offspring Study. Diabetes 2005, 54:3252–3257.

    Article  PubMed  CAS  Google Scholar 

  12. 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.

    Article  PubMed  CAS  Google Scholar 

  13. Pannier B, Thomas F, Bean K, et al.: The metabolic syndrome: similar deleterious impact on all-cause mortality in hypertensive and normotensive subjects. J Hypertens 2008, 26:1223–1228.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. Vlek AL, van der Graaf Y, Spiering W, et al.: SMART study group: Effect of metabolic syndrome or type II diabetes mellitus on the occurrence of recurrent vascular events in hypertensive patients. J Hum Hypertens 2008, 22:358–365.

    Article  PubMed  CAS  Google Scholar 

  16. Ford ES: Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005, 28:1769–1778.

    Article  PubMed  Google Scholar 

  17. Galassi A, Reynolds K, He J: Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med 2006, 119:812–819.

    Article  PubMed  CAS  Google Scholar 

  18. Ho JS, Cannaday JJ, Barlow CE, et al.: Relation of the number of metabolic syndrome risk factors with all-cause and cardiovascular mortality. Am J Cardiol 2008, 102:689–692.

    Article  PubMed  Google Scholar 

  19. Hsu PF, Chuang SY, Cheng HM, et al.: Clinical significance of the metabolic syndrome in the absence of established hypertension and diabetes: a community-based study. Diabetes Res Clin Pract 2008, 79:461–467.

    Article  PubMed  CAS  Google Scholar 

  20. Mozaffarian D, Kamineni A, Prineas RJ, Siscovick DS: Metabolic syndrome and mortality in older adults: the Cardiovascular Health Study. Arch Intern Med 2008, 168:969–978.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. Hong Y, Jin X, Mo J, et al.: Metabolic syndrome, its preeminent clusters, incident coronary heart disease and all-cause mortality—results of prospective analysis for the Atherosclerosis Risk in Communities study. J Intern Med 2007, 262:113–122.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  CAS  Google Scholar 

  24. Appel LJ, Moore TJ, Obarzanek E, et al.: A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997, 336:1117–1124.

    Article  PubMed  CAS  Google Scholar 

  25. Azadbakht L, Mirmiran P, Esmaillzadeh A, et al.: Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005, 28:2823–2831.

    Article  PubMed  CAS  Google Scholar 

  26. Lien LF, Brown AJ, Ard JD, et al.: Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome. Hypertension 2007, 50:609–616.

    Article  PubMed  CAS  Google Scholar 

  27. Whelton SP, Chin A, Xin X, He J: Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002, 136:493–503.

    PubMed  Google Scholar 

  28. Pescatello LS, Blanchard BE, Van Heest JL, et al.: The metabolic syndrome and the immediate antihypertensive effects of aerobic exercise: a randomized control design. BMC Cardiovasc Disord 2008, 8:12.

    Article  PubMed  Google Scholar 

  29. Mourad JJ, Lameira D, Guillausseau PJ: Blood pressure normalization by fixed perindopril/indapamide combination in hypertensive patients with or without associate metabolic syndrome: results of the OPTIMAX 2 study. Vasc Health Risk Manag 2008, 4:443–451.

    PubMed  CAS  Google Scholar 

  30. Malacco E, Omboni S: Antihypertensive efficacy of zofenopril plus hydrochlorothiazide fixed combination for treatment in metabolic syndrome. Adv Ther 2007, 24:1006–1015.

    Article  PubMed  CAS  Google Scholar 

  31. Rossi R, Nuzzo A, Origliani G, Modena MG: Metabolic syndrome affects cardiovascular risk profile and response to treatment in hypertensive postmenopausal women. Hypertension 2008, 52:865–872.

    Article  PubMed  CAS  Google Scholar 

  32. Redon J, Cifkova R: The metabolic syndrome in hypertension: diagnostic and therapeutic implications. Curr Hypertens Rep 2007, 9:305–313.

    Article  PubMed  CAS  Google Scholar 

  33. Gress TW, Nieto FJ, Shahar E, et al.: Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 2000, 342:905–912.

    Article  PubMed  CAS  Google Scholar 

  34. Hansson L, Lindholm LH, Niskanen L, et al.: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999, 353:611–616.

    Article  PubMed  CAS  Google Scholar 

  35. Yusuf S, Gerstein H, Hoogwerf B, et al.: Ramipril and the development of diabetes. JAMA 2001, 286:1882–1885.

    Article  PubMed  CAS  Google Scholar 

  36. Messerli FH, Grossman E, Leonetti G: Antihypertensive therapy and new onset diabetes. J Hypertens 2004, 22:1845–1847.

    Article  PubMed  CAS  Google Scholar 

  37. Mancia G, Grassi G, Zanchetti A. New-onset diabetes and antihypertensive drugs. J Hypertens 2006, 24:3–10.

    Article  PubMed  CAS  Google Scholar 

  38. Opie LH, Schall R: Old antihypertensives and new diabetes. J Hypertens 2004, 22:1453–1458.

    Article  PubMed  CAS  Google Scholar 

  39. Mason JM, Dickinson HO, Nicolson DJ, et al.: The diabetogenic potential of thiazide-type diuretic and beta-blocker combinations in patients with hypertension. J Hypertens 2005, 23:1777–1781.

    Article  PubMed  CAS  Google Scholar 

  40. Kostis JB, Wilson AC, Freudenberger RS, et al.: Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. Am J Cardiol 2005, 95:29–35.

    Article  PubMed  CAS  Google Scholar 

  41. Barzilay JI, Davis BR, Cutler JA, et al.: Fasting glucose levels and incident diabetes mellitus in older nondiabetic adults randomized to receive 3 different classes of antihypertensive treatment: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 2006, 166:2191–2201.

    Article  PubMed  CAS  Google Scholar 

  42. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998, 317:713–720.

  43. Turnbull F, Neal B, Algert C, et al.: Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 2005, 165:1410–1419.

    Article  PubMed  Google Scholar 

  44. Black HR, Davis B, Barzilay J, et al.: Metabolic and clinical outcomes in nondiabetic individuals with the metabolic syndrome assigned to chlorthalidone, amlodipine, or lisinopril as initial treatment for hypertension: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Diabetes Care 2008, 31:353–360.

    Article  PubMed  CAS  Google Scholar 

  45. Wright JT Jr, Harris-Haywood S, Pressel S, et al.: Clinical outcomes by race in hypertensive patients with and without the metabolic syndrome: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 2008, 168:207–217.

    Article  PubMed  CAS  Google Scholar 

  46. Hilgers KF, Mann JF: The choice of antihypertensive therapy in patients with the metabolic syndrome—time to change recommendations? Nephrol Dial Transplant 2008, 23:3389–3391.

    Article  PubMed  CAS  Google Scholar 

  47. Kahn R: Metabolic syndrome: is it a syndrome? Does it matter? Circulation 2007, 115:1806–1810.

    Article  PubMed  Google Scholar 

  48. Kahn R, Buse J, Ferrannini E, Stern M: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005, 28:2289–2304.

    Article  PubMed  Google Scholar 

  49. Greenland P: Critical questions about the metabolic syndrome. Circulation 2005, 112:3675–3676.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kristi Reynolds.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reynolds, K., Wildman, R.P. Update on the metabolic syndrome: Hypertension. Current Science Inc 11, 150–155 (2009). https://doi.org/10.1007/s11906-009-0026-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-009-0026-5

Keywords

Navigation