Essential hypertension, metabolic disorders, and insulin resistance

Journal of Hypertension, 2008

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, angiotensinconverting enzyme inhibitors, angiotensin II-AT1 receptor blockers, or even calcium channel blockers are preferable over diuretics and classical b-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 b-blockers should be avoided.

Journal of Internal Medicine, 1992

Metabolic disturbances in hypertension : results from the population study 'Men born in 1913 '. journal of lnternal Medicine 1992 : 232: 389-395.

Cardiovascular Endocrinology, 2014

The American Journal of Medicine, 1991

TAJ: Journal of Teachers Association, 2018

Background-Metabolic syndrome is a risk factor for cardiovascular disease, so it should call attention. South Asian person has preponderance to it. Objectives-The proper findings of metabolic syndrome are a key to prevent cardiovascular disease. Hypertension is a component of metabolic syndrome with which patients are at increased risk for cardiovascular disease. Methods-This study was carried out in cardiology outdoor of Shaheed Suhrawardy medical college hospital, Dhaka. A total of 322 patients were enrolled from January 2008 to December 2010. Metabolic syndrome was defined as three of the followings: (a) Abnormal fasting serum level of glucose (>_110 mg/dl or 6.1 mmol/L), (b) abdominal obesity (waist circumference >102 cm in men and >88 cm in women), (c) Triglycerides (>_150 mg/dl), (d) High density lipoprotein cholesterol (<40 mg/dl in men and <50 mg/dl in woman), (e) Hypertension, which was common in all patients. Results-Among hypertensive's patients 31.8% had hyperglycemia, 37.9% had high waist circumference, 69.8% had low HDL cholesterol and 54.3% high triglycerides. As per definition of NCEP-ATP-III, metabolic syndrome had been detected in 17% of male, 37% of female and 27% of the total population. Conclusion-Metabolic factors are a common association in hypertensive cases. These patients are at increased risk of coronary and cerebro-vascular disease and require more vigorous prevention. Furthermore in all hypertensive patients metabolic screening is recommended.

Acta Diabetologica, 1995

The effects of the angiotensin-converting enzyme lisinopril were compared with those of the calcium antagonist nifedipine in 162 non-insulin-dependent diabetic hypertensive patients for a 24-week period. In 83 and 79 patients, respectively, lisinopril and slow-release nifedipine produced similar reductions in blood pressure (systolic/diastolic: -16/-13 mmHg supine and -14/-11 mmHg standing after lisinopril; -15/-12mmHg supine and -14/-11 mmHg standing after nifedipine). Fasting and post-prandial plasma glucose, glycosylated haemoglobin and plasma lipids appeared to be unaffected by either agent. Also, 28% of the patients on lisinopril and 30% of those on nifedipine presented microalbuminuria. Both drugs induced a reduction in the albumin excretion rate (AER). The geometric mean Y:tolerance factor of the reduction in AER among the 23 microalbuminuric patients on lisinopril (-10.0 2-: 1.3 gg/min) was greater, though not significantly so, than that observed in the 26 on nifedipine (-0.9 2-: 1.2 gg/min). Moreover, lisinopril appeared to be better tolerated than nifedipine in our study population. Microalbuminuria is an important risk factor for cardiovascular mortality in non-insulin-dependent diabetic patients as well as in the general population. To what extent a reduction in the AER could ameliorate the cardiovascular prognosis in non-insulin-dependent diabetic patients is, at present, unknown. Finally, both lisinopril and nifedipine showed a similar antihypertensive effect in these patients which was not associated with significant differences in plasma glucose, insulin or lipid concentrations. The clinical consequences of the insignificant differences in AER remain unclear.

Journal of Hypertension, 2013

The VALSIM (Estudo de Prevalê ncia da Síndrome Metabó lica) survey was designed as an observational cross-sectional study performed in a primary healthcare setting in Portugal. The first two adult patients scheduled for an appointment on a given day were invited to participate. The treatment effectiveness was evaluated by the occurrence of uncontrolled hypertension (!140/ 90 mmHg) in patients taking antihypertensive drugs. Logistic regression analysis was used to determine the association between uncontrolled hypertension and metabolic risk factors, with adjustments for age, sex, and pattern of antihypertensive treatment.

Hypertension, 1991

individuals comprising all treated hypertensive patients identified within a representative sample (n=3,532, aged 40-70 years) of the Jewish population in Israel. A rate of dosage score (a summed ranking of dosages of all drugs taken) of two or more increased significantly with increasing levels of body mass index (BMI) from 37.5% in levels less than 23, 54.9% in levels 23.0-29.9, and 76.4% in levels of 30 or greater (/?<0.0001). Multivariate analyses, adjusting for age, gender, arm circumference, and ethnic group, confirmed the independent effect of BMI on dosage score (p<0.001). At each level of dosage score, mean blood pressure levels were equivalent at all levels of BMI after adjusting for potential confounders. This indicates that achieved blood pressure level and not BMI itself was the main determinant of the higher dosing regimens prescribed at higher levels of BMI. In representative subgroups, glucose tolerance (n=372) and hyperinsulinemia (n=190) were determined and were found to be positively associated with a dosage score of two or more (p<0.05) independently of BMI. These effects could not be accounted for by poor compliance or by altered drug absorption or disposition since overnight urinary drug excretion and plasma drug concentrations 2 hours after ingestion, measured in 80 randomly selected patients from the study group, were not different across BMI categories at similar dosages. These findings indicate that obesity, even at mild levels, as well as glucose intolerance and hyperinsulinemia, is associated with decreased responsiveness to antihypertensive medications, perhaps as a manifestation of the insulin resistance that characterizes these conditions. (Hypertension 1991;17:565-573)

Revista argentina de …, 2009

Diabetes, Obesity and Metabolism, 2003

Aim: To examine the prevalence and characteristics of uncontrolled hypertension (HT). Methods: A cross-sectional community-based study was carried out in Skara, Sweden, including 894 patients who consecutively underwent an annual follow-up at the hypertension outpatient clinic in primary care. Controlled HT was defined as diastolic blood pressure (DBP) 90 mmHg and systolic blood pressure (SBP) 160 mmHg and was used as reference. Uncontrolled DBP was defined as DBP >90 mmHg regardless of SBP level, and isolated uncontrolled SBP was defined as SBP >160 mmHg and DBP 90 mmHg. Proportions were age-standardized using the Skara population as reference. Results: The prevalence of uncontrolled HT was 43% (isolated uncontrolled SBP 18% and uncontrolled DBP 25%). Both men and women with isolated uncontrolled SBP were older (73 years, CI: 70-75; and 73 years; CI: 72-75) than patients with controlled HT (64 years, CI: 63-66; and 65 years, CI: 64-66). Men and women with known cardiovascular disease (CVD) less often had isolated uncontrolled SBP (OR: 0.4, CI: 0.2-0.9; and OR: 0.5, CI: 0.3-0.9), whereas men and women with known diabetes more often had uncontrolled DBP (OR: 2.3, CI: 1.3-4.