Hypertension in Metabolic Syndrome-An Overview

Metabolic syndrome is a cluster of insulin resistance (IR), obesity, dyslipidemia. Hypertension, hyperglycemia and vascular disorders. Hypertension(HTN) is a very prominent component of the metabolic syndrome(Mets), present in up to 85% of patients. HTN is a very common condition which frequently remains silent and undiagnosed till late in its course. The establishment of HTN as a component of the metabolic syndrome has enabled better insight into the condition. HTN is associated with the laboratory and anthropometric findings linked to the Mets. IR and central obesity, recognized as the main factors linked with pathophysiology of the Mets, contribute to HTN which further promotes vascular damage in cardiac, renal, eye and brain tissue. IR and the resulting hyperinsulinemia induce blood pressure elevation by the activation of sympathetic nervous system(SNS) and renin-angiotensin-aldosterone system (RAAS) with 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. One of the proposed mechanisms by which hypertension is linked with central obesity includes sympathetic SNS overactivation. There is strong link between vasoconstriction due to IR and HTN as per insulin hypothesis of hypertension in Mets. Therapeutic approach to patients with HTN and Mets includes modification of unhealthy lifestyle which includes sodium, alcohol and calorie restriction, smoking cessation, weight reduction and increased physical activity. However, it is often insufficient to obtain the target values of blood pressure. Concerning pharmacological agents, emphasis is in particular placed on the RAAS blockade with angiotensin converting enzyme(ACE) inhibitors, angiotensin II receptor blockers(ARB) and on central sympatholytic agents that exert additional beneficial effects. An overview of hypertension in metabolic syndrome has been attempted in this review article.