The clinical significance of metabolic syndrome in hypertension: metabolic syndrome increases cardiovascular risk : the pro position.

Changes in lifestyle in the developed world are promoting the epidemic growth of overweight and obesity, leading to several metabolic abnormalities (lipids, glucose and blood pressure), and increasing the future risk of type 2 diabetes mellitus, cardiovascular events and death. Metabolic syndrome represents the combination of abdominal obesity, insulin resistance, atherogenic dyslipidaemia, and prothrombotic and proinflammatory states. Although some controversies in the pathogenesis and clinical importance of metabolic syndrome still remain, the development of useful clinical tools to identify these patients more easily has enabled an increased recognition in the adult population. Management of patients with metabolic syndrome is a clinical challenge and requires a multifactorial, multidisciplinary approach. Changes in lifestyle are obviously the first therapeutic step and include both dietary modifications and increased daily exercise. Several questions remain to be elucidated with respect to pharmacological treatment. The blood pressure levels required to initiate antihypertensive treatment, the blood pressure goal to be achieved and the possibility of including a renin-angiotensin system blocker as a part of the pharmacological treatment are still under discussion. Moreover, there is either a lack of or poor evidence on the need for specific drugs to reduce triglycerides, to increase high-density lipoprotein-cholesterol, to improve insulin sensitivity or to decrease abdominal obesity. Independently, it is generally accepted that earlier and more aggressive therapy in subjects with metabolic syndrome will result in a future decrease in cardiovascular morbidity and mortality worldwide.