HYPERTENSION MANAGEMENT IN METABOLIC SYNDROME

Hypertension is one of the key risk factors for cardiovascular morbidity and mortality. Metabolic syndrome (synonyms: syndrome X, insulin resistance syndrome) is characterized by increased visceral fat mass, decreased sensitivity of peripheral tissues to insulin (insulin resistance) and hyperinsulinemia, which cause disorders of carbohydrate, lipid, and purine metabolism. Hypertension is an integral component of the metabolic syndrome. The severity of hypertension in patients with metabolic syndrome is higher in comparison with patients without metabolic disorders. In patients with metabolic syndrome, the probability of cardiac and brain damage increases fivefold, kidney damage threefold, and the vessels twofold. The presence of diabetes reduces the likelihood of achieving effective control of blood pressure by 1.4 times, hypercholesterolemia — by 1.5 times, obesity — by 1.7 times. In the presence of any three factors, the effectiveness of treatment is reduced twofold. In this article, approaches to the management of patients with hypertension and metabolic syndrome, aspects of non-drug therapy, target blood pressure levels, and the choice of drugs are presented in accordance with evidence-based medicine and current recommendations.

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High TSH Level within Normal Range Is Associated with Obesity, Dyslipidemia, Hypertension, Inflammation, Hypercoagulability, and the Metabolic Syndrome: A Novel Cardiometabolic Marker

Journal of Clinical Medicine ◽

10.3390/jcm8060817 ◽

2019 ◽

Vol 8 (6) ◽

pp. 817 ◽

Cited By ~ 8

Author(s):

Yi-Cheng Chang ◽

Shih-Che Hua ◽

Chia-Hsuin Chang ◽

Wei-Yi Kao ◽

Hsiao-Lin Lee ◽

...

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Central Obesity ◽

Cardiometabolic Risk ◽

Fasting Glucose ◽

Reference Group ◽

Elevated Blood ◽

Normal Range ◽

The Metabolic Syndrome

(1) Background: Overt and subclinical hypothyroidism has been associated with increased cardiometabolic risks. Here we further explore whether thyroid function within normal range is associated with cardiometabolic risk factors in a large population-based study. (2) Methods: We screened 24,765 adults participating in health examinations in Taiwan. Participants were grouped according to high-sensitive thyroid-stimulating hormone (hsTSH) level as: <50th percentile (0.47–1.48 mIU/L, the reference group), 50–60th percentile (1.49–1.68 mIU/L), 60–70th percentile (1.69–1.94 mIU/L), 70–80th percentile (1.95–2.3 mIU/L), 80–90th percentile (2.31–2.93 mIU/L), and >90th percentile (>2.93 mIU/L). Cardiometabolic traits of each percentile were compared with the reference group. (3) Results: Elevated hsTSH levels within normal range were dose-dependently associated with increased body mass index, body fat percentage, waist circumferences, blood pressure, hemoglobin A1c (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high homeostasis model of assessment of beta-cell (HOMA-β), triglycerides, total cholesterols, fibrinogen, and uric acids (p-for-trend <0.001), but not with fasting glucose levels. The association remained significant after adjustment of age, sex, and lifestyle. As compared to the reference group, subjects with the highest hsTSH percentile had significantly increased risk of being overweight (adjusted odds ratio (adjOR): 1.35), increased body fat (adjOR: 1.29), central obesity (adjOR: 1.36), elevated blood pressure (adjOR: 1.26), high HbA1c (adjOR: 1.20), hyperinsulinemia (adjOR: 1.75), increased HOMA-IR (adjOR: 1.45), increased HOMA-β (adjOR: 1.40), hypertriglyceridemia (adjOR: 1.60), hypercholesterolemia (adjOR: 1.25), elevated hsCRP (adjOR: 1.34), increased fibrinogen (adjOR: 1.45), hyperuricemia (adjOR: 1.47), and metabolic syndrome (adjOR: 1.42), but significant risk of low fasting glucose (adjOR: 0.89). Mediation analysis indicates that insulin resistance mediates the majority of the association between thyroid hormone status and the metabolic syndrome. (4) Conclusion: Elevated hsTSH within the normal range is a cardiometabolic risk marker associated with central obesity, insulin resistance, elevated blood pressure, dyslipidemia, hyperuricemia, inflammation, and hypercoagulability.

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Electronic Cigarette Use and Metabolic Syndrome Development: A Critical Review

Toxics ◽

10.3390/toxics8040105 ◽

2020 ◽

Vol 8 (4) ◽

pp. 105

Author(s):

Ilona Górna ◽

Marta Napierala ◽

Ewa Florek

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Arterial Blood Pressure ◽

Abdominal Obesity ◽

Critical Review ◽

Lifestyle Modifications ◽

The Metabolic Syndrome ◽

Arterial Blood ◽

The Impact

The metabolic syndrome is a combination of several metabolic disorders, such as cardiovascular disease, atherosclerosis, and type 2 diabetes. Lifestyle modifications, including quitting smoking, are recommended to reduce the risk of metabolic syndrome and its associated complications. Not much research has been conducted in the field of e-cigarettes and the risk of metabolic syndrome. Furthermore, taking into account the influence of e-cigarettes vaping on the individual components of metabolic syndrome, i.e, abdominal obesity, insulin resistance, dyslipidemia and elevated arterial blood pressure, the results are also ambiguous. This article is a review and summary of existing reports on the impact of e-cigarettes on the development of metabolic syndrome as well as its individual components. A critical review for English language articles published until 30 June 2020 was made, using a PubMed (including MEDLINE), Cochrane, CINAHL Plus, and Web of Science data. The current research indicated that e-cigarettes use does not affect the development of insulin resistance, but could influence the level of glucose and pre-diabetic state development. The lipid of profile an increase in the TG level was reported, while the influence on the level of concentration of total cholesterol, LDL fraction, and HDL fraction differed. In most cases, e-cigarettes use increased the risk of developing abdominal obesity or higher arterial blood pressure. Further research is required to provide more evidence on this topic.

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Effects of pharmacological reversal of hyperuricemia on features of the metabolic syndrome in patients with gouty arthritis

Journal of Investigative Medicine ◽

10.1136/jim-2018-000728 ◽

2018 ◽

Vol 66 (7) ◽

pp. 1031-1036

Author(s):

Mariana Marin ◽

Naim M Maalouf

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Gouty Arthritis ◽

Oxidase Inhibitor ◽

Model Assessment ◽

Urine Ph ◽

Serum Triglycerides ◽

Xanthine Oxidase Inhibitor ◽

The Metabolic Syndrome

Hyperuricemia has been associated in epidemiological studies with the development of obesity, hypertension, insulin resistance and type 2 diabetes. Nevertheless, it remains unclear whether lowering of serum uric acid (UA) alters any of the features of the metabolic syndrome. In this prospective study (ClinicalTrials.gov identifier: NCT01654276), 24 patients with gouty arthritis and hyperuricemia were treated for 6 months with the xanthine oxidase inhibitor febuxostat to lower serum UA to <6 mg/dL. Measurements of 24 hours ambulatory blood pressure (ABP) and serum and urine markers of the metabolic syndrome were measured at baseline and at the end of 6 months of febuxostat. The study population consisted of 18 men and 6 women, 18 of which completed the baseline and 6 months visits. Serum UA decreased significantly from 8.7±1.5 mg/dL at baseline to 4.4±1.1 mg/dL at 6 months (P<0.0001). During that time frame, there was no significant change in body mass index, systolic or diastolic blood pressure measured by 24 hours ABP monitor, serum glucose, insulin or homeostatic model assessment for insulin resistance, serum total and high-density lipoprotein-cholesterol, serum triglycerides or urine pH (P>0.05 for all). There was no correlation between parameters of the metabolic syndrome and the decline in serum UA or serum UA achieved at study end. In conclusion, in patients with gouty arthritis, UA lowering with febuxostat below 6 mg/dL had no significant impact on features of the metabolic syndrome.

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Association of Metabolic Syndrome with Sensorineural Hearing Loss

Journal of Clinical Medicine ◽

10.3390/jcm10214866 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4866

Author(s):

Hwa-Sung Rim ◽

Myung-Gu Kim ◽

Dong-Choon Park ◽

Sung-Soo Kim ◽

Dae-Woong Kang ◽

...

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Health Examination ◽

Number Of Components ◽

The Metabolic Syndrome ◽

Hearing Thresholds

The prevalence of sensorineural hearing loss has increased along with increases in life expectancy and exposure to noisy environments. Metabolic syndrome (MetS) is a cluster of co-occurring conditions that increase the risk of heart disease, stroke and type 2 diabetes, along with other conditions that affect the blood vessels. Components of MetS include insulin resistance, body weight, lipid concentration, blood pressure, and blood glucose concentration, as well as other features of insulin resistance such as microalbuminuria. MetS has become a major public health problem affecting 20–30% of the global population. This study utilized health examination to investigate whether metabolic syndrome was related to hearing loss. Methods: A total of 94,223 people who underwent health check-ups, including hearing tests, from January 2010 to December 2020 were evaluated. Subjects were divided into two groups, with and without metabolic syndrome. In addition, Scopus, Embase, PubMed, and Cochrane libraries were systematically searched, using keywords such as “hearing loss” and “metabolic syndrome”, for studies that evaluated the relationship between the two. Results: Of the 94,223 subjects, 11,414 (12.1%) had metabolic syndrome and 82,809 did not. The mean ages of subjects in the two groups were 46.1 and 43.9 years, respectively. A comparison of hearing thresholds by age in subjects with and without metabolic syndrome showed that the average pure tone hearing thresholds were significantly higher in subjects with metabolic syndrome than in subjects without it in all age groups. (p < 0.001) Rates of hearing loss in subjects with 0, 1, 2, 3, 4, and 5 of the components of metabolic syndrome were 7.9%, 12.1%, 13.8%, 13.8%, 15.5% and 16.3%, respectively, indicating a significant association between the number of components of metabolic syndrome and the rate of hearing loss (p < 0.0001). The odds ratio of hearing loss was significantly higher in subjects with four components of metabolic syndrome: waist circumference, blood pressure, and triglyceride and fasting blood sugar concentrations (p < 0.0001). (4) Conclusions: The number of components of the metabolic syndrome is positively correlated with the rate of sensorineural hearing loss.

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Lipid behavior in metabolic syndrome pathophysiology

Current Diabetes Reviews ◽

10.2174/1573399817666210915101321 ◽

2021 ◽

Vol 17 ◽

Author(s):

Basheer Marzoog

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Lipid Level ◽

Visceral Obesity ◽

Insulin Resistance Syndrome ◽

Chronic Inflammatory Response ◽

Cell Dysfunction ◽

Commensal Microbiota ◽

The Metabolic Syndrome

: Undeniably, lipid plays an extremely important role in the homeostasis balance, since lipid contributes to the regulation of the metabolic processes. The metabolic syndrome pathogenesis is multi-pathway that composes neurohormonal disorders, endothelial cell dysfunction, metabolic disturbance, genetic predisposition, in addition to gut commensal microbiota. The heterogenicity of the possible mechanisms gives the metabolic syndrome its complexity and limitation of therapeutic accesses. The main pathological link that lipid contributes to the emergence of metabolic syndrome via central obesity and visceral obesity that consequently lead to oxidative stress and chronic inflammatory response promotion. Physiologically, a balance is kept between the adiponectin and adipokines level to maintain the lipid level in the organism. Clinically, extremely important to define the borders of the lipid level in which the pathogenesis of the metabolic syndrome is reversible, otherwise will be accompanied by irreversible complications and sequelae of the metabolic syndrome (cardiovascular, insulin resistance). The present paper is dedicated to providing novel insights into the role of lipid in the development of metabolic syndrome hence dyslipidemia is the initiator of insulin resistance syndrome (metabolic syndrome).

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METABOLIC SYNDROME AS A GERONTOLOGICAL PROBLEM (LITERATURE REVIEW)

Успехи геронтологии ◽

10.34922/ae.2020.33.3.008 ◽

2020 ◽

pp. 479-487

Author(s):

В. А. Карпин

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Cardiovascular Diseases ◽

Metabolic Disorders ◽

Fat Metabolism ◽

Peripheral Tissues ◽

The Metabolic Syndrome ◽

Tissue Sensitivity ◽

Almost All

Метаболический синдром - это комплекс взаимосвязанных нарушений углеводного и жирового обмена, а также механизмов регуляции АД и функции эндотелия, в основе развития которых лежит снижение чувствительности тканей к инсулину. Следовательно, ведущим компонентом, патофизиологической основой и объединяющим фактором большинства симптомов, описываемых в рамках метаболического синдрома, является резистентность периферических тканей к действию инсулина, тесно коррелирующая с большинством метаболических нарушений. Необходимо подчеркнуть, что практически все составляющие метаболического синдрома являются установленными факторами риска развития сердечно-сосудистых заболеваний. Вероятность развития метаболического синдрома увеличивается с возрастом. В статье обсуждается возможность представления метаболического синдрома как геронтологической проблемы. Metabolic syndrome is a complex of interrelated disorders of carbohydrate and fat metabolism, as well as mechanisms for regulating blood pressure and endothelial function, which are based on a decrease in tissue sensitivity to insulin. Therefore, the leading component, pathophysiological basis and uniting factor of most of the symptoms described in metabolic syndrome is the resistance of peripheral tissues to the action of insulin, which is closely correlated with most metabolic disorders. It should be emphasized that almost all components of metabolic syndrome are established risk factors for developing cardiovascular diseases. The likelihood of developing metabolic syndrome increases with age. The article discusses the possibility of presenting the metabolic syndrome as a gerontological problem.

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Exercise Blood Pressure is associated with Insulin Resistance in subjects with the Metabolic Syndrome.

Canadian Journal of Diabetes ◽

10.1016/s1499-2671(08)24124-9 ◽

2008 ◽

Vol 32 (4) ◽

pp. 330

Author(s):

V. Gaudreault ◽

N. Almeras ◽

J.P. DesprÉs ◽

A. Tremblay ◽

J. Bergeron ◽

...

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

The Metabolic Syndrome ◽

Exercise Blood Pressure

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Modulation of the action of insulin by angiotensin-(1–7)

Clinical Science ◽

10.1042/cs20130333 ◽

2014 ◽

Vol 126 (9) ◽

pp. 613-630 ◽

Cited By ~ 28

Author(s):

Fernando P. Dominici ◽

Valeria Burghi ◽

Marina C. Muñoz ◽

Jorge F. Giani

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Molecular Mechanisms ◽

Insulin Signalling ◽

Pathological Condition ◽

Signalling Pathway ◽

Systemic Hypertension ◽

The Metabolic Syndrome ◽

Insulin Signalling Pathway ◽

Cardiovascular Morbidity And Mortality

The prevalence of Type 2 diabetes mellitus is predicted to increase dramatically over the coming years and the clinical implications and healthcare costs from this disease are overwhelming. In many cases, this pathological condition is linked to a cluster of metabolic disorders, such as obesity, systemic hypertension and dyslipidaemia, defined as the metabolic syndrome. Insulin resistance has been proposed as the key mediator of all of these features and contributes to the associated high cardiovascular morbidity and mortality. Although the molecular mechanisms behind insulin resistance are not completely understood, a negative cross-talk between AngII (angiotensin II) and the insulin signalling pathway has been the focus of great interest in the last decade. Indeed, substantial evidence has shown that anti-hypertensive drugs that block the RAS (renin–angiotensin system) may also act to prevent diabetes. Despite its long history, new components within the RAS continue to be discovered. Among them, Ang-(1–7) [angiotensin-(1–7)] has gained special attention as a counter-regulatory hormone opposing many of the AngII-related deleterious effects. Specifically, we and others have demonstrated that Ang-(1–7) improves the action of insulin and opposes the negative effect that AngII exerts at this level. In the present review, we provide evidence showing that insulin and Ang-(1–7) share a common intracellular signalling pathway. We also address the molecular mechanisms behind the beneficial effects of Ang-(1–7) on AngII-mediated insulin resistance. Finally, we discuss potential therapeutic approaches leading to modulation of the ACE2 (angiotensin-converting enzyme 2)/Ang-(1–7)/Mas receptor axis as a very attractive strategy in the therapy of the metabolic syndrome and diabetes-associated diseases.

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Abstract 19742: Effects of a "Health Partner" Intervention on the Metabolic Syndrome

Circulation ◽

10.1161/circ.130.suppl_2.19742 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Natalee K Wilson ◽

Ibhar Al Mheid ◽

Lynn Cunningham ◽

Kenneth Brigham ◽

Greg S. Martin ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Vascular Function ◽

Action Plan ◽

Well Being ◽

Academic Program ◽

Atherogenic Dyslipidemia ◽

The Metabolic Syndrome ◽

Cardiovascular Morbidity And Mortality

Introduction: The Metabolic Syndrome (MetS) is highly prevalent, afflicting a third of U.S. adults, and confers higher cardiovascular morbidity and mortality. Features of MetS include abdominal obesity, elevated blood pressure, dysglycemia and atherogenic dyslipidemia. While lifestyle modifications are the first-line of MetS treatment, sustained adherence is achieved by a minority of patients. We investigated the effects of a Health Partner (HP) intervention on MetS. Methods and Results: A total of 119 university employees with MetS (51±9 years, 59% women, 26% African Americans) were enrolled in an academic program that promotes clinical self-knowledge and healthier lifestyles at the Center for Health Discovery and Well Being at Emory University in Atlanta, GA. Baseline anthropometric, laboratory and vascular function measurements were used by the HP to generate an action plan with detailed strategies to improve dietary and exercise habits, and subjects returned for follow up at 6 months and annually thereafter for 2 years. Repeated measures ANOVA showed statistically significant changes in waist circumference (p=0.007; baseline vs. 2 years: 103.1 vs. 98.2 cm), weight (p=0.004; 216.1±35 vs. 204.9±37 lbs), body fat percent (p=0.042; 39.6±7.4 vs. 38.1±7.9), fasting insulin levels (p=0.034; 11.4±8.3 vs. 7.9±9.9 μIU/ml), low density lipoprotein (p=0.005; 114.7±31.2 vs. 104.9±28.9 mg/dl), as well as a reduction in carotid-femoral pulse wave velocity (p=0.016; 7.4±2.2 vs. 6.7±1.1 m/s), systolic (p=0.001; 131.6±17.5 vs. 125.7±14.2 mmHg) and diastolic blood pressure (p=006; 84.7±11.1 vs. 80.1±10). There were no significant changes in glucose, triglyceride levels or brachial-artery flow mediated dilation. Conclusion: A personalized, goal directed HP intervention improves abnormalities associated with MetS, including body habitus, lipid and insulin secretion abnormalities, and resulted in significant blood pressure improvements that accompanied decreased central arterial stiffness. These improvements were sustained after two years of follow-up. Whether HP intervention improves long-term outcomes and whether it is cost-effective needs further investigation.

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METABOLIC SYNDROME - THIS IS SERIOUS!

Medical Journal of the Russian Federation ◽

10.18821/0869-2106-2019-25-4-234-237 ◽

2019 ◽

Vol 25 (4) ◽

pp. 234-237

Author(s):

Tatiana I. Turkina ◽

S. N Shcherbo ◽

P. D Vaganov

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Cardiovascular Diseases ◽

Common Variant ◽

The Metabolic Syndrome ◽

Clinical Disorders

Metabolic syndrome is a complex of metabolic, hormonal and clinical disorders that are risk factors for the development of cardiovascular diseases, which are based on insulin resistance and compensatory hyperinsulinemia. The main mechanisms of the effects of chronic hyperinsulinemia on blood pressure are given, and the main symptoms and manifestations of the metabolic syndrome are given. The most common variant of dyslipidemia in the metabolic syndrome is the lipid triad.

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