Should hypertension guidelines be changed for hypertensive patients with the metabolic syndrome?
The authors analyzed the impact of present guidelines for hypertension management on cardiovascular (CV) risk factors in hypertensive patients with and without the metabolic syndrome (MS). Results in 549 nondiabetic hypertensive patients with a mean follow-up of 3.8+/-1.2 years on usual recommended care were reviewed. At baseline, 231 (42.1%) patients had MS and, per the definition, showed significantly higher values of traditional CV risk factors than non-MS patients. At the end of follow-up, blood pressure levels were similar in both groups; the lipid profile tended to improve in MS patients. Eighteen MS patients (7.8%) and 7 non-MS patients (2.2%) developed diabetes (P<.001). Prevalence of microalbuminuria was reduced in both groups, but it remained significantly higher in MS patients. Usual care of hypertensive patients achieved similar blood pressure and low-density lipoprotein cholesterol goals, both in MS and non-MS patients. Global CV risk, however, remained higher in MS patients, as suggested by a 3-fold higher incidence of new-onset diabetes (absolute increase of 5.6%) and a 2-fold increase in microalbuminuria.
Segura
Julian
J
Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain. hta@juliansegura.com
Banegas
Jose Ramon
JR
García-Donaire
Jose Antonio
JA
Rodríguez-Artalejo
Fernando
F
de la Cruz
Juan Jose
JJ
Praga
Manuel
M
Ruilope
Luis Miguel
LM
D000419:Albuminuria; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents