The metabolic syndrome in hypertension: European society of hypertension position statement

Redon, Josepa; Cifkova, Renatab; Laurent, Stephanec; Nilsson, Peterd; Narkiewicz, Krzysztofe; Erdine, Serapf; Mancia, Giuseppeg; on behalf of the Scientific Council of the European Society of Hypertension

doi: 10.1097/HJH.0b013e328302ca38
ESH position statement

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

aUniversity of Valencia and CIBER 06/03 Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain

bDepartment of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

cDepartment of Pharmacology and INSERM U872, European Hospital Georges Pompidou, Paris, France

dDepartment of Clinical Sciences Medicine, University Hospital, University of Lund, Malmo, Sweden

eDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland

fIstanbul University Cerrahpasa, School of Medicine, Cardiology, Department, Istanbul, Turkey

gClinica Medica, Ospedale S Gerardo, Universita di Milano-Bicocca, Monza, Italy

Received 20 February, 2008

Revised 22 March, 2008

Accepted 27 March, 2008

Correspondence to Josep Redon, Internal Medicine, Hospital Clinico, University of Valencia, Avda Blasco Ibanez, 17, 46010 Valencia, Spain Tel: +34 96 3862647; fax: +34 96 3862647; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.