Institutional members access full text with Ovid®

Share this article on:

Association of metabolic risk factors with uncontrolled hypertension: comparison of the several definitions of metabolic syndrome

Cortez-Dias, Nunoa,b,c; Martins, Susana R.a,b; Belo, Adrianad; Fiuza, Manuelaa,bon behalf of VALSIM Study investigators

doi: 10.1097/HJH.0b013e32836342f7
ORIGINAL PAPERS: Metabolic syndrome

Aims: To evaluate the influence of metabolic syndrome in the effectiveness of antihypertensive treatment and to compare it using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2001 and 2004), International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung and Blood Institute (AHA-NHLBI) definitions.

Methods: The VALSIM (Estudo de Prevalência da Síndrome Metabólica) survey was designed as an observational cross-sectional study performed in a primary healthcare setting in Portugal. The first two adult patients scheduled for an appointment on a given day were invited to participate. The treatment effectiveness was evaluated by the occurrence of uncontrolled hypertension (≥140/90 mmHg) in patients taking antihypertensive drugs. Logistic regression analysis was used to determine the association between uncontrolled hypertension and metabolic risk factors, with adjustments for age, sex, and pattern of antihypertensive treatment.

Results: Among the 16 856 individuals evaluated, 8925-treated hypertensive patients were identified. Only 35.8% of them had controlled hypertension. The risk of poor blood pressure control increased with age, waist circumference, serum levels of triglycerides and HDL-cholesterol. Among treatable risk factors, metabolic syndrome as defined by NCEP-ATP III 2001 diagnostic criteria was the strongest independent predictor of uncontrolled hypertension (odds ratio: 1.23; 95% CI: 1.08–1.41; P = 0.002). In opposition, the IDF or AHA-NHLBI definitions of metabolic syndrome failed to identify patients at risk of poor blood pressure control.

Conclusion: Metabolic syndrome is associated with lower effectiveness of antihypertensive therapy and the NCEP-ATP III 2001 definition of metabolic syndrome is the one that better identifies patients at risk of poor blood pressure control.

Supplemental Digital Content is available in the text

aDepartment of Cardiology, Santa Maria University Hospital

bLisbon Medical School, University of Lisbon

cProgramme for Advanced Medical Education (Fundação Calouste Gulbenkian, Ministry of Health and Foundation for Science and Technology)

dPortuguese Society of Cardiology, Lisbon, Portugal

Correspondence to Nuno Cortez-Dias, Rua Professor Moisés Amzalak, n° 14, 7° Fte, 1600-648 Lisbon, Portugal. Tel: +351964175339; fax: +351261864897; e-mail:

Abbreviations: BP, blood pressure; HDL-C, HDL-cholesterol

Received 27 December, 2012

Revised 7 April, 2013

Accepted 15 May, 2013

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins