Influence of Metabolic Syndrome on Hypertension-related Target Organ Damage: Diagnosis of Metabolic Syndrome Is Still Necessary

Q: What are the key findings of this study?

Metabolic syndrome in hypertensive patients was associated with a significantly higher risk of target organ damage (18.6% vs 14.8%; OR 1.827, 95% CI 1.823-1.831, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension and Metabolic Syndrome (n=2940). Intervention: Metabolic syndrome (NCEP-ATP III criteria with Korean waist circumference cutoffs >=90 cm in men and >=85 cm in women) vs. Absence of metabolic syndrome in hypertensive patients. Primary outcome: Target organ damage (composite of history of myocardial infarction, angina, stroke, or chronic renal disease, or presence of proteinuria >=1+ on dipstick) (OR 1.827, 95% CI 1.823-1.831, p=<0.001).

Q: What does this research mean for the field?

Metabolic syndrome in hypertensive patients is associated with a significantly increased risk of target organ damage, predicting risk better than any of its individual components. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

So-Ryung Lee; Dae Jung Kim; Ki-Cheol Sung; Eun-Joo Cho; Min-Soo Hyun; Jeong-Bae Park; Young-Kwon Kim; In Kyu Lee; Cheol‐Ho Kim; Hae‐Young Lee

doi:10.5646/jksh.2011.17.3.125

January 1, 2011Journal of the Korean Society of HypertensionOpen Access

Influence of Metabolic Syndrome on Hypertension-related Target Organ Damage: Diagnosis of Metabolic Syndrome Is Still Necessary

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Key result

Metabolic syndrome in hypertension is linked to ~83% higher odds of target organ damage.

OR 1.827
95% CI 1.823-1.831
P<0.001
n=2,940

Why the study?

The value of evaluating metabolic syndrome in predicting cardiovascular disease had recently been criticized, prompting investigation into its influence on target organ damage in hypertensive patients without diabetes mellitus.

Does the presence of metabolic syndrome increase the risk of target organ damage compared to absence of metabolic syndrome or single metabolic components in hypertensive patients?

Study Design

Type

Cross-Sectional (n=2,940)

Multicenter

Yes

Structured PICO

Does the presence of metabolic syndrome increase the risk of target organ damage compared to absence of metabolic syndrome or single metabolic components in hypertensive patients?

P

Population

2,940 Korean adults aged >=20 years (mean age 50 years, 58% female) from the 2008 Korean National Health and Nutrition Examination Survey, including 787 hypertensive individuals, evaluated cross-sectionally for target organ damage.

E

Exposure

Presence of metabolic syndrome, defined by 2001 NCEP-ATP III criteria with 2005 Korean Society for the Study of Obesity waist circumference cutoffs (3 or more of: waist circumference ≥90 cm in men or ≥85 cm in women, fasting triglycerides ≥150 mg/dL, fasting HDL cholesterol <40 mg/dL in men or <50 mg/dL in women, BP >130/85 mmHg or antihypertensive medication, and fasting glucose ≥100 mg/dL).

C

Comparator

Absence of metabolic syndrome (and comparison against individual metabolic syndrome components or obesity defined as BMI ≥25 kg/m²).

O

Outcome

Prevalence and cross-sectional odds of target organ damage (TOD), defined as a composite of self-reported history of angina, myocardial infarction, stroke, or chronic renal disease, or presence of dipstick proteinuria (≥1+).composite

Main Result

Odds Ratio: 1.827 (95% CI 1.823–1.831)

Absolute Event Rate: 18.6% vs 14.8%

p-value: p=<0.001

Limitations

Results may vary depending on the definition of metabolic syndrome components used (Korean waist circumference criteria >=90 cm for men and >=85 cm for women are smaller than NCEP-ATP III cutoffs, potentially overestimating prevalence)
Cross-sectional study design of the national survey precludes confirmation of a causal relationship between metabolic syndrome and target organ damage
Metabolic syndrome prevalence may have been overestimated due to using lower Korean waist circumference cutoffs (≥90 cm in men, ≥85 cm in women) compared to original NCEP-ATP III criteria
Cross-sectional study design prevents establishing a causal relationship between metabolic syndrome and target organ damage, requiring future prospective cohort studies

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Implication

In hypertensive patients without diabetes, metabolic syndrome as a composite diagnosis predicts target organ damage more strongly than obesity or any single metabolic component alone, supporting routine comprehensive metabolic evaluation.

Abstract

Background: The value of metabolic syndrome (MetS) evaluation in predicting cardiovascular disease is recently criticized.We investigated, in hypertensive patients without diabetes mellitus, the influence of MetS on the target organ damage.Methods: Data from the fourth Korean National Health and Nutrition Examination Survey performed in 2008 were analyzed. Metabolic syndrome is defined by the 2001 National Cholesterol Education Program-Third Adult Treatment Panel guideline.The category of hypertension is defined following the seventh report of the Joint National Commitee-7 guideline.Results:The prevalence of target organ damage (TOD), defined as history of myocardial infarction/angina/stroke/chronic renal disease as well as the presence of macroalbuminuria, was increased according to blood pressure; 8.5% in the population of normal blood pressure, 12.5% in those of prehypertensive range, and 20.5% in hypertensive population.Hypertensive population associated with MetS showed greater prevalence of TOD than those without MetS even excluding diabetic population.The presence of MetS in hypertensive population showed 2.2 fold increased risk for TOD.Any single parameter of MetS diagnostic criteria as well as obesity did not show the comparable range of risk prediction as MetS.Conclusions:These results indicate a strong relationship of Mets with TOD in hypertensive population.Evaluating the metabolic components in hypertensive population is necessary in establishing management strategies for overall risk.

Discussion

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Cite This Study

Lee et al. (2011) conducted a cross-sectional in Hypertension and Metabolic Syndrome (n=2,940). Metabolic syndrome (NCEP-ATP III criteria with Korean waist circumference cutoffs >=90 cm in men and >=85 cm in women) vs. Absence of metabolic syndrome in hypertensive patients was evaluated on Target organ damage (composite of history of myocardial infarction, angina, stroke, or chronic renal disease, or presence of proteinuria >=1+ on dipstick) (OR 1.827, 95% CI 1.823-1.831, p=<0.001). Metabolic syndrome in hypertensive patients was associated with a significantly higher risk of target organ damage (18.6% vs 14.8%; OR 1.827, 95% CI 1.823-1.831, p<0.001).

synapsesocial.com/papers/6a8254b7f337522b6774b394 https://doi.org/10.5646/jksh.2011.17.3.125

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Influence of Metabolic Syndrome on Hypertension-related Target Organ Damage: Diagnosis of Metabolic Syndrome Is Still Necessary

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Influence of Metabolic Syndrome on Hypertension-related Target Organ Damage: Diagnosis of Metabolic Syndrome Is Still Necessary

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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