Review: Blood pressure reduction in the metabolic syndrome and type 2 diabetes: current concepts

ypertension very frequently co-exists with type 2 diabetes and with the metabolic syndrome, though any links regarding underlying pathophysiology remain controversial. However, there is no doubt that the combination greatly increases cardiovascular and renal disease risks. At the same time there is extensive evidence that blood pressure (BP) lowering is a highly effective means of reducing these risks. Current guidelines and other advice emphasise that both the threshold for intervention and the target for BP lowering are below those for the general hypertensive population, at about 130/80 mmHg, but even less in the presence of nephropathy. Blockade of the renin-angiotensin system is considered highly desirable, preferably using angiotensin receptor blockers. Combination drug therapy is almost always needed, and the ABCD rule is helpful as a guide in this respect. The combination of beta blockers and thiazides should usually be avoided, especially in the metabolic syndrome, as it may promote the emergence of overt diabetes. But ultimately the key consideration should be the BP achieved rather than the means required to achieve it.