Key result
In hypertensive patients, the presence of metabolic syndrome without diabetes was associated with significantly higher systolic blood pressure (145 mmHg) compared to diabetes without metabolic syndrome (137 mmHg, p<0.001), highlighting visceral obesity and dyslipidemia as key drivers of treatment resistance.
Cross-Sectional (n=3,280)
Yes
Absolute Event Rate: 145% vs 137%
p-value: p=<0.001
In hypertensive patients, visceral obesity and dyslipidemia components of the metabolic syndrome are more strongly associated with poor blood pressure control than impaired glucose tolerance.
Visceral obesity and dyslipidemia may drive resistant hypertension more than diabetes; leaves open causal confirmation in prospective trials.
BACKGROUND: The GOOD (Global Cardiometabolic Risk Profile in Patients with Hypertension Disease) survey showed that blood pressure control was significantly worse in hypertensive patients with metabolic syndrome and/or diabetes mellitus than in those with essential hypertension only. This analysis aimed to investigate which components of the metabolic syndrome are primarily associated with poor blood pressure control. METHODS: The GOOD survey was designed as an observational cross-sectional survey in 12 European countries to assess the cardiometabolic risk profile in patients with essential hypertension. Investigators were randomly selected from a list of general practitioners (70% of investigators) and a list of specialists such as internists, cardiologists and hypertension specialists (30% of investigators). Data from 3,280 outpatients with hypertension, aged at least 30 years who were receiving antihypertensive treatment or had newly diagnosed hypertension according to the European Society of Hypertension and the European Society of Cardiology criteria, were included in the analyses. Blood pressure control, body mass index (BMI), waist circumference, serum triglycerides, total and high density lipoprotein (HDL) cholesterol measurements were compared in patients with diabetes mellitus and metabolic syndrome, with diabetes mellitus only, with metabolic syndrome only, and with neither metabolic syndrome nor diabetes mellitus. RESULTS: The highest blood pressure values were found in patients with metabolic syndrome with or without diabetes mellitus. Blood pressure was significantly lower in patients with diabetes mellitus only. The highest BMI, waist circumference and serum triglycerides, and the lowest HDL cholesterol levels among the groups studied occurred in patients with metabolic syndrome, either with or without diabetes mellitus. CONCLUSION: Among the components of the metabolic syndrome, it is not impaired glucose tolerance which is associated with the poor response to antihypertensive treatment. Instead, visceral obesity and dyslipidemia components of the metabolic syndrome, i.e. hypertriglyceridemia and low HDL cholesterol levels, are associated with resistance to antihypertensive treatment.
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Zidek et al. (2009) conducted a cross-sectional in Essential hypertension (n=3,280). Metabolic syndrome vs. Diabetes mellitus without metabolic syndrome was evaluated on Systolic blood pressure (p=<0.001). In hypertensive patients, the presence of metabolic syndrome without diabetes was associated with significantly higher systolic blood pressure (145 mmHg) compared to diabetes without metabolic syndrome (137 mmHg, p<0.001), highlighting visceral obesity and dyslipidemia as key drivers of treatment resistance.
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