Hypertension and the metabolic syndrome.
The metabolic syndrome is a highly prevalent condition in the United States and it has been estimated from the Third National Health and Nutrition Examination Survey that approximately 40 million individuals fulfill the diagnostic criteria, which include a waist circumference greater than 40 inches in men and 35 inches in women, triglycerides in excess of 150 mg/dL, and a high-density lipoprotein cholesterol under 40 mg/dL in men or under 50 mg/dL in women. Additionally, a blood pressure in excess of 130/85 mm Hg and a fasting plasma glucose above 110 mg/dL is required. The diagnosis of the metabolic syndrome requires at least three of the five major criteria for qualification. Hypertension, dyslipidemia, and diabetes frequently cluster and share common pathogenetic mechanisms, resulting in a complex interplay between these apparently disparate risk factors. This review centers on the common metabolic pathways that are common to the major conditions seen in the metabolic syndrome, and centers on the central role of hypertension and the clinical impact of drug therapy on other metabolic parameters.