Arterial hypertension and its ‘friends’

WE ALREADY know that arterial hypertension is a major risk factor for cardiovascular disease. As probably noticed by most, these patients frequently have other problems that go along with hypertension; some are overweight, some have cholesterol abnormalities, some have diabetes.

This association between certain metabolic disorders and cardiovascular disease has been known since the 1940s, and ‘metabolic syndrome’ is the term designated for this association since the 1980s.

Metabolic syndrome is quite common. In industrialised countries there is a prevalence of about 20 to 30 per cent. It is expected that 50-70 million people in the US will have metabolic syndrome by the year 2010.

What is metabolic syndrome?

There are several definitions, depending on the group of experts. The Cholesterol Education Program Adult Treatment Panel (ATP III) and the World Health Organisation (WHO) are examples of groups that dedicate their efforts to define metabolic syndrome in order for it to be possible to diagnose this important disease with accuracy. In fact, this disease is considered to be one of the most important pathological situations that will have dramatic consequences in morbidity and mortality in the 21st century.

• If your fasting blood glucose is 100 mg/dl or above, plus

• If your blood pressure is 140/90 or above, plus

• If you have a cholesterol unbalance, specifically if your ‘good’ cholesterol (HDL) is 40mg/dl or lower, or if your serum triglycerides are 150 mg/dl or above, plus

• If your waist circumference is over 102 cm (40 inches) in men and over 88cm (35 inches) in women (it means abdominal obesity).

So we can say that the main characteristic of ‘metabolic syndrome’ is the association of four different features that, isolated, are recognised to be risk factors for cardiovascular disease. When acting together, they are 10 times more powerful.

Those with a family history of type 2 diabetes, hypertension and early heart disease will have more chance of developing metabolic syndrome.

Environmental factors are also important: low exercise level, sedentary lifestyle and progressive weight gain significantly contribute to the risk of developing metabolic syndrome.

Body weight is very often associated with metabolic syndrome. The risk of developing metabolic syndrome increases with weight, while it is diagnosed in five per cent of people with normal body weight, it will be expected to be diagnosed in 60 per cent of those with obesity. A gain of about five pounds per year will increase the risk of developing metabolic syndrome by 45 per cent.

Patients with metabolic syndrome will be more prone to develop diabetes (10 to 30 times more) and heart disease (two to four times) compared with the normal population.

Treatment of metabolic syndrome

To treat metabolic syndrome is to treat the underlying diseases: correct the cholesterol abnormalities, correct hypertension, lose weight.

Diet and exercise are of major importance. To fight against obesity and improve overall fitness are a good start to approach the problem. Lifestyle changes are probably the key to the problem.

• Next time we will discuss the lifestyle changes required to treat metabolic syndrome that some authors believe to be the bill that we are paying for our ‘evolution’.