[Antihypertensive therapy in hypertensive patients with metabolic syndrome]

Abstract

A growing body of evidence indicates that the metabolic syndrome and hypertension are interrelated at an epidemiological as well as pathophysiological level. Due to the high prevalence of concomitant signs of subclinical organ damage and the high risk of cardiorenal complications, hypertensive patients with metabolic syndrome are to be considered at high risk. Although the management of this condition must begin with the implementation of a healthy lifestyle and dietary habits, these measures are usually insufficient to adequately control blood pressure values and reduce the cardiovascular risk in the long term. Therefore, in the presence of persistent blood pressure values above 140/90 mmHg, pharmacological antihypertensive therapy is often required to reach the recommended target of less than 130/80 mmHg. In the absence of specific, compelling indications to the contrary, inhibitors of the renin-angiotensin system and calcium-channel blockers should be preferred over diuretics and beta-blockers. However, diuretics, preferably at a low dosage, are often necessary to obtain satisfactory blood pressure control. The combination of diuretics and beta-blockers should be avoided, if possible, in patients with prediabetes or diabetes.