Treatment for Hypertension in Metabolic Syndrome

• MetS is defined by a constellation of an interconnected physiological, biochemical, clinical, and metabolic factors that directly increases the risk of atherosclerotic cardiovascular disease (ASCVD), (T2DM), and all cause mortality
• The collection of unhealthy body measurements and abnormal laboratory test results include atherogenic dyslipidemia, hypertension, glucose intolerance, proinflammatory state, and a prothrombotic state

Treatment

ACEi or ARB

• should be the first-line classes of agents in the MetS, especially in the setting of diabetes or CKD
• ARBs may be used in those who cannot tolerate ACE inhibitors or as an alternative to ACE inhibitors in people who have a left ventricular dysfunction
• shown to be effective in reducing the incidence of albuminuria or progression of nephropathy in patients with diabetes
• reduces the rate of new-onset diabetes as compared with the use of diuretic and/or β-blockers

Calcium Channel Blockers

• Recommended by ESH/ESC  as does not worsen insulin sensitivity

Beta Blockers and Diuretics

• associated with an increased risk for diabetes
• although diuretics/beta blockers do in fact lower the risk for cardiovascular events
• Most investigators in the hypertension field believe that the potential benefit of low-dose diuretics in combination antihypertensive therapy outweighs their risk

Selection can be carried out based on the criteria below:

Metabolic Syndrome: Risk Factors and Recommendations - http://www.uspharmacist.com/content/d/feature/c/46619/#sthash.JTviYKDC.dpuf

References:

1. ESH/ESC Hypertension Guidelines: Hypertension Treatment for People With Metabolic Syndrome. http://www.ccmdweb.org/dsl/middle.aspx?Slideid=3361&Catid=1035
2. A Comprehensive Review on Metabolic Syndrome. http://www.hindawi.com/journals/crp/2014/943162/
3. Metabolic Syndrome: Risk Factors and Recommendations http://www.uspharmacist.com/content/d/feature/c/46619/#sthash.JTviYKDC.dpuf