Hypertensive Treatment and the Metabolic Syndrome

Abstract

The prevalence of obesity, hypertension and type 2 diabetes mellitus-all part of the metabolic syndrome--is increasing in the US and worldwide. In this setting, it is important to understand the effects of antihypertensives on several components of the metabolic syndrome. Overall, has treatment of hypertension in diabetes been beneficial? To answer this question, the authors have reviewed pertinent clinical studies. The Action to Control Cardiovascular Risks in Diabetes Study (ACCORD) was a well-designed trial of 10,251 patients with type 2 diabetes mellitus that studied the effects of tight control of blood sugar, hypertension and lipids. Disappointingly, as compared with standard treatment, the use of intensive therapy to target normal glycated hemoglobin levels, tight lipid control by adding fenofibrate to a statin and aggressive blood pressure treatment with a goal of 120 mm Hg did not significantly reduce major cardiovascular events. Focusing on patients with hypertension, the authors compare these results to other studies of the same issues and speculate about reasons for the lack of benefit in ACCORD. Finally, the authors speculate on whether future treatment might be guided by genetic markers.