Therapy of Hypertension and Metabolic Syndrome: Today's Standard and Tomorrow's Perspectives

Abstract

Treatment of arterial hypertension is known to reduce cardiovascular morbidity and mortality and has apositive effect against stroke, where benefit is strongly linked to reduction in blood pressure per se. Theprotective effects against coronary heart disease (CHD) have also been significant but numerically lessimpressive than the effect against stroke. It is conceivable that this due to the fact that not just bloodpressure, but also a number of metabolic variables need to be considered in this context. The insight thathypertension is often just one of the components of the so-called metabolic syndrome suggests that amodern antihypertensive drug should not only lower blood pressure; to exert optimal cardioprotectiveproperties it should also have a neutral or even positive metabolic profile as regards its effects on lipids,glucose and insulin in order to achieve a better protection against CHD. Against this background thecentrally acting selective imidazoline receptor (I1) agonist moxonidine is of considerable interest.Moxonidine has been shown to improve glucose tolerance in man, probably by two different mechanisms,i.e. by augmenting insulin sensitivity in peripheral tissues and by enhancing glucose-stimulated insulinrelease from the pancreas. By employing a therapeutic intervention against hypertension that not onlylowers elevated arterial pressure but also positively affects some of the frequently occurring concomitantmetabolic disturbances, it appears that today's standard of antihypertensive therapy may be surpassed intomorows perspective.