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Query: UMLS:C0948265 (metabolic syndrome)
 24,271 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of resistant hypertension remains to be clarified. In this article, three categories of resistance are distinguished: resistant patient, resistant clinician and refractory hypertension. Inadequate compliance, which in case of antihypertensive treatment means taking fewer doses of medications than prescribed, remains a significant cause of poor blood pressure control. Among most frequent physician-related causes of resistant hypertension, there are measurement errors, pseudohypertension, white coat hypertension and therapy errors. Careful elimination of patient- and physician-related reasons of inadequate blood pressure control should lead to the diagnosis of truly resistant hypertension. One of the causes of refractory hypertension may be concomitant use of other medications that are known to reduce antihypertensive effect of main drugs. Resistance may be associated with increased intravascular volume or fluid overload or with sympathetic activation. Modifiable contributing factors responsible for resistant hypertension include obesity often coexisting with insulin resistance and metabolic syndrome as well as excessive alcohol use and cigarette smoking. Another potential cause of refractory hypertension is the presence of secondary hypertension. Certain therapeutic modifications are essential in resistant hypertension.
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PMID:Resistant hypertension. 1642 42

Although white coat hypertension (WCH) is believed to have an effect on health, there is no term defining WCH in metabolic syndrome. Consecutive patients 20 years old or older who underwent a check-up were included. The study included 1068 cases. The prevalences of hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired glucose tolerance (IGT), and WCH were similar to excess weight in that they increased significantly until the seventh decade of life and decreased thereafter significantly (P < 0.05 in most steps). On the other hand, the prevalences of hypertension (HT), diabetes mellitus (DM), and coronary heart disease (CHD) always increased significantly with age without any decrease (P < 0.05 in most steps), indicating their irreversibility in contrast to the reversibility of excess weight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH. Metabolic syndrome is a reversible progression step between health and irreversible final diseases terminating with increased mortality and disabilities. Thus, the definition of metabolic syndrome should include reversible metabolic risk factors such as excess weight (overweight and obesity), hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH, instead of irrevesible diseases such as DM, HT, CHD, and stroke that have already developed and require drug therapy. After development of one of the final metabolic diseases, the term metabolic syndrome probably loses most of its significance, since from that point on, nonpharmaceutical approaches such as lifestyle changes, diet, and exercise will provide little benefit to prevent development of the others, most likely due to the cumulative effects of the risk factors on body systems over a long period of time.
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PMID:White coat hypertension in definition of metabolic syndrome. 1875 28

White coat hypertension (WCH) is most likely a disorder associated with metabolic syndrome. The study was performed at the Internal Medicine Polyclinic of Dumlupinar University on routine check-up patients. WCH cases who were overweight or obese and desiring weight loss were divided into two subgroups according to whether they preferred to achieve weight loss by medication or diet therapy. The study included 324 cases (204 females) with WCH, 45 of whom were in normal weight range. Therefore, 86.1% (279) of cases with WCH were either overweight or obese, and 41.3% (134) of all WCH cases had dyslipidemia. Twenty-five cases (14.7%) stopped metformin therapy due to excessive anorexia. At the end of a 6-month period, there were highly significant differences between the two groups with respect to the prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight and obesity, and decreased fasting plasma glucose below 110 mg/dL (P < 0.001 for all). Due to gradually increased prevalences of impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, excess body weight, and obesity-like disorders from sustained normotension towards WCH and hypertension (HT) cases, and very high prevalences of excess weight and dyslipidemia in the WCH group, WCH may be an associated disorder of metabolic syndrome rather than just being a predisposing factor of atherosclerosis or HT alone. Thus, the management of WCH should not focus solely on the regulation of blood pressure with antihypertensive medications, but rather on the prevention of future excess weight and various associated disorders, and metformin alone is an effective therapeutic option, most likely due to its powerful inhibitory effect on appetite.
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PMID:Treatment of white coat hypertension with metformin. 1907 83

Pregnancy-related hypertension is defined by systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg at any term. It is more appropriate to talk about "hypertensive pregnancy syndromes", for the clinical aspects can be very heterogeneous. This disease is still common and affects approximately 10 to 15% of pregnancies. It essentially involves pathological placentation. When the maternal endothelium tolerates the trophoblast, the pregnancy is normal. Two elements play pivotal roles in the genesis of preeclampsia: defective placentation around 16 weeks of gestation and abnormal maternal response to placentation. Hypertension is difficult to diagnose during pregnancy because pregnant women are very subject to white coat hypertension. Self-monitoring and ambulatory monitoring of blood pressure are especially useful in this situation. Insofar as possible, it is important to distinguish preexisting hypertension, which preceded pregnancy, simple pregnancy-related hypertension, and more complicated forms, for their management differs. Treatment to lower blood pressure is aimed solely at preventing maternal complications of hypertension; lt has no effect on the course of the pregnancy and is sometimes even harmful for fetal growth. Except in cases of preeclampsia, it is not urgent to begin such treatment during pregnancy. If required, blood pressure should be reduced very progressively to maintain placental perfusion while slowly reaching a target value between 120/80 and 140/90 mmHg. Platelet aggregation inhibitors are the only effective preventive treatment for placental ischemia. They are reserved for at-risk pregnancies after 16 weeks of gestation, at a dose of 100mg/day. Short-term risks are associated especially with the complicated forms of hypertension. In the long term, preeclampsia is a marker of cardiovascular risk, for these women are at risk of developing chronic hypertension or having a cardiovascular accident in later years. Pregnancy is currently considered a situation that can reveal the likelihood of developing the metabolic syndrome and its cardiovascular complications.
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PMID:[Pregnancy-related hypertension: a cardiovascular risk situation]. 1925 Jul 98

We reviewed the literature on ambulatory blood pressure (BP) monitoring in type 2 diabetes mellitus (T2DM) (focusing on organ damage progression, prognosis, white coat hypertension, and masked hypertension) and metabolic syndrome (MetS). In the text we reported 21 articles about T2DM and 11 about MetS, part of which were included in meta-analyses. In T2DM, individual studies and meta-analyses indicate that 24-h pulse pressure and reduced night-time BP fall or reverse dipping predict organ damage progression, total cardiovascular events and all-cause mortality. Moreover, white coat hypertension seems to be less frequent in T2DM and its impact on cardiovascular complications remains controversial. In contrast, masked hypertension is more frequent in T2DM and seems to be associated with increased organ damage. Some studies reported higher ambulatory BP in patients with MetS, but these patients were older and had higher clinical BP than those without MetS. With regard to the circadian BP profile, contrasting data have been reported, although pooled data suggest a higher risk of nondipping in patients with MetS.
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PMID:Ambulatory blood pressure monitoring in type 2 diabetes and metabolic syndrome: a review. 2007 77

Hypertension is a major risk factor for cardiovascular disease. About forty million people are estimated to have hypertension. But, only 50% of hypertensive patients achieve well control of blood pressure. To prevent cardiovascular disease, more careful attention to hypertension is needed. Diagnostic level for hypertension in clinic is > or = 140/90mmHg. On the other hand, home blood pressure and 24-h ambulatory blood pressure are necessary for distinguish masked hypertension, white coat hypertension and sustained hypertension. Blood pressure is classified into optimal, normal and high-normal, and the corresponding levels are classified into grade I, grade II and grade III hypertension, respectively. Hypertensive patients are stratified into low-, moderate- and high-risk groups according to the presence or absence of risk factors other than blood pressure, hypertensive target organ damage and cardiovascular disease. In particular, the presence of diabetes mellitus and chronic kidney disease increases the risk. Attention to metabolic syndrome including a high-normal pressure as a component is also necessary. The treatment program should be prepared according to stratification of the risk; all patients must be guided to modify their lifestyle, and hypertensive medication should be started if necessary to achieve the target blood pressure level. In this paper most recommended timing to start medication for hypertensive patients is discussed.
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PMID:[Most recommended timing to start medication for hypertensive patients]. 2084 60

The issue of resistant hypertension is complex and from the clinical aspect very current, especially in the elderly. For the diagnosis of resistant hypertension in routine practice, ambulatory blood pressure monitoring is a proven method to distinguish it from the white coat hypertension. Fixed combinations of antihypertensive drugs helps to improve compliance not only in geriatric patients, but are also indicated in hypertensive patients with diabetes mellitus, metabolic syndrome, in patients with target organ damage, renal disease, coronary heart disease and post stroke conditions. Especially in the population of older hypertensive patients, listed diseases with polymorbidity are frequently present.
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PMID:[Resistant hypertension in the elderly]. 2380 39