BackgroundMetabolic syndrome (MetS) is widespread among hypertensive patients. Clinical features and potential biomarkers of MetS in the presence of hypertension and resistant hypertension (RHTN) represent a great area of interest for investigation.ObjectiveThe purpose of this study was to evaluate the prevalence of MetS and the clinical features associated with it in resistant and mild to moderate hypertensives.MethodsThis cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with RHTN. We measured blood pressure (BP) and adipokines levels, and performed bioelectrical impedance analysis. Microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. The significance level of alpha = 0.05 was adopted.ResultsWe found a MetS prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. In a multiple regression analysis, MA (odds ratio = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (odds ratio = 4.13; p = 0.01) and RHTN (odds ratio = 3.75; p = 0.03) were independently associated with the presence of MetS apart from potential confounders.ConclusionsOur findings suggest that both resistant and controlled hypertensive subjects have a high prevalence of MetS. In addition, MetS-related metabolic derangements may cause early renal and hormonal changes. Finally, LAR may be useful as a reliable biomarker for identifying those hypertensive subjects who are at risk for developing MetS.

The authors previously demonstrated that acute administration of sildenafil—a phosphodiesterase 5 (PDE5) inhibitor—improves hemodynamic parameters in patients with resistant hypertensive (RH), but its effect on ambulatory blood pressure monitoring (ABPM) is unknown. This interventional, nonrandomized, single‐blinded, placebo‐controlled, crossover trial included 26 patients with RH. A dose of sildenafil (187.5mg) was given, and after a washout period of 14 days the patients received a single oral dose of placebo and the protocol was repeated. The patients underwent 24‐hour ABPM recordings the day before and immediately after the protocols. The reduction of systolic (−8.8±1.4 vs 1.3±1.2 mm Hg, P=.02), diastolic (−5.3±3.3 vs 1.8±1.1 mm Hg, P=.03), and mean (−7.9±3.6 vs 0.8±0.9 mm Hg, P=.01) 24‐hour BP were found after the use of sildenafil compared with placebo. Improvement in daytime BP levels was also observed (systolic −6.0±4.7 vs 4.4±1.5 mm Hg [P=.02] and mean −4.8±3.9 vs 3.5±1.4 mm Hg [P=.02] for sildenafil vs placebo, respectively). Considering its antihypertensive effect, sildenafil may represent a therapeutic option for RH treatment.

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Objective: The purpose of this study was to evaluate the prevalence of metabolic syndrome (MetS) and the clinical features associated with it in resistant and mild to moderate hypertensives. Methods: This cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with resistant hypertension (RHTN). We determined blood pressure measurements and adipokines levels. Target organ damages such as microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. Results: We found a prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. The patients with MetS showed a higher prevalence of MA ≥30mg.g⁻¹ compared to their counterparts (20% vs. 4%). Adiponectin levels were significantly lower in patients with MetS (5.30 vs. 7.50 µg.mL⁻¹), while leptin demonstrated to be increased in those patients, compared to the subjects without MetS (21.0 vs. 15.7 ng.mL⁻¹). Finally, in a multiple regression analysis MA (OR=8.51; p=0.01), leptin/adiponectin ratio (LAR) (OR=4.13; p=0.01) and RHTN (OR=3.75; p=0.03) were independently associated with the presence of MetS, apart from potential confounders. Conclusions: Our findings suggest that the metabolic derangements present in MetS tend to develop early signs of end-organ damage with hormonal changes in hypertensive patients. Indeed, LAR may be useful as a reliable biomarker for identifying those who are at risk for developing MetS.