Metabolic syndrome and target organ damage in untreated essential hypertensives

Cuspidi, Cesare; Meani, Stefano; Fusi, Veronica; Severgnini, B; Valerio, Cristiana; Catini, Eleonora; Leonetti, Gastone; Magrini, Fabio; Zanchetti, Alberto

doi:10.1097/00004872-200410000-00023

Cited by 174 publications

(164 citation statements)

References 40 publications

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“…This observation is in agreement with previous studies in hypertensive and in normotensive subjects with signs of insulin resistance. [20][21][22] The present study also showed that of the five components of the MS body size and BP were particularly associated with LVM but also blood glucose was independently related to cardiac dimensions.…”

Section: Discussionsupporting

confidence: 74%

“…The observation of an early dysfunction of the diastolic ventricular filling is, however, one of the first findings of such abnormality in subjects with MS observed in a population sample, confirming data detected in the American Indian population. 24 In patients from the Hypertension Outpatient Clinic, the corresponding data are, however, conflicting since differences in diastolic function between subjects with and without MS were present in a study 25 and absent in another, 22 possibly because differences were obscured by the equally elevated BP values in both groups. Regarding the possible phenomenon of the pseudo-normalization of the E/A ratio, which occurs in subjects with particularly deteriorated diastolic function, it does not appear to influence the results of the present study since it should have played against our observation of a reduced E/A.…”

Section: H Ig H B Lo O D P R E S S U R E H Ig H F a S T In G B G L O mentioning

confidence: 99%

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Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Ferrara

Cardoni²,

Mancini

et al. 2007

J Hum Hypertens

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Aims of this study were to investigate the prevalence of metabolic syndrome (MS), diagnosed according to the International Diabetes Federation (IDF) criteria and its relationship with echocardiographic parameters of cardiac structure and function. The study was performed in 707 subjects, age 45-54 years, of the Gubbio Population Study who underwent a comprehensive examination including measurement of body size, blood pressure (BP) and heart rate, 12-lead electrocardiogram, Doppler echocardiography, standardized blood and urine laboratory tests. One hundred and fifty-three subjects were found to have MS, which was more frequent among hypertensive patients than normotensive controls (36.2 vs 13.7%, Po0.001). Apart from visceral obesity present in all subjects by definition according to the IDF criteria, high levels of BP (4130/85 mm Hg) and triglycerides (X150 mg/dl) were the most frequently observed components of the syndrome, since their prevalence averaged 75% of those with the syndrome. Left ventricular mass (95.6722 vs 86.4722 g/m 2 ; Po0.001) and prevalence of left ventricular hypertrophy were increased in the subgroup with MS. Waist circumference, BP and blood glucose were the components of the syndrome with stronger impact on cardiac mass. An early impairment of the diastolic function was detected in this subgroup with a reduction of the early-to-late diastolic filling (0.9170.17 vs 0.9970.23, Po0.001). The results of the present study indicate that MS is frequent in middleaged general population, particularly in subjects with arterial hypertension. The syndrome is associated to the increase in ventricular mass and the early impairment of diastolic function.

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Section: Discussionsupporting

confidence: 74%

Section: H Ig H B Lo O D P R E S S U R E H Ig H F a S T In G B G L O mentioning

confidence: 99%

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Ferrara

Cardoni²,

Mancini

et al. 2007

J Hum Hypertens

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“…12,23,24 In hypertensive patients without manifest vascular disease, the metabolic syndrome has been shown to be associated with increased intima-media thickness and left ventricular hypertrophy as well as with increased incidence of cardiovascular events. [25][26][27][28][29] It is not yet known whether the metabolic syndrome still is a predictor of new cardiovascular events in hypertensive patients with already clinically manifest cardiovascular disease. If the risk for future cardiovascular events in patients with hypertension and the metabolic syndrome is higher compared to those without the metabolic syndrome, these patients may benefit from more aggressive treatment of blood pressure and other risk factors.…”

Section: Introductionmentioning

confidence: 99%

Effect of metabolic syndrome or type II diabetes mellitus on the occurrence of recurrent vascular events in hypertensive patients

et al. 2008

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Patients with hypertension and manifest vascular disease are at high risk for recurrent cardiovascular diseases. It is unknown if the metabolic syndrome further increases the risk in these patients. This study aims to quantify the effect of metabolic syndrome and type II diabetes on cardiovascular events in hypertensive patients with vascular disease. A total of 2196 hypertensive patients with vascular disease (cerebrovascular disease (34%), coronary heart disease (50%), peripheral arterial disease (28%), abdominal aortic aneurysm (13%)) from the Second Manifestations of Arterial Disease study were followed for up to 10 years (mean 3.9 years) for death, stroke and myocardial infarction. Age and sex adjusted hazard ratios (HR) were calculated for hypertensive patients with metabolic syndrome but without diabetes (n ¼ 775) and for hypertensive patients with type II diabetes (n ¼ 381), compared to merely hypertensive patients (n ¼ 1040).Forty-nine percent had metabolic syndrome (NCEP ATPIII definition) and 17% had type II diabetes. Metabolic syndrome predicted vascular death (HR 1.41, 95% confidence interval (CI) 1.01-1.98), stroke (HR 1.36, 95% CI 0.85-2.16) and myocardial infarction (HR 1.40, 95% CI 0.97-2.01). Type II diabetes accounted for even higher risks of vascular end points (HR 1.41-1.64). The effect of metabolic syndrome on future events could not be explained by the presence of type II diabetes. Even in high-risk patients with hypertension and vascular disease, presence of metabolic syndrome or type II diabetes identifies patients at high risk for future cardiovascular events. Identifying metabolic syndrome patients may direct therapy focusing on treatment of insulin resistance by reducing weight and increasing physical activity.

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“…Previous studies showed that subjects with the metabolic syndrome often present with increased LV mass (and LV hypertrophy) [10,11] The Framingham Heart Study evaluated LV mass using echocardiography and observed that increased LV mass is an independent predictor of clinical events such as heart failure, ischemia, ventricular arrhythmia, and sudden cardiac death [12]. Accordingly, reduction of LV mass is important for improvement of clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies revealed that patients with the metabolic syndrome often present with increased left ventricular (LV) mass (and LV hypertrophy) [10,11]. The Framingham Heart Study evaluated LV mass using echocardiography in relation to long-term clinical outcome, and observed that an increase in LV mass is an independent predictor of clinical events, including death, attributable to cardiovascular disease [12].…”

Section: Introductionmentioning

confidence: 99%

Effect of lifestyle intervention plus rosiglitazone or placebo therapy on left ventricular mass assessed with cardiovascular magnetic resonance in the metabolic syndrome

Roes

Dehnavi

Westenberg

et al. 2011

Journal of Cardiovascular Magnetic Resonance

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BackgroundTo evaluate the effect of lifestyle intervention in conjunction with rosiglitazone or placebo therapy on left ventricular (LV) mass, using cardiovascular magnetic resonance (CMR) in the metabolic syndrome.MethodsThe present study was a pre-specified substudy of a double-blind randomized controlled trial evaluating the effect of lifestyle intervention in conjunction with rosiglitazone or placebo therapy on carotid artery atherosclerosis in the metabolic syndrome. From this original study population, 10 subjects from the placebo group and 10 from the rosiglitazone group were randomly selected. At baseline and follow-up (52 weeks), clinical and laboratory measurements were assessed and a CMR-examination was performed to evaluate LV mass indexed for body surface area (LV mass-I). Subsequently, the effect of therapy (rosiglitazone vs. placebo) and clinical and laboratory variables on LV mass-I was evaluated.ResultsIn both groups, body mass index, waist circumference, systolic and diastolic blood pressure significantly decreased during follow-up. Interestingly, LV mass-I significantly decreased in the placebo group (48.9 ± 5.3 g/m2 vs. 44.3 ± 5.6 g/m2, p < 0.001) indicating reverse remodeling, whereas LV mass-I remained unchanged in the rosiglitazone group (54.7 ± 9.9 g/m2 vs. 53.7 ± 9.2 g/m2, p = 0.3). After correction for systolic and diastolic blood pressure and triglyceride, the kind of therapy (rosiglitazone vs. placebo) remained the only significant predictor of LV mass-I reduction.ConclusionsLifestyle intervention resulted in a reduction of LV mass-I in the metabolic syndrome, indicating reverse remodeling. However, rosiglitazone therapy may have inhibited this positive reverse remodeling.Trial registrationCurrent Controlled Trials ISRCTN54951661.

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Metabolic syndrome and target organ damage in untreated essential hypertensives

Cited by 174 publications

References 40 publications

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Effect of metabolic syndrome or type II diabetes mellitus on the occurrence of recurrent vascular events in hypertensive patients

Effect of lifestyle intervention plus rosiglitazone or placebo therapy on left ventricular mass assessed with cardiovascular magnetic resonance in the metabolic syndrome

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