Obesity-related hypertension frequently occurs in association with other CV risk factors, forming a constellation referred to as the metabolic syndrome (Table II).76 Although the concept of a metabolic syndrome has achieved widespread acceptance over the past 2 decades, no consensus has developed over the precise definition of the syndrome, nor over the criteria required to establish the diagnosis. No less than five sets of diagnostic criteria have been proposed by different international and national panels including the International Diabetes Federation (IDF), the World Health Organization (WHO), and the US National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), among others.77 The differences in criteria, although small and overlapping, point to the imprecision in defining the metabolic syndrome, and to the differences in the perceived importance of the various manifestations. Using the NCEP-ATP III criteria and the NHANES III survey it has been estimated that about 30% of the US population has the metabolic syndrome.78 The prevalence increases with age so that by 60 years, more than 40% of people meet criteria for the diagnosis.
Table II. Metabolic Syndrome-
Many sets of diagnostic criteria:
Critical components:
Hypertension,
Central obesity,
Insulin resistance (hyperinsulinemia),
Characteristic dyslipidemia,
High triglycerides,
Low high-density lipoprotein cholesterol.
Other associations-
Impaired glucose tolerance; type 2 diabetes mellitus,
Microalbuminuria; chronic renal disease,
Prothrombotic diathesi,s
Small dense low-density lipoprotein,
[UPWARDS ARROW] Inflammatory markers
SOURCE: American Society of Hypertension
