A comprehensive management of hypertension among patients with metabolic syndrome: an evidence-based update

  • Alvin Nursalim Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • Parlindungan Siregar Department of Internal Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: Cardiovascular, diabetes, hypertension, metabolic syndrome


Individuals with hypertension and metabolic syndrome are at increased risk of developing future morbidities. Therefore, an evidence-based comprehensive approach is required. It is recommended to start with lifestyle modification as the first step, then followed by antihypertensive drugs. Weight loss through decreased caloric intake and increased excercise have been proven to yield a better control over diabetes, blood pressure, and lipid profile. Inhibitor of renin-angiotensin is the recommended first-line drugs for this population, while β-blocker and diuretic should remain as the second line drugs due to increased risk of developing new onset diabetes with these drugs.  A more rigorous blood pressure control is reasonable with a target of < 130/80 mmHg. A comprehensive management which include good control over blood pressure, weight, blood glucose, and lipid profile, may reduce future morbidities among hypertensive individuals with metabolic syndrome. (Med J Indones. 2013;22:189-94. doi: 10.13181/mji.v22i3.590)


Grundy SM, Brewer HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/ American Heart Association conference on scientific issues related to definition. Circulation. 2004;109(3):433-8. http://dx.doi.org/10.1161/01.CIR.0000111245.75752.C6

Purnamasari D. Metabolic syndrome. Acta Med Indones. 2010;42(4):185-6.

Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Rocella E. Trends in hypertension prevalence, awareness, treatment and control rates in United States Adults between 1988-1994 and 1999-2004. Hypertension. 2008;52(5):818-27. http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.113357

Arcucci O, de Simone G, Izzo R, et al. Association of suboptimal blood pressure control with body size and metabolic abnormalities. J Hypertens. 2007;25(11):2296-300. http://dx.doi.org/10.1097/HJH.0b013e3282e9a9e4

Izzo R, Simone GD, Chinali M, et al. Insufficient control of blood pressure and incident diabetes. Diabetes Care. 2009;32(5):845-50. http://dx.doi.org/10.2337/dc08-1881

Conen D, Ridker PM, Mora S, Buring JE, Glynn RJ. Blood pressure and risk of developing type 2 diabetes mellitus: The womenâs health study. Eur Heart J. 2007;28(23):2937-43. http://dx.doi.org/10.1093/eurheartj/ehm400

Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American heart Association/ National heart, Lung and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-52. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.169404

World Health Organization [Internet]. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO Consultation. Part 1: diagnosis and classification of diabetes mellitus [update 1999; cited 2003 Dec 12]. Geneva, Switzerland: World Health Organization. Available from: http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.2.pdf.

Chen G, McAlister FA, Walker RL, Hemmelgarn BR, Campbell NRC. Cardiovascular outcomes in Framingham participants with diabetes: The importance of blood pressure. Hypertension. 2011;57(5):891-7. http://dx.doi.org/10.1161/HYPERTENSIONAHA.110.162446

Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the west of Scotland Coronary Prevention Study. Circulation. 2003;108(4):414-9. http://dx.doi.org/10.1161/01.CIR.0000080897.52664.94

Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-87. http://dx.doi.org/10.1097/HJH.0b013e3281fc975a

Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52. http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2

Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with Impaired Glucose Tolerance. N Engl J Med. 2001;344(18):1343-50. http://dx.doi.org/10.1056/NEJM200105033441801

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393-403. http://dx.doi.org/10.1056/NEJMoa012512

Lien LF, Brown AJ, Ard JD, et al. Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome. Hypertension. 2007;50(4):609-16. http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.089458

HOPE investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Eng J Med. 2000;342:145-53. http://dx.doi.org/10.1056/NEJM200001203420301

Matchar DB, McCrory DC, Orlando LA, et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med. 2008;148(1):16-29. http://dx.doi.org/10.7326/0003-4819-148-1-200801010-00189

The ONTARGET investigators. Telmisartan, Ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547-59. http://dx.doi.org/10.1056/NEJMoa0801317

Lam SKH, Owen A. Incident diabetes in clinical trials of antihypertensive drugs. Lancet. 2007, 369(9572):1513-4. http://dx.doi.org/10.1056/NEJM200001203420301

Tuomilehto J, Rastenyte D, Birkenhager WH, et al. Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension. N Engl J Med. 1999;340(9):677-84. http://dx.doi.org/10.1056/NEJM199903043400902

Schrier RW, Estacio RO, Esler A, Mehler P. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int. 2002;61(3):1086-97. http://dx.doi.org/10.1046/j.1523-1755.2002.00213.x

The ACCORD study group. Effect of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575-85. http://dx.doi.org/10.1056/NEJMoa1001286

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13. http://dx.doi.org/10.1016/S0140-6736(02)11911-8

Diabetes Prevention Program Research Group. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care. 2003;26(9):2518-23. http://dx.doi.org/10.2337/diacare.26.9.2518

Look AHEAD Research Group, Pi-Sunyer X, Blackburn G. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30(6):1374-83. http://dx.doi.org/10.2337/dc07-0048

Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685-96. http://dx.doi.org/10.1016/S0140-6736(04)16895-5

Collins R, Armitage J, Parish S, Sleight P, Peto R; Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004;363(9411):757-67. http://dx.doi.org/10.1016/S0140-6736(04)15690-0

Goldberg RB, Mellies MJ, Sacks et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators. Circulation. 1998;98(23);2513-9. http://dx.doi.org/10.1161/01.CIR.98.23.2513

Smith SC, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458-73. http://dx.doi.org/10.1161/CIR.0b013e318235eb4d

Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537-44. http://dx.doi.org/10.2337/diacare.20.4.537

How to Cite
Nursalim A, Siregar P. A comprehensive management of hypertension among patients with metabolic syndrome: an evidence-based update. Med J Indones [Internet]. 2013Aug.23 [cited 2024Feb.22];22(3):189-94. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/590
Review Article