Pathophysiology and Optimal Management of Hypertension in Patients with Cardiometabolic Syndrome

S. Ihm
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引用次数: 1

Abstract

Metabolic syndrome (MS) is a common cardiometabolic disorder that increases in prevalence as the population becomes more obese and increases the risk for cardiovascular disease (CVD). MS is highly prevalent among hypertensive patients and hypertension (HTN) is a major risk factor for CVD. Therefore, strict blood pressure (BP) control is an important factor for prevention and proper management of CVD in patients with MS. The underlying mechanisms for development of HTN in the MS and obesity are very complicated and has not yet been fully elucidated. However, several pathophysiology including central obesity, insulin resistance and increased sympathetic nervous system (SNS) activity, renin-angiotensinaldosterone system (RAAS) activity and sodium reabsorption (salt sensitivity) have been proposed. In addition, the leptin-related brain system, endothelial dysfunction, natriuretic peptides and other various factors may be involved in the development of HTN in MS/ obese patients. Lifestyle modifications including weight loss with diet and exercise are very important strategy in management of HTN. For the treatment of HTN in this population, agents that block the RAAS, the SNS and renal sodium excretion are frequently required. In patients with MS, data from prospective studies are very limited, but many guidelines recommended angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors as initial antihypertensive drugs. Calcium channel blockers or low dose thiazide diuretic are recommended in addition to ARBs or ACE inhibitors, and then the use of a 3-drug combination comprising these 3 antihypertensive drugs. Further longer-term, prospective studies including new drugs and devices are needed.
心脏代谢综合征患者高血压的病理生理学和最佳管理
代谢综合征(MS)是一种常见的心脏代谢紊乱,随着人群肥胖和心血管疾病(CVD)风险的增加,其患病率也在增加。多发性硬化症在高血压患者中非常普遍,而高血压(HTN)是心血管疾病的主要危险因素。因此,严格控制血压是预防和妥善管理MS患者心血管疾病的重要因素。MS和肥胖中HTN发生的潜在机制非常复杂,尚未完全阐明。然而,一些病理生理学包括中枢肥胖,胰岛素抵抗和增加交感神经系统(SNS)活性,肾素-血管紧张醛固酮系统(RAAS)活性和钠重吸收(盐敏感性)被提出。此外,瘦素相关脑系统、内皮功能障碍、利钠肽等多种因素可能参与MS/肥胖患者HTN的发展。生活方式的改变,包括饮食和运动减肥是治疗HTN的重要策略。对于这一人群的HTN治疗,通常需要阻断RAAS、SNS和肾脏钠排泄的药物。在多发性硬化症患者中,前瞻性研究的数据非常有限,但许多指南推荐血管紧张素受体阻滞剂(ARBs)和血管紧张素转换酶(ACE)抑制剂作为初始抗高血压药物。除了arb或ACE抑制剂外,推荐使用钙通道阻滞剂或低剂量噻嗪类利尿剂,然后使用由这3种抗高血压药物组成的3药联合治疗。需要进一步的长期、前瞻性研究,包括新的药物和设备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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