Prehypertension and the cardiometabolic syndrome: targeting several risk factors to achieve maximum benefit

Abstract

Response to: Duprez D, Toleuova A. Prehypertension and the cardiometabolic syndrome: pathological and clinical consequences. Expert Rev Cardiovasc Ther 2013;11(12):1725-33

We read the review by Duprez and Toleuova [1] with interest. They discuss prehypertension (defined as systolic and diastolic blood pressure 120–139 and 85–89 mmHg, respectively) and the associated increased risk for cardiovascular (CV) morbidity and mortality. They also mention that elevated blood pressure (i.e., systolic ≥130 and/or diastolic ≥85 mmHg) are included in the joint definition of the metabolic syndrome (MetS) [2]. Several pathogenic mechanisms and treatment options are discussed with emphasis on lifestyle measures [1]. While we acknowledge the authors focused specifically on the prehypertension phenotype, we also believe that other components of the cardiometabolic syndrome are important. In this contest, a few comments may be useful.

Similarly to diet, we have recently reported exercise-related beneficial effects with regard to the progression from prehypertension to hypertension [3].

Apart from the diagnostic criteria, MetS has been related to several other CV risk factors including LDL and HDL dysfunctional subfractions, postprandial hypertriglyceridemia, hyperuricemia, nonalcoholic fatty lever disease and arterial stiffness; these associations have been recently reviewed [4]. Briefly, small dense LDL particles have been linked to CV risk independently of traditional risk factors [5] as discussed by a European expert panel [6,7]. HDL quality, and not only quantity, seems to play an important role in the diagnosis and treatment of CV diseases [8,9]. The clinical relevance and assessment of postprandial hypertriglyceridemia have been reviewed by a recent expert panel [10–12]. Associations between elevated serum uric acid, prehypertension and MetS have been previously reported [13,14]. Nonalcoholic fatty lever disease is the hepatic manifestation of MetS, and it is characterized by increased CV risk [15,16]. Increased arterial stiffness has been associated with the development of hypertension in the presence of prehypertension [17].

MetS has also been linked to noncardiac vascular diseases (i.e., stroke, carotid artery disease, peripheral artery disease, chronic kidney disease, atherosclerotic renal artery stenosis and abdominal aortic aneurysms) [18].

We have previously shown that multifactorial treatment, including lifestyle changes, hypolipidemic, antihypertensive, hypoglycemic and antiobesity drugs, is beneficial in MetS patients not only in terms of CV risk but also with regard to liver and renal function [19–22]. Therefore, several CV risk factors should be evaluated and adequately treated in high-risk patients in order to maximize clinical benefit.

Financial & competing interests disclosure

N Katsiki has given talks and attended conferences sponsored by Novartis, Pfizer, MSD and AstraZeneca. A Karagiannis has given talks and attended conferences sponsored by Menarini, AstraZeneca, Novartis and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.