Review article
Metabolic Syndrome – Relationship between Insulin Resistance, Arterial Hypertension and Microalbuminuria
Željko Reiner
Mario Laganović
Abstract
Hyperinsulinemia and hypertension are
the components of the metabolic syndrome that frequently
coexist with a possible common genetic predisposition.
When grouped together, they are associated with an
increased risk of cardiovascular morbidity and mortality and
progressive renal disease. Visceral obesity, in particular
abdominal obesity, and insulin resistance are risk factors
for the development of arterial hypertension. A mayor
contributor to the development of insulin resistance is an
overabundance of circulating free fatty acids, mainly derived
from adipose tissue triglyceride stores. Visceral obesity is
a state of low-grade infl ammation and a source of several
proinfl ammatory cytokines responsible for endothelial
dysfunction and progression of arterial hypertension. It is
also a state with a relative defi ciency of adiponectin. Insulin
resistance/hyperinsulinemia contributes to the development
of hypertension through several mechanisms: sympathetic
nervous system and renin-angiotensin-aldosterone system
(RAAS) activation, with resultant sodium retention, volume
expansion, endothelial dysfunction and alteration in renal
function. Microalbuminuria is associated with several
components of the metabolic syndrome. It is also an
early marker of this syndrome. Microalbuminuria appears
to be a signal from the kidney of generalized endothelial
dysfunction, atherosclerosis, increased risk of cardiovascular
morbidity and mortality and progressive renal disease. Multitarget
approach, based on the assessment of the overall
cardiovascular risk and comprising lifestyle changes and
management of metabolic risk factors, should be applied.
A particular emphasis is placed on the RAAS blockade with
ACE inhibitors and angiotensin II receptor blockers (ARB).
In addition to the RAAS blockade, ARBs also exert some
anti-atherogenic effects through the selective modulation
of PPARγ. However, clinical trials are required to determine
metabolic benefi ts. It should be stressed that the adequate
management of hypertensive patients with diabetes or
impaired glucose tolerance requires a strict blood pressure
control, often with lower target blood pressure values
and almost always in combination with complementary
antihypertensive drugs.
Keywords
hypertension; hyperinsulinemia/insulin resistance; microalbuminuria; renin-angiotensin-aldosterone system; ACE inhibitors; angiotensin II receptor blockers
Hrčak ID:
19004
URI
Publication date:
15.11.2004.
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