Hypertension in the metabolic syndrome.

Increased blood pressure is considered an important component of metabolic syndrome. More than 85% of those with metabolic syndrome, even in the absence of diabetes, have elevated blood pressure (BP) or hypertension. The association of elevated BP with the metabolic syndrome is strongly linked through the causative pathway of obesity. Hypertension is the leading metabolic syndrome risk factor that predisposes to increased cardiovascular morbidity and mortality, and is additionally an important risk factor for development of chronic kidney disease in the presence of obesity, the metabolic syndrome, and microalbuminuria. Control of blood pressure in persons with the metabolic syndrome may prevent a significant number of coronary heart disease events. The primary modality of treatment is lifestyle intervention with reduced caloric intake and increased physical activity. Pharmacologic intervention is indicated on the basis of the severity of BP elevation, associated cardiovascular risk factors, and the presence of target organ damage.