In hypertensive subjects, the metabolic syndrome amplifies cardiovascular risk associated with high BP, independent of the effect of several traditional cardiovascular risk factors.

Abstract-Metabolic syndrome (MS) is increasingly recognized as an important cardiovascular risk factor in hypertension, but its influence on left ventricular (LV) mass and function in the 2 genders has not been specifically addressed. Among 618 nondiabetic, untreated hypertensive subjects, echocardiographically detected LV mass was significantly greater in subjects with MS. A significant interaction was observed between sex and the MS (PϽ0.003 for the multiplicative interaction term). Compared with women without the MS, those with the syndrome had a 24% greater LV mass (49.5Ϯ12 versus 40.0Ϯ10 gϫm Ϫ2.7 ; PϽ0.001), whereas the difference was only 9% in men (50.3Ϯ12 versus 46.1Ϯ10 gϫm Ϫ2.7 ; Pϭ0.003). A greater prevalence of LV hypertrophy was found in women (37% versus 14%; PϽ0.001) but not in men (39% versus 29%; Pϭ0.09) with the MS. After adjustment for the effect of age, body mass index, 24-hour systolic blood pressure, and several confounders, the MS was independently associated with a greater LV mass index in women (regression coefficient, 4.80; PϽ0.001) but not in men. Women with the MS also had a greater LV relative wall thickness (0.42Ϯ0.07 versus 0.39Ϯ0.07; Pϭ0.004) and a depressed afterload-corrected midwall fractional shortening (94.0Ϯ12% versus 101.0Ϯ13%; PϽ0.001) than women without the syndrome, whereas no differences emerged in men. We conclude that, in untreated hypertension, MS has a different impact on LV hypertrophy and function in men and women. The effect of MS is more pronounced in women and is partly independent from the effect of several hemodynamic and nonhemodynamic determinants of LV mass. Key Words: hypertrophy Ⅲ remodeling Ⅲ metabolism Ⅲ gender Ⅲ risk factors T he metabolic syndrome (MS), a clustering of lipid and nonlipid cardiovascular risk factors, is increasingly recognized as an independent predictor of cardiovascular disease in hypertension. 1 The notion that the MS may have different relative importance for atherogenesis and cardiovascular disease in the 2 genders arises from observations indicating that elevated triglycerides and decreased high-density lipoprotein cholesterol, 2 basic components of the syndrome, are better predictors of the risk of adverse outcomes in women than in men. [2][3][4] Moreover, in those studies in which the prognostic impact of the MS has been examined separately in men and women, the coronary or cardiovascular morbidity/mortality hazard ratios associated with the syndrome were almost invariably found to be higher in the female sex. 1,5-10 Similarly, Iglseder et al 11 have observed in a healthy population that the effect of MS on carotid intimamedia thickness is more pronounced in women than in men.Left ventricular (LV) hypertrophy, a major manifestation of hypertensive heart disease, is a strong and independent herald for cardiovascular morbidity and mortality, 12,13 and its treatment-induced regression has been unequivocally associated with an improved cardiovascular prognosis, even after accounting for the confounding effect of treatment-induced b...

Systolic blood pressure and pulse pressure, but not diastolic blood pressure, are predictors of plasma C-reactive protein concentrations in patients with newly diagnosed, never-treated hypertension, irrespective of the potential proinflammatory action of traditional cardiovascular risk factors.