Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

Abstract

Hypertension poses a significant burden in the general population, being responsible for increasing cardiovascular morbidity and mortality, leading to adverse outcomes. Moreover, the association of hypertension with dyslipidaemia, obesity, and insulin resistance, also known as metabolic syndrome, further increases the overall cardiovascular risk of an individual. The complex pathophysiological overlap between the components of the metabolic syndrome may in part explain how novel antidiabetic drugs express pleiotropic effects. Taking into consideration that a significant proportion of patients do not achieve target blood pressure values or glucose levels, more efforts need to be undertaken to increase awareness among patients and physicians. Novel drugs, such as incretin-based therapies and renal glucose reuptake inhibitors, show promising results in decreasing cardiovascular events in patients with metabolic syndrome. The effects of sodium-glucose co-transporter-2 inhibitors are expressed at different levels, including renoprotection through glucosuria, natriuresis and decreased intraglomerular pressure, metabolic effects such as enhanced insulin sensitivity, cardiac protection through decreased myocardial oxidative stress and, to a lesser extent, decreased blood pressure values. These pleiotropic effects are also observed after treatment with glucagon-like peptide-1 receptor agonists, positively influencing the cardiovascular outcomes of patients with metabolic syndrome. The initial combination of the two classes may be the best choice in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors because of their complementary mechanisms of action. In addition, the novel mineralocorticoid receptor antagonists show significant cardio-renal benefits, as well as anti-inflammatory and anti-fibrotic effects. Overall, the key to better control of hypertension in patients with metabolic syndrome is to consider targeting multiple pathogenic mechanisms, using a combination of the different therapeutic agents, as well as drastic lifestyle changes. This article will briefly summarize the association of hypertension with metabolic syndrome, as well as take into account the influence of antidiabetic drugs on blood pressure control.

Temporal change in multimorbidity prevalence, clustering patterns, and the association with mortality: findings from the China Kadoorie Biobank study in Jiangsu Province

“…The present study found a high prevalence of the combinations of hypertension + diabetes, hypertension + stroke, and hypertension + CHD. Hypertension and diabetes are the main components of metabolic syndrome and share pathophysiological mechanisms ( 21 ). Hypertension is the primary risk factor for cardiovascular diseases such as CHD and stroke, making it likely that these conditions occur together.…”

Association of metabolic syndrome and lifestyle factors with lower urinary tract symptoms and benign prostatic hyperplasia

“…Metabolic syndrome affects not only the urinary system but also various other bodily systems. Researchers have examined the connection between metabolic syndrome and the severity and frequency of lower urinary tract symptoms (LUTS) (3). The association between voiding and storage symptoms with metabolic syndrome involves understanding the underlying pathological mechanisms related to atherosclerosis (9).…”

“…It has gained significant attention recently because of its link to cardiovascular diseases and type 2 diabetes. However, its role in urological conditions like BPH and LUTS is increasingly recognized (3).…”

Influence of early use of sodium-glucose transport protein 2 inhibitors, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors on the legacy effect of hyperglycemia

“…These novel anti-hyperglycemic agents possess multiple pleiotropic effects, particularly, for SGLT-2i and GLP-1RA. Previous studies have reported that in addition to controlling blood glucose levels, these agents also have significant beneficial impacts on cardiovascular protection, renal protection, and improvement of cognitive function ( 18 – 20 ). However, no studies in China have reported the influence of early treatment with these novel anti-hyperglycemic agents on the legacy effect of poor early glycemic control.…”