Dyslipidemia and hyperglycemia in hypertensive patients with metabolic syndrome

Abstract

Introduction: Metabolic syndrome (MS) is a combination of interrelated risk factors, which include: dyslipidemia (DLP), hyperglycemia, high blood pressure, and abdominal obesity. This coexistence of metabolic disorders promotes atherosclerotic cardiovascular disease, being also a causative factor for type 2 difabetes mellitus (DM). Hypertension is one of the most common manifestations of MS, which has a high prevalence worldwide (25-35% in adults and 60-70% in people over 70 years) due to the global epidemic of DM and obesity. Another association of hypertension and MS is DLP, induced by the action of insulin on lipid metabolism, which increases very low density lipoprotein synthesis in the liver. Methods: It was a retrospective study of patients from the Institute of Cardiology, the key criterion being grade I-II hypertension. Diagnosis of MS was established according to criteria proposed by NCEP/ ATP III in 2005. MS was considered in patients having at least 3 of 5 criteria. DM was established according to American Diabetes Association definition in 2003. Results: There were 168 hypertensive patients included of which we selected 114 patients with grade I-II hypertension divided subsequently into four groups: with MS and DM (n=32); with MS, but no DM (n=29); no MS and no DM (n=37); no MS, but with DM (n=16). Following evaluation in these groups included determination of lipid and glucose metabolism features. Patients with MS only had significantly higher TG levels than patients with DM only (2.23±0,04 vs. 1.30±0,06 mmol/1, respectively). Similarly, values of TC and LDL-C were highest in patients with MS only (5.80±0.04 and 4.71±0.03 mmol/1, respectively). Serum levels of HDL-C had shown inverse correlations compared with TG. Calculating the atherogenic coefficient revealed that TC/HDL-C ratio is significantly higher in MS groups compared to non-MS groups, independently of the presence of DM. Evaluation of glucose metabolism in the study group revealed that 45 (39.5%) patients were diagnosed with type 2 diabetes and 69 (60.51%) patients were nondiabetic, of which 38 (33.3%) patients with impaired glucose homeostasis (IGH) and 31 (27.2%) patients with normal glucose regulation (NGR). Group assessment found that IGH meets in higher proportion among nondiabetic patients with MS (84.4%), than among nondiabetic patients without MS (29.7%). Conclusions: Lipid metabolism disorders is more common in the group of hypertensive patients with MS, and were not altered by the presence of DM. DLP was mainly manifested by a significant reduction in HDL-C, high levels of TG, TC and LDL-C and increased TC/HDL-C ratio, which implies a more enhanced atherogenic activity in groups of patients with MS. Glucose metabolism disorders are common in 72.8% of hypertensive patients and only 27.2% of them have normal glucose regulation. Comparison of nondiabetic groups revealed that IGH meets in higher proportion among nondiabetic patients with MS, than among nondiabetic patients without MS. Thus, hyperglycemia is highly associated with hypertension, particularly in patients with MS.