MEDIX, God. 17 Br. 97  •  Pregledni članak  •  Interna medicina HR ENG

Hipertenzija i metabolički sindromHypertension and metabolic syndrome

Ivana Vuković Lela, Bojan Jelaković

Metabolički sindrom se sastoji od niza metaboličkih i kardiovaskularnih čimbenika rizika od kojih je jedan povišen arterijski tlak (AT). Uočeno je da bolesnici s visoko normalnim AT-om u sklopu metaboličkog sindroma (MS) imaju veći rizik nastanka hipertenzije. U onih u kojih se hipertenzija razvije u sklopu metaboličkog sindroma njihov ukupni kardiovaskularni rizik veći je nego što bi se to moglo pripisati samo razvoju hipertenzije. Stoga se procjenom komponenti MS-a liječenje hipertenzije može utemeljiti prema individualnom riziku. Glavni mehanizmi odgovorni za povišenje AT-a u MS-u su pojačana aktivnost simpatičkog i renin-angiotenzinskog sustava (RAS), zadržavanje natrija i endotelna disfunkcija. Cilj je liječenja smanjiti povećani ukupni kardiovaskularni i bubrežni rizik koji je povezan uz pojedine sastavnice MS-a, te smanjiti rizik razvoja šećerne bolesti tipa 2. Uravnotežena prehrana i redovita tjelesna aktivnost su ključne u liječenju MS-a, iako predstavljaju često nedovoljan oblik liječenja. Pri medikamentnom liječenju hipertenzije treba izabrati one antihipertenzive koji smanjuju inzulinsku rezistenciju, ili je barem ne pogoršavaju, te one koji imaju posljedične povoljne učinke na razinu glukoze i lipida. 

Ključne riječi:
antihipertenzivi; hipertenzija, metabolički sindrom

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 17 Br. 97

Metabolic syndrome consists of a number of metabolic and cardiovascular risk factors, including increased blood pressure. Patients with upper-normal blood pressure who have the metabolic syndrome seem to have increased risk of hypertension. Those with metabolic syndrome who develop hypertension have a higher overall cardiovascular risk than what could be ascribed only to the development of hypertension. Therefore, the assessment of metabolic syndrome components should include the treatment of hypertension based on individual risk. The main mechanisms leading to increased blood pressure in metabolic syndrome are increased activity of both sympathetic system and renin-angiotensin system, retention of sodium and endothelial dysfunction. The treatment goal is to decrease the overall cardiovascular and renal risks associated with individual components of metabolic syndrome and reduce the risk of type 2 diabetes mellitus. Balanced diet and regular physical activity play an important role in metabolic syndrome treatment, but often produce unsatisfactory results. Therefore, medical treatment of hypertension often has to be introduced including antihypertensives that reduce, or at least do not aggravate, insulin resistance and have beneficial effects on the glucose and lipid blood levels. 

Key words:
antihypertensive agents; hypertension; metabolic syndrome X