[The hypertensive metabolic syndrome]

Systemic arterial hypertension is not merely a simple haemodynamic abnormality. It is as frequently as in 80% associated with metabolic deviations such as impaired glucose tolerance or NIDDM, obesity, hyperuricaemia, hyperlipoproteinaemia, rapid development of atherosclerosis. This cluster of different symptoms with higher BP readings is too frequent to be incidental. We speak therefore of hypertensive metabolic syndrome which is close to or identical with Reaven's syndrome X or familial dyslipidaemic hypertension. The common pathogenetic basis of the listed metabolic deviations and hypertension is probably genetic or acquired reduction of tissue sensitivity, in particular striated muscle sensitivity to the physiological action of insulin. The consequence of this insulin resistance and the effort to maintain euglycaemia is a compensating adaptational risk of plasma insulin. Hyperinsulinism in addition to an increased synthesis of triacylglycerols, VLDL and LDL lipoproteins can promote the rise of BP by a complex mechanism: it stimulates the activity of the sympathetic nervous system, it promotes sodium retention in the kidneys, it affects transmembrane transport mechanisms for electrolytes and an increase of intracellular sodium and calcium, it stimulates hypertrophy and remodelling of the vascular wall and hastens the development of atherosclerosis. Hyperinsulinaemia is also associated with resistance of hypertonic patients to antihypertensive treatment. Its reduction by non-pharmacological procedures (reduction of body weight, physical activity etc.) restore the effectiveness of antihypertensive drugs. Insulin resistance is most probably a genetically conditioned abnormality which has multiple phenotypic manifestations, depending how this congenital disposition is amplified or associated with other genetic abnormalties or external and internal factors.(ABSTRACT TRUNCATED AT 250 WORDS)