[The treatment of hypertension in patients with a metabolic disorder]

Life expectancy has increased significantly in the last decades in many Western populations, due to the fall of total and cardiovascular death rates. However, morbidity for cardiovascular diseases has decreased to a smaller extent due to the still unsatisfactory improvement in the overall population risk profile. This is true for blood pressure control (with only 20% of hypertensive patients achieving normotension with antihypertensive drugs), hypercholesterolemia (with borderline-high serum cholesterol levels in 50% of the population), and smoking habits. Since hypertension, hypercholesterolemia, hyperglycemia and insulin resistance are frequently associated, further improvement in cardiovascular risk can be obtained only with a comprehensive approach to the hypertensive patients, including dietary and life style modifications and the use of antihypertensive drugs with beneficial effects on lipid and glucose metabolism. It has to be noted in fact that some antihypertensive drugs have divergent effects on lipid and glucose metabolism. Long-term diuretic administration may reduce glucose tolerance, increase serum glucose and cholesterol. Beta-adrenergic blockers with no sympathomimetic activity raise triglycerides and decrease HDL cholesterol. ACE-inhibitors improve insulin sensitivity, while calcium entry blockers are neutral on both glucose and lipid metabolism. Recent reports suggest that alpha-1 adrenoceptor blockers may reduce total and LDL cholesterol while alleviating insulin resistance and increasing HDL cholesterol.