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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (2) : 201-206     DOI: 10.1007/s11684-013-0264-4
REVIEW |
Metabolic hypertension: concept and practice
Zhiming Zhu1(), Peijian Wang1, Shuangtao Ma2
1. Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China; 2. Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu 610083, China
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Abstract  

Hypertension is a serious public health problem worldwide. More than 60% of the risk factors for hypertension are associated with metabolic disturbances. Metabolic abnormalities increase the risk for hypertension and cause high blood pressure. Improving metabolic disturbances is beneficial for hypertension treatment. Due to the importance of metabolic abnormalities in the pathogenesis of hypertension, we propose a concept of metabolic hypertension. In this review, we discuss and review the clinical types, pathogenesis, risk evaluation and management of metabolic hypertension. Elucidation of the mechanism of metabolic hypertension should facilitate the design of novel pharmacotherapeutics and dedicated antihypertensive manipulations.

Keywords hypertension      cardiometabolic risk factors      metabolic abnormalities     
Corresponding Authors: Zhu Zhiming,Email:zhuzm@yahoo.com   
Issue Date: 05 June 2013
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0264-4     OR     http://academic.hep.com.cn/fmd/EN/Y2013/V7/I2/201
Fig.1  Potential mechanisms of metabolic hypertension. The gastrointestinal tract is a main pathway of absorption of cardiometabolic risk factors, such as a salt-, fat- and carbohydrate-rich diet. An unbalanced diet can alter gut barrier functions and promote metabolic endotoxaemia, reactive oxygen species (ROS) and inflammation. These disturbances contribute to the dysfunction of the cardiometabolic system, to organ damage and to high blood pressure.
Primary (genetic) hypertensionMetabolic hypertension
Family historyUsually with genetic background of hypertensionOften with genetic background of metabolic disorders
Initiating factorsHypertensive susceptibility genesUnhealthy diet and lifestyles
Blood pressure≥140/90 mmHg, hypertensive patients without metabolic disorders or other secondary factors≥130/85 mmHg, blood pressure secondary to metabolic abnormalities
Target organ damageHypertensive cardiomyopathy, stroke, renal arteriosclerosis, hypertensive retinopathyMicrovascular disease (diabetic nephropathy, retinopathy), renal dysfunction, atherosclerosis, coronary heart disease and stroke
Vascular pathological featuresRemodelling of peripheral resistant artery, increased vascular reactivityLarge vascular damage (endothelial dysfunction, atherosclerosis) and microvascular lesions
Treatment and BP goalLifestyle changes, blood pressure<140/90 mmHgMetabolic improvement and lifestyle intervention, blood pressure<130/85 mmHg
InterventionCombination therapy with varieties of antihypertensive drugsHypoglycaemic, lipid-lowering, antihypertensive and weight control treatment, some patients needs metabolic surgery
Tab.1  Differences between metabolic hypertension and primary (genetic) hypertension
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