Antihypertensive Therapie beim metabolischen Syndrom

In the metabolic syndrome with hypertension, dyslipidemia, obesity, and glucose intolerance, insulin resistance and compensatory hyperinsulinemia are thought to play a central role. Retrospective epidemiological data indicate a lower than expected reduction of coronary events, although blood pressure had been effectively controlled. Neglect of concomitant risk factors, and a further deterioration of these cardiovascular risk factors through the type of antihypertensive intervention used seem to have contributed to this 'coronary paradox'. Recently, glucose clamp studies showed that diuretics and betablockers reduce insulin sensitivity and worsen dyslipidemia; these effects were reversible after the drugs were discontinued. Calcium channel blockers seem to be metabolically neutral, while ACE-inhibitors, vasodilating betablockers, α1-inhibitors and moxonidine even improve hyperlipidemia and insulin resistance. Thus, antihypertensive agents which further increase the known cardiovascular risk factors, should not be considered as drugs of first choice in hypertensive patients with the metabolic syndrome. Although, up to now, no long-term morbidity study is available to prove superiority of these newer agents, we believe that it would be wrong to withhold a modern, risk factor-adapted antihypertensive treatment from patients with the metabolic syndrome.