Hypertensive patients may have multiple complications, what should be done when combined with metabolic syndrome? How to intervene in lifestyle, which medications will be used and which will be used with caution? Patients with hypertension should know in advance.
1, how to diagnose hypertension combined with metabolic syndrome? What should I do in this case?
First of all, how to determine whether hypertension has a combination of metabolic syndrome, in the clinical diagnosis of criteria.
That is, under the premise of clear hypertension (without antihypertensive drugs, systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, or a previous history of hypertension, currently taking antihypertensive drugs), the diagnosis can be made by meeting three or more of the following
– Abdominal obesity: waist circumference ≥ 90 cm in men and ≥ 85 cm in women.
– Increased blood pressure: blood pressure ≥ 130/85 mmHg and/or those who have been diagnosed and treated for hypertension.
– Dyslipidemia: fasting triglycerides ≥ 1.7 mmol/L, fasting high-density lipoprotein (HDL-C) < 1.04 mmol/L, or diagnosed dyslipidemia and treated with medication.
– Hyperglycemia: fasting blood glucose ≥ 6.1 mmol/L or 2 hours after sugar load blood glucose ≥ 7.8 mmol/L, and/or those who have been diagnosed and treated for diabetes mellitus.
Second, what should be done when this condition occurs?
Treat it early! The treatment principle of hypertension combined with metabolic syndrome is early intervention and comprehensive attainment to reduce cardiovascular risk and prevent target organ damage such as heart, brain and kidney.
Hypertension combined with metabolic syndrome is a frequent problem faced in the clinic. These patients often have multiple risk factors and aggregation of target organ damage. Therefore, the diagnostic process should be more complete in these patients.
In terms of treatment, strict lifestyle interventions are the primary treatment strategy, such as healthy diet and reasonable exercise are very important and effective. Regarding the intervention of antihypertensive drugs, the first choice should be renin-angiotensin-aldosterone system blockers, and the target value for lowering blood pressure is <130/80 mmHg.
2, hypertension combined with metabolic syndrome, how to make interventions in lifestyle, what drugs will be used in treatment?
(1) Lifestyle interventions
Lifestyle interventions and other non-pharmacological treatments are the main and basic means of treatment for metabolic syndrome, and are the basis of treatment for hypertension combined with metabolic syndrome. It is mainly regulated by adjusting diet and insisting on moderate exercise.
– Reasonable diet: we should limit the intake of fat and sugar, advocate the combination of meat and vegetarian, mainly vegetarian; increase the intake of fibrous food and nuts, such as mixed grains, corn, buckwheat, soybeans, oats, peanuts, walnuts and so on. Limit sodium intake, do not smoke, limit alcohol consumption.
– Moderate exercise: appropriate exercise can lower blood pressure, increase insulin sensitivity, help lower blood sugar, but also reduce the risk of complications of metabolic syndrome. It is advisable to do more aerobic metabolic exercises such as walking, swimming, table tennis, tai chi, dancing, cycling, gymnastics, etc.
(2) Drug modality intervention
When lifestyle interventions are not effective, pharmacological interventions should be used.
Hypertension combined with metabolic syndrome should be treated with angiotensin converting enzyme inhibitors (such as benazepril hydrochloride tablets) or angiotensin receptor anti-binding agents (such as valsartan capsules).
Long-acting calcium antagonists (e.g., amlodipine besylate tablets, nifedipine controlled-release tablets, felodipine extended-release tablets) and potassium-preserving diuretics (e.g., spironolactone) can also be used secondarily.
Be cautious with beta-blockers and thiazide diuretics (such as hydrochlorothiazide), because they have adverse effects on lipid and blood glucose metabolism.
For high blood glucose, lipid should be given hypoglycemic, lipid regulating treatment, such as hypertension combined with metabolic syndrome patients with metformin can reduce the risk of new diabetes mellitus, metformin can also improve due to taking beta-blockers and calcium antagonists combined antihypertensive resulting in abnormal glucose and lipid metabolism, and can reduce body weight.
For lipid regulation, statins are preferred, which not only can significantly reduce high-density lipoprotein (LDL-C), but also have the effects of improving endothelial function, reducing inflammatory response and improving insulin resistance.
References
[1] Zhao YL, Deng B. Clinical study of lipid regulating and hypoglycemic tablets in the treatment of hypertension combined with metabolic syndrome [J]. Journal of Integrative Medicine and Cardiovascular Diseases,2022,20(04):725-728.
[2] Revision Committee of the Chinese Guidelines for the Prevention and Treatment of Hypertension. Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition) [J]. Chinese Journal of Cardiovascular Diseases,2019,24(1):46-47.
[3] Li Qin Companions, ed. Family medicine and health care [M]. Shanghai:Shanghai Science Popularization Press,2017(02):93-94.