Obesity, Metabolic Syndrome, Diabetes and Arterial Hypertension

Hypertension is a frequent condition in obese subjects and in subjects with diabetes and other components of the metabolic syndrome. The pathophysiology of the increase in blood pressure (BP) is multifactorial. Three targets, heart, vessels and the kidneys, are involved in BP regulation. Insulin, leptin and some adipocytokins, whose plasma levels are often increased in these subjects, are likely to play a major role. They act through various mechanisms, some of them contributing to rise BP and others to lower BP. An imbalance between these opposite effects, as evidenced in insulin resistance state, may account for elevated BP. Because hypertension is a major determinant for cardiovascular complications and also for microangiopathic complications in patients with diabetes, tight BP control is mandatory to prevent these complications. Weight loss and lifestyle changes are the cornerstone of hypertensive management, but pharmacological anti-hypertensive treatments are often required to achieve this goal. Drugs with favourable metabolic effects, including for some of them a demonstrated effect in diabetes prevention, should be preferably chosen.