Metabolic syndrome in hypertensive patients: An unholy alliance

Table 1 Prospective studies exploring the association of metabolic syndrome with cardiovascular events and all-cause mortality in hypertensive subjects

Ref.	No. of subjects (population)	Mean follow-up (yr)	Mean age (yr)	MetS (%)	MetS definition	T2DM (%)	Risk of all-cause mortality	Risk of CV events
Schillaci et al[25]	1742 (Italian hypertensives without CVD at baseline)	4.1	50	34.0	Modified ATP III	6.0	Not reported	HR = 1.73 (1.25-2.38) Cardiac events: HR = 1.48, (1.01-2.27). Cerebrovascular events: HR = 2.11 (1.27-3.50) After exclusion of T2DM HR = 1.43 (1.02-2.08)
Pierdomenico et al[27]	802 (Italian hypertensives without T2DM, TOD and CVD at baseline)	6.9	53	27.2	Modified ATP III	0	Not assessed	HR = 2.64 (1.52-4.58)
Andreadis et al[29]	1007 (Greek hypertensives without CVD at baseline)	2.1	59	42.1	Modified ATP III	13.2	Not assessed	HR = 1.75 (1.15-2.66) Cardiac events: HR = 1.73 (1.00-3.00). Cerebrovascular events: HR = 1.91 (1.01-3.58) After exclusion of T2DM: HR = 1.67 (1.01-2.74)
Zanchetti et al[28]	2034 (European hypertensives participating in the ELSA study)	3.7	56	33.3	Modified ATP III	4.5	Not assessed	Incidence of CV events not different (about 6% in subjects with and in those without MetS)
Pannier et al[22]	26447 French hypertensives without CVD at baseline	4.1	50	17.8	ATP III	Not reported	HR = 1.40 (1.13-1.74)	Not assessed
de Simone et al[30]	8243 hypertensives with EKG-LVH participating in the LIFE study	4.8	67	19.3	Modified ATP III	12.5	Not assessed	HR = 1.47 (1.27-1.71) CV death: HR = 1.73 (1.38-2.17)
Vlek et al[31]	1815 hypertensives with CVD at baseline and without T2DM	3.9	61	42.7	ATP III	0	Not assessed	HR = 1.24 (0.95-1.62) CV death: HR = 1.41 (1.01-1.98)
Gupta et al[32]	19257 hypertensives participating in the ASCOT-BPLA study	5.5	63	43.8	ATP III	27.0	HR = 1.35 (1.16-1.58)1	Stroke: HR = 1.34 (1.07-1.68)1 MI: HR = 1.16 (0.95-1.43)1

¹HR are adjusted for the individual components of MetS. MetS: Metabolic syndrome; CVD: Cardiovascular disease; ATP III: Third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults; T2DM: Type 2 diabetes mellitus; TOD: Target organ damage; CV: Cardiovascular; MI: Myocardial infarction; EKG-LVH: Left ventricular hypertrophy detected by electrocardiography; ELSA: European Lacidipine Study on Atherosclerosis; LIFE: Losartan Intervention For Endpoint reduction; ASCOT-BPLA: Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm.