The metabolic syndrome (MetS) is characterized by the variable combination of visceral obesity and alterations in glucose metabolism, lipid metabolism and blood pressure (BP). It has a high prevalence in the middle age and elderly population.

   Subjects with the MetS also have a higher prevalence of microalbuminuria, left ventricular hypertrophy and arterial stiffness than those without the  syndrome. Their CV risk is high and the chance of developing diabetes markedly increased.

    In patients with MetS diagnostic procedures should include a more in-depth assessment of subclinical organ damage, measuring ambulatory and home BP is also desirable.

    In all individuals with MetS intense lifestyle measures should be adopted. High BP is included in MetS as one metabolic disorder or derangement. And according to Najarian RM, et al (Arch Intern Med 2006;166:106), elevated systolic BP is found with highest prevalence ≈ 95% in Framingham Offspring Study.  Antihypertensive treatment should be given according to existed guiderlines to lower the BP and to protect future cardiovascular risk. It is important to know that certain antihypertensive drug may negatively modify the glucose and lipid metabolism and prone to developing diabetes and dyslipidemia later on in the course of treatment. Therefore a blocker of the renin-angiotensin system (RAS) should be used and followed. If needed, by the addition of a calcium antagonist or low-dose thiazide diuretic. It appears desirable to bring BP to the normal range.  

   However, lack of evidence from specific clinical trials prevents firm recommendations on use of antihypertensive drugs in all MetS subjects with a high normal BP. There is some evidence that blocking the RAS may also delay incident hypertension.