Invited review
The metabolic syndrome in hypertension

The metabolic syndrome (MS) is currently considered to be a cluster of metabolic and cardiovascular risk factors including blood pressure elevation. A higher risk to develop hypertension in MS subjects with high-normal blood pressure has been observed and, when hypertension is established, seems to be what confers a higher cardiovascular risk on top of the risk induced by blood pressure elevation. Therefore, assessment of MS components can result in clinical utility strategy to manage hypertension based on individual risk. The main mechanisms for blood pressure elevation include overactivity of the sympathetic and the renin-angiotensin system, abnormal renal sodium handling, and endothelial dysfunction. Treatment aim to reduce the high cardiovascular and renal risk associated with the individual components of MS, and to reduce the risk of developing type-2 diabetes. Diet and regular physical exercise should be strongly recommended. The first choice among the antihypertensive drugs should be those which may induce reduction of insulin resistance and the consequent changes in lipid profile and glucose levels.