ABC | Volume 110, Nº6, June 2018

Artigo Original Metabolic Syndrome-Related Features in Controlled and Resistant Hypertensive Subjects Arthur Santa Catharina, 1 Rodrigo Modolo, 1 Alessandra Mileni Versuti Ritter, 1 Andréa Rodrigues Sabbatini, 1 Heno Ferreira Lopes, 2 Heitor Moreno Junior, 1 Ana Paula de Faria 1 Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), 1 Campinas, SP – Brazil Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, 2 São Paulo, SP – Brazil Mailing Address: Arthur Santa Catharina • Rua Manoel Avelino, 09. Postal Code 13450-445, Vila Linópolis, Santa Bárbara d´Oeste, Campinas, SP – Brazil E-mail: arthurscatharina@gmail.com Manuscript received August 03, 2017, revised manuscript November 15, 2017, accepted December 01, 2017 DOI: 10.5935/abc.20180076 Abstract Background: Metabolic syndrome (MetS) is widespread among hypertensive patients. Clinical features and potential biomarkers of MetS in the presence of hypertension and resistant hypertension (RHTN) represent a great area of interest for investigation. Objective: The purpose of this study was to evaluate the prevalence of MetS and the clinical features associated with it in resistant and mild to moderate hypertensives. Methods: This cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with RHTN. We measured blood pressure (BP) and adipokines levels, and performed bioelectrical impedance analysis . Microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. The significance level of alpha = 0.05 was adopted. Results: We found a MetS prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. In a multiple regression analysis, MA (odds ratio = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (odds ratio = 4.13; p = 0.01) and RHTN (odds ratio = 3.75; p = 0.03) were independently associated with the presence of MetS apart from potential confounders. Conclusions: Our findings suggest that both resistant and controlled hypertensive subjects have a high prevalence of MetS. In addition, MetS‑related metabolic derangements may cause early renal and hormonal changes. Finally, LAR may be useful as a reliable biomarker for identifying those hypertensive subjects who are at risk for developing MetS. (Arq Bras Cardiol. 2018; 110(6):514-521) Keywords: Metabolic Syndrome / diagnosis; CardiovascularDiseases /mortality; Cholesterol;Waist Circumference; Triglycerides. Introduction Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that affects approximately a quarter of worldwide adult population, which makes it a serious public health challenge. 1 Ever since the MetS was described in 1988, 2 several scientific organizations have attempted to formulate a general definition for the syndrome. The National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATPIII) definition 3 has become the most widely used definition, probably because it provides a relatively simple approach for diagnosing MetS with easily measurable risk factors. The relationship between MetS and cardiovascular diseases (CVDs) is noteworthy. 4 In the largest meta-analysis on the theme comprising nearly one million patients, MetS was associated with a 2-fold increase in risk of CVD, cardiovascular mortality, myocardial infarction and stroke, and a 1.5-fold increase in the risk of all-cause mortality. 4 The negative prognostic impact of MetS was also observed in patients with hypertension. 5 Studies have shown a high prevalence of hypertension-related asymptomatic organ damage in hypertensive patients with MetS, such as left ventricular hypertrophy (LVH), elevated urinary albumin excretion rate and arterial stiffness. 5 The majority of these patients have shown a deregulated production of adipokines. 6 Adiponectin, an adipokine with anti-atherogenic, insulin sensitization, lipid oxidation, and vasodilatation activities 7 showed to be decreased in obese and subjects with essential and resistant 8 hypertension (RHTN). In contrast, elevated leptin levels are associated with MetS, hypertension and atherosclerosis. On the other hand, there are few data regarding MetS, resistant hypertension and mild to moderate hypertension. Thus, this study aimed to evaluate the prevalence of MetS and the clinical features associated with MetS in resistant and mild to moderate hypertensive patients. 514