Summary and conclusion: It is clear that hypertension is associated with a clustering of dyslipidemia, diabetes and obesity, in addition to other metabolic disturbances. However, it is equally clear that the components of these clusters or syndromes differ among the various metabolic abnormalities. Clinicians would do well to remember that drugs used in the treatment of hypertension may have an influence on lipid patterns [17]. The data may very well fit the hypothesis advanced by Williams and colleagues [6] (Fig. 1) concerning the interactions between genetic and environmental factors that produce several syndromes, many of which feature hypertension and dyslipidemia as major components.
GoodeGKMillerJPHeagertyAM: Hyperlipidaemia, hypertension, and coronary heart diseaseLancet1995, 345:362–364.
2.
ZanchettiA: Hyperlipidemia in the hypertensive patientAm J Med1994, 96 (suppl 6A):6A-3S-6A-8S.
3.
WilliamsRRHuntSCHopkinsPNStultsBMWuLLHasstedtSJ: Familial dyslipidemic hypertension: Evidence from 58 Utah families for a syndrome present in approximately 12% of patients with essential hypertensionJAMA1988, 259:3579–3586. * A landmark paper that identified the genetic character of the relationship between hypertension and lipid abnormalities. The syndrome of familial dyslipidemic hypertension was first described in this publication.
4.
ReavenGM: Banting Lecture 1988: Role of insulin resistance in human diseaseDiabetes1988, 37:1595–1607. *Syndrome X was described in this outstanding contribution to our understanding of the relationship between insulin resistance and hypertension and lipid abnormalities. The combination of clinical and experimental observations culminated in the description of the clustering of abnormalities and illustrates the power of well-done clinical investigation.
5.
ReavenGMLithellHLandsbergL: Hypertension and associated metabolic abnormalities — the role of insulin resistance and the sympathoadrenal systemN Engl J Med1996, 334:374–381. ∗ An important summary of the history and current thought regarding syndrome X. In particular, the role of insulin resistance in pathogenesis is described in detail.
6.
WilliamsRRHuntSCHopkinsPNWuLLLalouelJM: Evidence for single gene contributions to hypertension and lipid disturbances: Definition, genetics, and clinical significanceClin Genet1994, 46:80–87. * A superb review of the genetic and environmental factors that may account for the clustering of abnormalities that comprise the various hypertension/lipid syndromes. The author is careful to separate what Is known from speculation. Anyone interested in the field of hypertension, lipid disturbances or preventative medicine will want to read this paper.
7.
SelbyJVNewmanBQuirogaJChristianJCAustinMAFabsitzRR: Concordance for dyslipidemic hypertension in male twinsJAMA1991, 265:2079–2084. ∗ An important contribution to the literature. The magnitude of the study (60 cases of dyslipidemic hypertension) allowed for conclusions relevant to the genetics of the hypertension/lipid syndrome. It was concluded that genetic factors influence development of the dyslipidemic hypertension syndrome, but that potentially modifiable aspects of obesity were also important.
8.
WelbornTABreckenridgeARubinsteinAHDolleryCTFraserTR: Serum-insulin in essential hypertension and in peripheral vascular diseaseLancet1966, i:1336–1337.
9.
GanongWF: Endocrine functions of the pancreas and the regulation of carbohydrate metabolism In Review of Medical Physiology.16th edn. Edited by GanongWF.Norwalk, CT: Appleton and Lange; 1993:302–322.
10.
LemneCHamstenAKarpeFNilsson-EhlePde FaireU: Dyslipoproteinemic changes in borderline hypertensionHypertension1994, 24:605–610.
11.
HallJEBrandsMWZappeDHGaliciaMA: Insulin resistance, hyperinsulinemia, and hypertension: Causes, consequences, or merely correlations?Proc Soc Exp Biol Med1995, 208:317–329. ∗ This is an important paper, because it places the role of insulin resistance and its relationship to hypertension in a different perspective. The authors urge caution in ascribing everything in the hypertension/lipid syndromes to insulin resistance.
12.
HaffnerSMMiettinenHGaskillSPSternMP: Metabolic precursors of hypertension. The San Antonio Heart StudyArch Intern Med1996, 156:1994–2000.
13.
GarrisonRJKannelWBStokesJSIIICastelliWP: Incidence and precursors of hypertension in young adults; the Framingham Offspring StudyPrev Med1987, 16:235–251.
14.
KissebahAHVydalingumNMurryREvansDJHartzAJKalkhoffRK: Relation of body fat distribution to metabolic complications of obesityJ Clin Endocrinol Metab1992, 54:254–260.
15.
SchmidtMIWatsonRLDuncanBBMetcalfPBrancatiFLSharrettAR et al., for the Atherosclerosis Risk in Communities Study Investigators: Clustering of dyslipidemia, hyperunicemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general populationMetabolism1996, 45:699–706.
16.
LindLLithellH: Decreased peripheral blood flow in the pathogenesis of the metabolic syndrome comprising hypertension, hyperlipidemia, and hyperinsulinemiaAm Heart J1993, 125:1494–1497.
17.
AmesRP: Hyperlipidemia in hypertension: Causes and preventionAm Heart J1991, 122:1219–1224.
