2064 Original article
Increased prevalence of metabolic syndrome in uncontrolled
hypertension across Europe: the Global Cardiometabolic Risk
Profile in Patients with hypertension disease survey
Sverre E. Kjeldsena, Lisa Naditch-Bruleb, Stefano Perlinic, Walter Zidekd
and Csaba Farsange
Objectives The Global Cardiometabolic Risk Profile in
Patients with hypertension disease survey investigated the
cardiometabolic risk profile in adult outpatients with
hypertension in Europe according to the control of blood
pressure (BP) as defined in the European Society of
Hypertension and of the European Society of Cardiology
(ESH/ESC) guidelines.
Methods Data on BP control and cardiometabolic risk
factors were collected for 3370 patients with hypertension
in 12 European countries. Prevalence was analyzed
according to BP status and ATP III criteria for metabolic
syndrome.
control: odds ratio, 2.56 (metabolic syndrome); 5.16
(diabetes).
Conclusion In this European study, fewer than one third of
treated hypertensive patients had controlled BP. Metabolic
syndrome and diabetes were important characteristics
associated with poor BP control. Thus, more focus is
needed on controlling hypertension in people with high
cardiometabolic risk and diabetes. J Hypertens 26:2064–
2070 Q 2008 Wolters Kluwer Health | Lippincott Williams &
Wilkins.
Journal of Hypertension 2008, 26:2064–2070
Results BP was controlled (BP < 140/90 mmHg for
nondiabetic patients; BP < 130/80 mmHg for diabetic
patients) in 28.1% of patients. Patients with uncontrolled BP
had significantly higher mean weight, BMI, waist
circumference, fasting blood glucose, total cholesterol and
triglycerides and high-density lipoprotein cholesterol levels
were significantly lower (women only) compared with
patients with controlled BP (P < 0.05). The prevalence of
metabolic syndrome and type 2 diabetes was also
significantly higher in patients with uncontrolled BP
compared with controlled BP (P < 0.001) (metabolic
syndrome: 66.5 versus 35.5%; diabetes 41.1 versus 9.8%,
respectively). 95.3% of patients with both metabolic
syndrome and type 2 diabetes had uncontrolled BP. In a
multivariate analysis, diabetes and metabolic syndrome
were found to be associated with a high risk of poor BP
Introduction
Hypertension is a highly prevalent condition, which
presents a significant global challenge. In 2000, approximately 1 billion people worldwide (26.4% of the adult
population) were estimated to have hypertension, and
this is likely to increase to over 1.5 billion by 2025 as a
result of the aging population in many developed
countries, and an increasing incidence of hypertension
in developing countries [1]. Hypertension control rates
are poor despite the availability of many effective antihypertensive treatments [2–5] highlighting the need for
further analyses of potential underlying concomitant
factors that may influence blood pressure (BP) control.
Attainment and maintenance of BP control is important
given the morbidity and mortality associated with
0263-6352 ß 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Keywords: blood pressure control, cardiometabolic risk factors,
cardiovascular risk, diabetes, hypertension, metabolic syndrome
Abbreviations: ATP III, Adult Treatment Panel III; GEP, good epidemiology
practice; GOOD, Global Cardiometabolic Risk Profile in Patients with
hypertension disease; HDL, high-density lipoprotein; LDL, low-density
lipoprotein; MAU, microalbuminuria; TGs, plasma triglycerides; WC, waist
circumference
a
Department of Cardiology, Ullevaal Hospital, Norway, bSanofi aventis, Paris,
France, cDepartment of Internal Medicine, Fondazione IRCCS San Matteo,
Università di Pavia, Pavia, Italy, dEndocrinology and Nephrology, Medizinische
Klinik IV, Charité, Berlin, Germany and eSemmelweis University, Budapest,
Hungary
Correspondence to Professor Sverre Erik Kjeldsen, Department of Cardiology,
University of Oslo, Ullevaal Hospital, Kirkeveien 166, N-0407 Oslo, Norway
Tel: +47 22 119100; fax: +47 22 119181; e-mail: [email protected]
Received 12 February 2008 Revised 12 May 2008
Accepted 11 June 2008
hypertension, which is a major contributor to the development of cardiovascular disease and stroke [6,7].
Recognition of this risk has led to the development of
guidelines recommending lifestyle changes and antihypertensive treatments for individuals with hypertension,
especially if they also have other risk factors for cardiovascular disease [2,8,9]. The 2007 ESH/ESC guidelines
[2] recommend that antihypertensive treatment should
aim to achieve a systolic blood pressure (SBP) of less than
140 mmHg and a diastolic blood pressure (DBP) of less
than 90 mmHg for those at low risk, and a SBP of less than
130 mmHg and a DBP of less than 80 mmHg for patients
with diabetes or with high added cardiovascular risk
factors. These guidelines acknowledge that achieving
these goals may be difficult, particularly in elderly and
diabetic patients and in patients with cardiovascular
DOI:10.1097/HJH.0b013e32830c45c3
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Metabolic syndrome in hypertension Kjeldsen et al. 2065
damage, and point out that treatment should be started
before significant cardiovascular damage develops.
Hypertension may be associated with several cardiometabolic risk factors that may impact on the success of
treatment [2]. When concomitantly present, elevated BP
and metabolic risk factors potentiate each other [2,10].
Approximately 38–62% of patients with hypertension
have metabolic syndrome, characterized by at least two
additional cardiometabolic risk factors that contribute to
their risk of future cardiovascular disease and diabetes
[11,12]. These risk factors include abdominal obesity,
elevated plasma triglycerides (TGs), either low levels of
high-density lipoprotein (HDL) cholesterol, or elevated
fasting plasma glucose or both due to insulin resistance
[13–16], and these can make management of hypertension more difficult. There are few data on the coexistence
of cardiometabolic risk factors and uncontrolled hypertension across the broad European population [3,17].
The aim of this study was to investigate the global cardiometabolic risk profile in adult outpatients with hypertension in 12 countries across Europe according to BP control,
as defined by the ESH/ESC guidelines [2,9]. Better knowledge of cardiometabolic risk factors associated with hypertension may put more focus on the need to aggressively
treat both high BP and the concomitant risk factors, to
provide increased cardiovascular protection.
Methods
Study design and patient criteria
The Global Cardiometabolic Risk Profile in Patients
with hypertension disease (GOOD) survey was a PanEuropean, observational, cross-sectional survey conducted in 305 sites in 12 European countries, between
October 6, 2006 and May 16, 2007. Participating countries
were Belgium, Germany, Hungary, Italy, the Netherlands,
Norway, Portugal, Slovenia, Spain, Sweden, Turkey and
the UK.
Investigators were randomly selected from two lists of
practitioners containing from three- to ten-fold the number of investigators needed, one for general practitioners
(70% of investigators) and the other for specialists (30% of
investigators: cardiologists, internists and hypertension
specialists). Investigators were requested to complete a
questionnaire regarding their practice and specialty.
Patient inclusion was systematic. The first patient of each
physician’s working day fulfilling the inclusion criteria was
asked to participate. If they declined, the next patient was
asked to participate. A maximum of two patients were
recruited per day per physician. There was no selective
exclusion of patients. Each investigator was requested
to provide information for 10–15 patients. The inclusion
criteria were: man or woman outpatients aged at least
30 years old currently receiving treatment for hyperten-
sion, or with newly diagnosed hypertension (defined
as either SBP 140 mmHg or DBP 90 mmHg in nondiabetic patients or both, or SBP 130 mmHg and/or
DBP 80 mmHg in patients with diabetes), assessed on
two previous consultations and confirmed on the day of
inclusion in the study. Patients gave written informed
consent. Exclusion criteria included known pregnancy,
menstruation, hospitalization, secondary hypertension,
fever, known renal disease with serum creatinine greater
than 177 mmol/l, or current drug treatment and/or concomitant conditions that could alter microalbuminuria testing. During the recruitment period, which lasted up to
2 months for each center, the physician entered consecutive patients (up to two per day) into the study.
Data collection
The following assessments were made during the patient’s
visit: measurement of weight, height, waist circumference,
seated BP (two measurements taken after at least 3 min
rest), heart rate at rest and microalbuminuria (30–300 mg
urine albumin/g creatinine). The investigator also collected information on demographics and cardiometabolic
risk factors including: duration of hypertension; history of
diabetes, cardiovascular disease or stroke; lifestyle factors
including alcohol consumption, physical exercise and
smoking habits, and laboratory measurements of fasting
blood glucose, fasting lipid profile and serum creatinine
data (provided from the patient’s file if data had been
collected within the previous 6 months). Information
on current antihypertensive medications and other current
chronic drug therapies, including cardiovascular drugs;
lipid, glucose and uric acid-lowering drugs; and antithrombotic treatment was also obtained. There was no selective
exclusion of patients with incomplete records.
Metabolic syndrome was defined according to ATP
III criteria [13], (i.e. three or more of the following:
BP 130/85 mmHg; waist circumference 102 cm
[men] or 88 cm [women]; TGs 1.69 mmol/l; HDL
cholesterol <1.03 mmol/l [men] or <1.29 mmol/l [women];
fasting glucose 5.55 mmol/l). In this study, history or
treatment of hypertension were not counted as criteria
for metabolic syndrome as they applied to all patients.
Statistics
The sample size estimation was defined at regional level
and based on the 95% confidence interval of the frequency of risk factors. Assuming a frequency of risk
factors around 50% and a precision of the 95% confidence
interval between 3 and 4%, the sample size needed per
geographical region was between 600 and 1100 patients.
All patients with evaluable data regarding age, gender,
BP and antihypertensive treatment were included in the
analysis. Comparisons between variables for participants
with controlled BP (<140/90 mmHg for nondiabetic
patients, <130/80 mmHg for diabetics) and uncontrolled
BP (140/90 mmHg for nondiabetic patients, 130/
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2066 Journal of Hypertension
2008, Vol 26 No 10
80 mmHg for diabetics) were made using a x2 test for
qualitative variables and Student’s t-test or Wilcoxon for
qualitative variables. An adjusted multivariate analysis of
‘drivers’ of lack of BP control was also performed: after
univariate analysis, explicative parameters for which the
significance test was inferior to 0.10 were submitted to a
stepwise multivariate logistic regression and only
parameters with adjusted P value less than 0.05 were
retained in the final model.
Ethics
The study was conducted in accordance with the principles laid down by the 18th World Medical Assembly
(Helsinki, 1964) and all subsequent amendments. The
study was also conducted in accordance with the European
guidelines for Good Epidemiology Practice (GEP), and
Proper Conduct in Epidemiologic Research (European
Federation, IEA and ‘societies’, 2004). Each participating
country ensured that all necessary regulatory submissions
(e.g., IRB/IEC) were performed in accordance with local
regulations including local data protection regulations.
Table 1 Characteristics of survey participants according to whether
their blood pressure was controlled or uncontrolled
BP controlled BP uncontrolled
(n ¼ 947)
(n ¼ 2423)
Age (years) (SD)
61.2 (11.9)
61.5 (11.1)
Gender (male)
451 (47.6%) 1216 (50.2%)
Height (cm) (SD)
167 (9)
168 (10)
Weight (kg) (SD)
80.6 (15.7)
83.8 (16.2)
2
BMI (kg/m ) (SD)
28.8 (4.8)
29.7 (4.9)
Waist circumference (cm) (SD)
Man
102.2 (12.0)
104.9 (12.7)
Woman
96.1 (14.1)
98.4 (13.6)
SBP (mmHg) (SD)
125 (9)
148 (15)
DBP (mmHg) (SD)
77 (7)
87 (10)
Duration of hypertension (years) (SD)
7.7 (7.1)
8.9 (7.7)
Hypertensive drugs
0
0 (0.0%)
17 (0.7%)
1
278 (29.5%)
661 (28.4%)
2
361 (38.4%)
772 (33.1%)
3
302 (32.1%)
881 (37.8%)
Nonsmokers
710 (75.0%) 1815 (74.9%)
History of cardiovascular disease
Left ventricular hypertrophy
134 (14.1%)
424 (17.5%)
Coronary artery disease
125 (13.2%)
374 (15.5%)
Peripheral artery disease
19 (2.0%)
100 (4.1%)
Stroke
39 (4.1%)
111 (4.6%)
P
0.015
<0.001
<0.001
<0.001
<0.002
<0.001
<0.001
<0.001
<0.001
0.017
0.002
BMI, body mass index; BP, blood pressure.
Results
Of the 289 investigators who took part in the study, 61%
were general practitioners, 24% internists, 14% cardiologists and 1% were hypertension specialists. Most (78%)
were working in urban practices, with 22% working in
rural practices.
In total, 3464 outpatients were recruited in the survey and
of these, 3370 were included in the analyses. The main
reasons for exclusion from the analysis were lack of
informed consent (0.9%) and type 1 rather than type 2
diabetes (1.2%).
According to ESH/ESC guidelines [2] BP was controlled
in 947/3370 of the study population (28.1%). The mean
(SD) SBP and DBP in participants with controlled BP
was 125 (9) mmHg and 77 (7) mmHg, respectively,
compared with 148 (15) mmHg and 87 (10) mmHg,
respectively, for participants whose BP was uncontrolled
(P < 0.001). The characteristics of patients with controlled versus uncontrolled BP are given in Table 1.
The mean age for the two groups was similar (61 years),
as was the ratio of man to woman patients. However,
participants with uncontrolled hypertension weighed
more, were taller and had a significantly higher BMI,
waist circumference, had a longer duration of hypertension, and more had left ventricular hypertrophy and
peripheral artery disease. Patients with uncontrolled
hypertension had mainly systolic hypertension. Hypertensive drug use was similar for the two groups; approximately 30% were receiving monotherapy and 70% were
receiving combination therapy (Table 1). However, 0.7%
of patients with uncontrolled BP were not receiving
antihypertensive therapy compared with none in those
with controlled BP. Use of angiotensin receptor blockers,
angiotensin converting enzyme inhibitors, b-blockers
and diuretics was similar in patients with controlled
and uncontrolled BP.
There were some differences in lifestyle factors between
those with controlled and uncontrolled BP. Although
smoking history was similar for the two groups, alcohol
consumption was higher in patients with uncontrolled BP
compared with those with controlled BP (P ¼ 0.018), with
8.4% of uncontrolled patients consuming at least three
glasses/day, compared with 5.4% of controlled patients,
and the percentage of patients taking regular physical
exercise was greater in the controlled BP group than in
the uncontrolled BP group (39.5 versus 34.9%, respectively, P ¼ 0.012).
Analysis of laboratory parameters indicated that there were
significant differences between patients with controlled
and uncontrolled BP in both glucose and lipid parameters
and in markers of renal function, as summarized in Table 2.
Mean fasting blood glucose, total cholesterol and fasting
triglycerides were all significantly higher in the uncontrolled BP group (P < 0.001). In women only, mean HDL
cholesterol levels were significantly lower and low-density
lipoprotein (LDL) cholesterol levels were significantly
higher in the uncontrolled BP group. Creatinine clearance
rates, and uric acid levels were higher in participants with
uncontrolled hypertension, and a greater proportion of
these patients had microalbuminuria (Table 2).
The prevalence of each of the five components of
the metabolic syndrome was significantly greater in the
uncontrolled BP group (P < 0.001) (Table 3). In the total
study population, 57.8% had metabolic syndrome, 32.3%
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Metabolic syndrome in hypertension Kjeldsen et al. 2067
Laboratory parameters relating to glucose and lipid
metabolism and renal function according to blood pressure status
Table 2
BP controlled
(n ¼ 947)
Glucose and lipid metabolism
Fasting blood glucose (mmol/l)
5.56 (1.22)
Total cholesterol (mmol/l)
5.21 (1.05)
HDL cholesterol (mmol/l)
Man
1.28 (0.34)
Woman
1.50 (0.41)
Fasting LDL cholesterol (mmol/l)
Man
3.04 (0.88)
Woman
3.19 (0.92)
TGs (mmol/l)
1.61 (0.89)
Renal function
Serum creatinine (mmol/l)
81.5 (19.6)
Creatinine clearance (ml/min)
93.6 (34.4)
Uric acid (mmol/l)
325 (88)
Renal insufficiency (GFR <60 ml/min/1.73 m2)
30–60 ml/min/1.73 m2
127 (13.5%)
3 (0.3%)
15–30 ml/min/1.73 m2
Microalbuminuria
280 (39.2%)
BP uncontrolled
(n ¼ 2423)
P
6.62 (2.36)
5.37 (1.16)
<0.001
<0.001
1.26 (0.38)
1.44 (0.42)
0.007
3.12 (0.98)
3.32 (0.99)
1.86 (1.00)
0.019
<0.001
82.8 (21.5)
97.5 (40.9)
335 (91)
0.050
0.029
290 (12.2%)
6 (0.3%)
939 (48.4%)
<0.001
Mean values (SD) unless otherwise stated. BP, blood pressure; GFR, glomerular
filtration rate; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TGs,
triglycerides.
had type 2 diabetes and 25.6% had both metabolic syndrome and type 2 diabetes. The prevalence of metabolic
syndrome was significantly greater in uncontrolled BP
patients compared with controlled BP patients (66.5 versus
35.5%, respectively, P < 0.001), as was the prevalence of
type 2 diabetes (41.1 versus 9.8%, respectively, P < 0.001).
In patients with diabetes, the prevalence of metabolic
syndrome was approximately twofold higher in the uncontrolled group compared with the controlled BP group
(controlled, 47.1; uncontrolled, 83.7%, P < 0.001). A vast
majority of patients with metabolic syndrome (72.4%),
type 2 diabetes (77.7%), and metabolic syndrome and
type 2 diabetes (95.3%) had uncontrolled BP, as shown
in Fig. 1.
The risk of uncontrolled hypertension was significantly
increased with alcohol consumption and in patients who
were obese (high BMI and waist circumference), or who
had metabolic syndrome, diabetes or microalbuminuria
Prevalence of components of the metabolic syndrome
according to blood pressure status
Table 3
BP controlled
(n ¼ 947)
Elevated waist circumference
(>102 cm men; >88 cm
women) (n)
Elevated fasting glucose
(5.55 mmol/l) (n)
Decreased fasting HDL
(<1.03 mmol/l [men];
<1.29 mmol/l [women]) (n)
Elevated fasting TG
(1.69 mmol/l) (n)
Elevated BP
(130/85 mmHg) (n)
BP uncontrolled
(n ¼ 2423)
P
540 (57%)
1591 (65.9%)
<0.001
367 (39.0%)
1445 (60.4%)
<0.001
244 (26.5%)
771 (32.9%)
<0.001
326 (34.9%)
1107 (46.8%)
<0.001
473 (49.9%)
2362 (97.5%)
<0.001
BP, Blood pressure; HDL, high-density lipoprotein; TG, triglyceride.
(Fig. 2). This was confirmed for metabolic syndrome and
diabetes in an adjusted multivariate analysis [odds ratio
(OR), 2.56 for metabolic syndrome, 5.16 for diabetes]
(Fig. 2).
Discussion
The results of the GOOD survey revealed that fewer than
30% of treated hypertensive patients in this European
study had their BP controlled to levels recommended by
ESH/ESC guidelines, leaving patients at unnecessary
cardiovascular risk [2,9]. These poor BP control rates
across Europe are in broad agreement with previous
studies [3–5] and may reflect physicians’ attitudes and
treatment strategies (not studied in the current survey),
as well as patient-related factors [18–20]. The gap
between clinical practice and guideline recommendations was endorsed in a recent survey, which included
1259 primary care physicians from 17 countries (including
Europe, the US, Asia and Africa) [21]. Although 86% of
physicians agreed to target the currently recommended
SBP and DBP levels for nondiabetic patients, and 72%
agreed to the lower targets for diabetic patients, 41% said
they stopped intensifying treatment before the recommended BP goals were reached as they thought
reductions to an acceptable level had been achieved.
The GOOD survey showed that uncontrolled hypertension is strongly associated with an increased prevalence
of cardiometabolic risk factors and either concomitant
metabolic syndrome (ATP III criteria [13]) or diabetes or
both. This confirms the well known difficulty in controlling BP in patients with diabetes and extends this to
patients with the metabolic syndrome, recognized as a
high-added risk by the ESH/ESC guidelines [2]. 41% of
patients with uncontrolled BP had diabetes (compared
with 10% for the controlled group). Of the 1088 patients
included in the study who had type 2 diabetes, only 22%
had controlled BP, compared with 28% for the total study
population. This no doubt reflects the fact that the BP
goals in patients with diabetes are more stringent (i.e.
<130/80 mmHg). However, given the increased risk of
cardiovascular disease in these patients compared with
nondiabetic individuals, achieving target BP control is
particularly important.
The prevalence of all five components of metabolic
syndrome, namely abdominal obesity, elevated fasting
blood glucose, decreased fasting HDL, elevated fasting
TGs and elevated BP was significantly greater in patients
with uncontrolled BP compared with those with controlled BP (P < 0.001). Two-thirds (66.5%) of patients
with uncontrolled BP had metabolic syndrome, compared
with 35.5% of the controlled group. The higher prevalence of metabolic syndrome in the uncontrolled BP
group was not due to elevated BP per se but reflects
the observation that all the other criteria defining the
metabolic syndrome were worse in this group of patients
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2068 Journal of Hypertension
2008, Vol 26 No 10
Fig. 1
Controlled BP
Uncontrolled BP
95.3
100
90
% of patients
80
77.7
72.4
70
60
50
53.5
46.5
40
27.6
30
22.3
20
4.7
10
0
No metabolic syndrome
or diabetes
Metabolic syndrome
without diabetes
Diabetes without
metabolic syndrome
Metabolic syndrome
and diabetes
Percentage of patients with either metabolic syndrome or type 2 diabetes or both with controlled and uncontrolled blood pressure.
(Table 3). Metabolic syndrome was not considered a
unique entity but was defined by the ATP III criteria
in order to relate the prevalence to BP control [13,22].
The study data clearly indicate that many patients with
uncontrolled BP have cardiometabolic disorders and
multiple risk factors for cardiovascular disease in addition
to hypertension.
range. Schillaci et al. [16] reported a prevalence of metabolic syndrome of 34% in a study of hypertensive patients
without cardiovascular disease, whereas Navarro et al.
[23] reported a prevalence of 32.6% in nondiabetic hypertensive elderly (55 years) patients. These data compare
with a prevalence of 10–30% reported for general populations [24–26].
Previous reports have shown that approximately 38–62%
of patients with hypertension have at least two additional
cardiometabolic risk factors [14,15].
Metabolic syndrome is becoming more common in
middle age and increased cardiovascular disease and
all cause mortality are reported in this population
[27,28]. Early identification, treatment and prevention
of metabolic syndrome present a major challenge
for healthcare professionals facing an epidemic of
The prevalence of metabolic syndrome of 58% in our
study is in line with these data, at the higher end of the
Fig. 2
Age
1.00 (0.99; 1.01)
Duration of hypertension
1.01 (0.99; 1.02)
Gender
1.11 (0.95; 1.29)
Alcohol consumption
1.13 (1.01; 1.26)
BMI
1.38 (1.18; 1.61)
WC
1.46 (1.25; 1.70)
Obesity
Metabolic
syndrome
3.62 (3.08; 4.25)
Diabetes
6.40 (5.09; 8.04)
Renal insufficiency
0.88 (0.71; 1.10)
MAU
1.45 (1.22; 1.73)
Metabolic
Adjusted
(multivariate)
2.56 (2.17; 3.03)
syndrome
5.16 (4.04; 6.58)
Diabetes
0.5
1
2
5
10
Odds ratio
Drivers of blood pressure control: odds ratios for uncontrolled hypertension. BMI, body mass index; MAU, microalbuminuria; WC, waist
circumference.
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Metabolic syndrome in hypertension Kjeldsen et al. 2069
overweight individuals who lead a sedentary lifestyle
[28,29].
The presence of metabolic syndrome in hypertensive
patients increases the risk of clinical cardiovascular
events or cardiovascular disease. A study of 1742 hypertensive patients followed for up to 10.5 years found
that the incidence of cardiovascular events was almost twofold greater in these patients compared with those
without metabolic syndrome (3.23 versus 1.76 per
100 patient-years, P < 0.001) [16]. Metabolic syndrome
has been related to the prevalence of hypertensive
target organ damage, left ventricular hypertrophy,
kidney dysfunction, cardiovascular disease (including
myocardial infarction, angina, heart failure, stroke and
intermittent claudication), vascular damage and microalbuminuria [14,23,30–32].
In the present study, in which a majority of patients with
metabolic syndrome had uncontrolled hypertension, the
prevalence of left ventricular hypertrophy and peripheral
artery disease was higher in patients with uncontrolled
hypertension. The latter may be linked to the observation that uncontrolled hypertension was predominantly
systolic hypertension.
The GOOD study data highlight the importance of
appropriate and aggressive therapeutic management of
patients with hypertension and additional cardiometabolic disorders to bring them to the BP goal and reduce
the risk of cardiovascular disease.
patients with at least three cardiovascular risk factors in
addition to hypertension, only 24% were receiving lipidlowering drugs. These findings reflect the underrecognition and undertreatment of cardiovascular risk factors
among patients at risk of cardiovascular disease.
Conclusion
The results of the GOOD survey show that in this
European study less than a third of treated hypertensive
patients achieve BP control as recommended by ESH/
ESC guidelines. The prevalence of cardiometabolic disorders was significantly greater for patients with poor BP
control. The presence of either metabolic syndrome or
type 2 diabetes or both has a high impact on BP control.
These results suggest that consideration of the full cardiometabolic profile, rather than BP alone, is important in
the management of patients with hypertension. It appears
that more focus is needed on controlling hypertension in
people at high cardiometabolic risk and with diabetes.
Acknowledgement
The study was designed interactively between an advisory
board (later the authors of this paper), sanofi aventis and
Bristol-Myers Squibb. The sponsor managed the data and
did all the analysis but the authors had the right to request
analysis and publish. Pam Milner, PhD, of PAREXEL,
Uxbridge, UK is acknowledged for making the first draft of
this paper which has been further developed by the
authors. The sponsor was given the opportunity to review
and comment on the manuscript before submission.
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poor control of hypertension. Obesity, insulin resistance
and adipocyte cytokines have been linked to endothelial
dysfunction, an abnormal lipid profile and hypertension
[33] and so diabetes and metabolic syndrome may well be
causative of resistant hypertension and consequently
poor BP control.
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