Addressing BP. Lowering BP to <130/85 mm Hg is important in reducing the chance of cardiovascular events in patients at risk for metabolic syndrome. Lifestyle modifications are the starting point in any treatment related to hypertension control.
The findings in the JNC 7 support use of the Dietary Approaches to Stop Hypertension (DASH) diet, weight loss and moderate alcohol intake to reduce cardiovascular risk.35 Also, according to the guidelines, patients with a history of diabetes should aim for a BP ≤130/80 mm Hg.
Several drug combinations for the treatment of hypertension and metabolic syndrome have been studied, but no one combination has supremacy over another. Researchers have supported the use of angiotensin-converting enzyme (ACE) inhibitors in patients with metabolic syndrome, especially those who also have IFG or IGT.30 Diuretics have been proven to reduce cardiovascular risk, but there is debate about progression to frank diabetes in those who have IFG or IGT. Hypertensive blacks with metabolic syndrome respond better to thiazide diuretics than to ACE inhibitors as first-line therapy, based upon findings of the ALLHAT trial.56 Thus, clinical judgment is required to produce results that will bring the patient’s BP to goal.
Other considerations. The prothrombotic state and the proinflammatory state in metabolic syndrome are also recognized as major risk factors for CVD.12 The proinflammatory state involves elevation of cytokines and CRP. Weight loss improves the inflammatory response. Coagulation factors increase in patients with metabolic syndrome. Aspirin is a low-cost medication that can help prevent the likelihood of stroke in women and MI in men.
If there are no contraindications, aspirin should be considered for women aged 55 to 79 years and men aged 45 to 79 for primary prevention of CVD. According to the US Preventive Services Task Force, the daily use of aspirin will reduce the relative risk of stroke in women by 17% and the relative risk of MI in men by 32%.57 There is no consensus on the aspirin dosage — either 81 mg or 325 mg can be considered; however, the higher dose is linked to GI bleeding.
Implications for practice
Health-care providers must suspect that patients with any one of the five metabolic risk factors can have other hidden risk factors that are silently working together to exacerbate the situation. This suspicion should lead to further inquiry into family and personal medical history.
Consideration should be given to prescriptions for lifestyle modifications, investigative diagnostic procedures and therapeutic medications, as deemed appropriate. The components that make up metabolic syndrome are at epidemic levels in the United States, and as waistlines are continuing to increase, solutions to this global problem are urgently needed.
This paper has provided a review of the metabolic syndrome and reported guidelines that can be utilized in the office setting. With continuing research, modifications in the recommendations for metabolic syndrome can be expected. The turbulent atmosphere surrounding the syndrome may continue, but as long as the goal is improvement in patient outcome, the medical community will have to put aside differences and treat patient as a whole and not as a set of debatable numbers.
Jacinta Thomas, APRN-C, practices internal and family medicine in Atlanta, and is a student in the DNP Program at the University of Alabama, Birmingham, where Deborah K. Walker, DNP, CRNP, AOCN, is an assistant professor. Neither author has any relationships to disclose relating to the content of this article.
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