Treatment of obesity hypertension and diabetes syndrome

Obesity has been shown to be an independent risk factor for coronary heart disease. The insulin resistance associated with obesity contributes to the development of other cardiovascular risk factors, including dyslipidemia, h ypertension, and type 2 diabetes. The coexistence of hypertension and diabe tes increases the risk for macrovascular and microvascular complications, t hus predisposing patients to cardiac death, congestive heart failure, coron ary heart disease, cerebral and peripheral vascular diseases, nephropathy, and retinopathy. Body weight reduction increases insulin sensitivity and im proves both blood glucose and blood pressure control. Metformin therapy als o improves insulin sensitivity and has been associated with decreases in ca rdiovascular events in obese diabetic patients. Antihypertensive treatment in diabetics decreases cardiovascular mortality and slows the decline in gl omerular function. However, pharmacological treatment should take into acco unt the effects of the antihypertensive agents on insulin sensitivity and l ipid profile. Diuretics and P-blockers are reported to reduce insulin sensi tivity and increase triglyceride levels, whereas calcium channel blockers a re metabolically neutral and ACE inhibitors increase insulin sensitivity. F or the high-risk hypertensive diabetic patients, ACE inhibition has proven to confer additional renal and vascular protection. Because hypertension an d glycemic control are very important determinants of cardiovascular outcom e in obese diabetic hypertensive patients, weight reduction, physical exerc ise, and a combination of antihypertensive and insulin sensitizers agents a re strongly recommended to achieve target blood pressure and glucose levels .