Title Hipertenzija u metaboličkom sindromu: uzroci i liječenje Title (english) Hypertension in metabolic syndrome: causes and treatment Author Mislav Bjeliš Mentor Tomislav Bulum (mentor)Committee member Ingrid Prkačin (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Tomislav Bulum (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Metabolički sindrom je skupina metaboličkih i kardiovaskularnih simptoma koji su
snažno povezani s razvojem šećerne bolesti tipa 2 (ŠB2). Brojne ekspertne grupe su
dale svoju definiciju metaboličkog sindroma među kojima su najčešće korištene
definicija Svjetske zdravstvene organizacije (WHO), Nacionalnog programa
proučavanja kolesterola, visoki kolesterol u krvi ATP III (NCEP ATP III) i
Međunarodnog dijabetološkog udruženja (IDF). Svim definicijama su zajednički
inzulinska rezistencija, povišena glukoza u krvi, dislipidemija (povišeni trigliceridi, niski
lipoproteini visoke gustoće - HDL), povišeni krvni tlak i centralna pretilost.
Patofiziologija metaboličkog sindroma je složena i nije potpuno jasna. Centralnu ulogu
u razvoju metaboličkog sindroma imaju inzulinska rezistencija, kronična upala i
neurohormonalna aktivacija. Liječenje metaboličkog sindroma uključuje mjere
prevencije kao što su fizička aktivnost, gubitak tjelesne težine, promjena prehrambenih
navika i farmakološko liječenje koje ima za cilj spriječiti daljnju progresiju sindroma i
razvoj kardiovaskularnih bolesti. Hipertenzija ima važnu ulogu u metaboličkom
sindromu u kojem su vaskularni poremećaji centralni dio. Temeljni mehanizmi za
razvoj hipertenzije u metaboličkom sindromu su vrlo kompleksni i nisu još u potpunosti
jasni. Kao mogući uzroci nastanka hipertenzije u metaboličkom sindromu su
predloženi visceralna pretilost, inzulinska rezistencija, prekomjerna aktivnost
simpatikusa, oksidativni stres i endotelna disfunkcija, aktivacija sustava reninangiotenzin-
aldosteron (RAAS), povećana razina upalnih medijatora i opstruktivna
apnea u spavanju. Nefarmakološko liječenje hipertenzije u metaboličkom sindromu
uključuje: promjenu životnih navika, gubitak težine, smanjenje unosa soli, fizičku
aktivnost i smanjenje unosa alkohola. Prema trenutnim smjernicama Europskog
društva za hipertenziju/Europskog kardiološkog društva (ESH/ESC) iz 2018. potrebno
je sniziti arterijski tlak na 130/80 mmHg unutar 3 mjeseca koristeći kombinaciju lijekova
prvog izbora RAAS inhibitora i blokatora kalcijskih kanala ili diuretik. Ukoliko se optimalni tlak ne postigne s dva lijeka uvodi se i treći lijek u terapiju. Po smjernicama
Europskog kardiološkog društva (ESC) iz 2018. u trojnoj terapiji se daje kombinacija
inhibitora angiotenzin konvertirajućeg enzima (ACE-inhibitor), kalcijskog blokatora i
diuretika.
Abstract (english) Metabolic syndrome is cluster of metabolic and cardiovascular symptoms which are
strongly associated with type 2 diabetes. Many expert groups gave their own definition
of metabolic syndrome among which most used ones are World Health Organization
(WHO), National Cholesterol Education Program High Blood Cholesterol ATP III
(NCEP ATP III) and International Diabetes Federation (IDF) definition. All definitions
have in common insulin resistance, blood glucose, dyslipidaemia (high triglycerides,
low High density lipoprotein - HDL), blood pressure and central obesity.
Pathophysiology of metabolic syndrome is complex and is not entirely clear. Insulin
resistance, chronic inflammation and neurohormonal activation have shown central
role in progression of metabolic syndrome. Management of metabolic syndrome
includes prevention measures such as physical activity, weight loss, change in diet
and pharmacological treatment which aims to prevent further progression of metabolic
syndrome and development of cardiovascular diseases. Hypertension has important
role in metabolic syndrome in which vascular disorders are central part. Core
mechanisms for developing hypertension in metabolic syndrome are very complicated
and they are not completely clear. Visceral obesity, insulin resistance, sympatic over
activity, oxidative stress and endothelial dysfunction, activation of renin-angiotensinaldosteron
system (RAAS), increased levels of inflammatory mediators and
obstructive sleeping apnea have been suggested as possible causes of hypertension
in metabolic syndrome. Non – pharmacological treatment of hypertension in metabolic
syndrome includes change in lifestyle, weight loss, reduced salt intake, physical
activity and reduced alcohol intake. According to current guidelines of European
Society of Hypertension/European Society of Cardiology (ESH/ESC) from 2018 it is
required to reduce blood pressure to 130/80 mmHg within three months using first
choice medications RAAS inhibitors with calcium channel blocker or diuretic. If optimal
blood pressure is not achieved with two medications, a third medication must be
introduced. According to European Society of Cardiology (ESC) guidelines in triple
therapy combination of angiotensin-converting enzyme inhibitor (ACE inhibitor),
calcium channel blocker and diuretic is given.
Keywords
metabolički sindrom
hipertenzija
visceralna pretilost
inzulinska rezistencija
RAAS
oksidativni stres
apnea u spavanju
simpatikus
endotelna disfunkcija
liječenje
Keywords (english)
metabolic syndrome
hypertension
visceral obesity
insulin resistance
RAAS
oxidative stress
OSA
sympathicus
endothelial dysfunction
treatment
Language croatian URN:NBN urn:nbn:hr:105:375296 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-01-03 12:09:39
