In order to investigate the impact of the metabolic syndrome on hypertension and the response to antihypertensive treatment in postmenopausal women, Rossi et al. enrolled 350 hypertensive postmenopausal women and divided the cohort on the basis of presence/absence of the metabolic syndrome (NCEP-ATP III clinical criteria). Compared to women without the metabolic syndrome, the cardiovascular risk profile was less favourable in women with the metabolic syndrome, which included higher C-reactive protein (CRP) and insulin levels, deteriorated endothelial function-related parameters, a greater left ventricular mass, and left ventricular hypertrophy. The number of antihypertensive drugs was higher in patients with the metabolic syndrome (4.5±1 vs. 3.5±1, p<0.05). Finally, in hypertensive women with the metabolic syndrome, the improvement of endothelial dysfunction and inflammation (CRP) following the one-year antihypertensive treatment was of lower magnitude than in women without the metabolic syndrome. The accompanying editorial by Djoussé and Gaziano raised the point that hypertension is a complex disease and that comorbid conditions may exert a critical role through their synergistic effects on cardiovascular disease risk or their influence on the management of hypertension. They also emphasized that clinicians should not only monitor body weight but should also encourage their patients to achieve a healthy body weight, especially when hypertension is present. As the study by Rossi did not include data on mortality or major hard endpoints, additional studies are warranted to carefully examine whether there is a synergistic effect between the metabolic syndrome and hypertension regarding the risk of cardiovascular disease and related mortality in postmenopausal women.
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