How controlling of hypertension might matter.

ypertension is one of the major risk factors of cardiovascular diseases. In Japan as well as in western countries, the number of obese individuals with hypertension has been rapidly increasing. It has been demonstrated that visceral obesity causes qualitative and quantitative abnormalities in adipokines, thus leading to the condition that is defined as metabolic syndrome.1 The main aim of lowering blood pressure is to prevent cardiovascular diseases. The results of previous trials indicate that the amount of blood pressure reduction, not the class of drugs, is the major determinant of reduction in cardiovascular risk;2 all the antihypertensive drugs have both positive indications and contraindications according to the condition under which they are used. Therefore, appropriate antihypertensive drugs should be selected based on various factors, including positive indications, conditions that require careful use of drugs and the presence or absence of complications. The Japanese guideline of JSH 2009 recommends that the antihypertensive drugs primarily administered to patients with diabetes mellitus and metabolic syndrome should be selected from angiotensin-converting enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB).3 In case an amount of one class of antihypertensive drug is not sufficient to lower blood pressure, the dose should be increased or a low dose of an antihypertensive drug from a different class should be used concomitantly.4 However, there is not a lot of evidence as to which combination is better than other combinations in a specific condition such as metabolic syndrome.