Utility of the metabolic syndrome diagnosis: can home blood pressures help settle the debate?

T here is significant debate regarding the clinical utility of the metabolic syndrome.1–3 Limited data suggest that the syndrome is not associated with cardio­ vascular disease above and beyond its individual components, or above and beyond current risk pre­ diction schemes such as the Framingham Risk Score, though additional data are needed in large populations to clarify these points.1 However, it is also argued that even if the syndrome is not found to predict cardiovascular disease above its compo­ nents or current risk stratification schemes, a diagnosis of the metabolic syndrome may act as a significant patient motivator.2 If a patient hears they have a “syndrome,” they may be more motivated to undertake beneficial lifestyle changes and display better adherence to medications. It appears that such a trial examining the utility of the metabolic syndrome in enhancing patient compliance has not been done. In this issue, Sato et al.4 compare and contrast the use of home blood pressure (HBP) measurements to clinic blood pressure (CBP) measurements in the diagnosis of the meta­ bolic syndrome among a subset of participants in the Japanese Ohasama Study, presenting initial data in a line of research that may help to settle the metabolic syndrome debate. As the authors note, they have previously shown HBP measures to more strongly predict cardiovascular morbidity and morta­ lity than CBP measures in the Ohasama study. In the current analyses, which are limited to the subsample of individuals who participated in the diabetes screening program of the Ohasama Study, the authors further find that HBP measures are superior in identifying risk factor clustering compared to CBP measures, with overall sample estimates indicating an increase in the odds ratio associated with risk factor clustering from ~1.2 to 1.7 for the Adult Treatment Panel III metabolic syndrome definition. The authors note the ability of HBP to identify those individuals both with masked hypertension and white coat hypertension,