Background Arterial hypertension is often accompanied by metabolic disorders. Isolated hypertension as well as metabolic syndrome lead to an inflammatory state which is probably responsible for the initiation and progression of atherogenesis in these groups of patients. The aim of the study was to evaluate certain markers of inflammatory reaction in patients with hypertension and coexisting metabolic disorders and to examine correlations between grade of inflammatory process and metabolic and biochemical parameters.
Materials and methods The study group comprised 44 patients with essential hypertension constituting one of definable component of metabolic syndrome according to ATP III (group I) and 26 persons with hypertension accompanied by only one component of metabolic syndrome (group II). The control group consisted of 12 healthy volunteers. Serum concentration of tumor necrosis factor soluble receptor type 2 (sTNFR2), soluble intercellular adhesion molecule (sICAM-1) and fasting insulin were measured. Insulin resisrtance ratio (IRI/G) was calculated. Fat content was evaluated using bioimpedancy method.
Results Higher concentrations of sTNFR2 and sICAM 1 were observed in both study groups when compared to the control group. In group I concentrations of both parameters were significantly higher in comparison with group II. The obese hypertensives with dyslipidemia presented higher concentrations of the studied cytokines than the slim ones, as well as the obese diabetic hypertensives with dyslipidemia when compared to non-diabetic ones. Along with the increasing number of definable components of the metabolic syndrome the serum concentrations of sTNFR2 and sICAM 1 were also found to elevate. Finally, in case of diabetes accompanying other metabolic disorders, the concentrations of studied parameters were observed to be the highest. In patients with hypertension and visceral obesity and no diabetes positive correlations between sTNFR2 and %FAT, insulin and IRI/G ratio were proven.
Conclusions 1. Hypertension and other features of insulin resistance are associated with aggravation of an inflammatory process. 2. Aggravation of an inflammatory reaction in patients with hypertension is becoming more distinct along with increasing number of definable components of the metabolic syndrome 3. It seems that diabetes mellitus in the highest extent contributes to aggravation of an inflammatory reaction 4. Chronic inflammation should be considered as an important feature in development of atherogenesis in patients with "metabolic" hypertension. 5. Positive correlations between sTNFR2 and %FAT, insulin and IRI/G ratio can be considered as a potential circumstance for crucial role of TNF system in complex pathogenesis of insulin resistance in obese patients.