Published Online
on November 27, 2006

A more recent version of this article appeared on January 1, 2007

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Submitted on July 25, 2006
Revised on August 7, 2006

Metabolic Syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) Study. Daily Life Blood Pressure, Cardiac Damage, and Prognosis

Giuseppe Mancia^*; Michele Bombelli; Giovanni Corrao; Rita Facchetti; Fabiana Madotto; Cristina Giannattasio; Fosca Quarti Trevano; Guido Grassi; Alberto Zanchetti; and Roberto Sega

From the Clinica Medica (G.M., M.B., G.C., R.F., F.M., C.G., F.Q.T., G.G., A.Z., R.S.), Dipartimento di Medicina Clinica e Prevenzione and Dipartimento di Statistica, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Milan, Italy; Istituto Auxologico Italiano (G.M., G.G., C.G., A.Z.), Milan, Italy; and Centro Interuniversitario di Fisiologia Clinica e Ipertensione (G.M., G.G., C.G., A.Z.), Università di Milano, Milano-Bicocca and Pavia, Italy.

^* To whom correspondence should be addressed. E-mail: giuseppe.mancia{at}unimib.it.

{abs}Abstract--The prevalence of the metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel III criteria) and its relationships with daily life blood pressures, cardiac damage, and prognosis were determined in 2013 subjects from a Northern Italian population aged 25 to 74 years. Home blood pressure, 24-hour blood pressure, and left ventricular mass index (echocardiography) were also measured. Cardiovascular and noncardiovascular deaths were registered over 148 months. Metabolic syndrome was found in 16.2% of the sample, an office blood pressure elevation being the most frequent (95.4%) and the blood glucose abnormality the least frequent (31.5%) component. There was in metabolic syndrome a frequent elevation in home and/or 24-hour average blood pressure, as well as a greater left ventricular mass index and prevalence of left ventricular hypertrophy, which was manifest even when data were adjusted for between-group differences, including blood pressure. The adjusted risk of cardiovascular and all-cause mortality was greater in metabolic syndrome subjects (+71.0% and +37.0%; P<0.05), a further marked increase being observed with left ventricular hypertrophy or "in-office" and "out-of-office" blood pressure elevations. The increased risk was related to the blood pressure and the blood glucose component of metabolic syndrome, with no contribution of the remaining components. Thus, metabolic syndrome is common in a Mediterranean population in which it significantly increases the long-term risk of death. Cardiac abnormalities and increases in home and 24-hour blood pressure are common in metabolic syndrome, and their occurrence further enhances the risk. The contribution of metabolic syndrome components to the risk, however, is unbalanced and mainly related to blood pressure and glucose abnormalities.

Key words: metabolic syndrome • blood pressure • cardiac hypertrophy • cardiovascular morbidity • cardiovascular mortality

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