Renin-angiotensin System Blocking Antihypertensive Therapy Effect on Surrogate Glycemic and Lipid Markers in Metabolic Syndrome Patients


  • Adnan A. Zainal Department of Pharmacology and Toxicology, College of Pharmacy, University of Mosul, Mosul, Iraq
  • Loay A. Alchalaby Department of Pharmacology and Toxicology, College of Pharmacy, University of Mosul, Mosul, Iraq



Castelli risk index, Enalapril, InsuTAG, Metabolic syndrome, TyG index


BACKGROUND: Metabolic syndrome (MetS) is a constellation of metabolic disorders, that together, aggravate the cardiovascular, and atherosclerotic risks. ACE inhibitors class, used for managing hypertension in MetS, induces favorable effects on glycemic control and insulin action on tissues as well as reducing all-cause mortality in HT patients. However, exploring changes associated with ACEI use and the exact impact of ACE inhibitors in hypertensive MetS patients on surrogate lipid and glycemic markers has not been reported in previous research extensively, if any.

AIM: The aim of the study was to assess metabolic impact of ACE inhibition in MetS patients in terms of surrogate glucose-, insulin-, and lipid fraction-based markers.

METHODS: A case–control study involving subjects diagnosed with MetS was conducted. Two study groups were involved: Hypertensive MetS patients maintained on Enalapril (n = 27), and normotensive control patients (n = 24). Triglyceride and glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI), serum insulin by TG (InsuTAG), atherogenic index of plasma (AIP), Castelli risk index-I (CRI-I) and -II (CRI-II), were calculated.

RESULTS: Compared to controls, InsuTAG and TyG index were non-significantly different, AIP was significantly lower, TyG-BMI was significantly higher and CRI-I was significantly lower while CRI- II was non-significantly higher, in the treatment group.

CONCLUSION: Despite controversy and scarcity of evidence in the literature, benefits of using enalapril on important components of MetS, indirectly assessed by surrogate markers, were shown in the current study and using ACE inhibitor in hypertensive MetS patients probably minimized metabolic and cardiovascular risk.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Grundy SM, Hansen B, Smith SC Jr., Cleeman JI, Kahn RA, Participants C. Clinical management of metabolic syndrome: Report of the American heart association/national heart, lung, and blood institute/American diabetes association conference on scientific issues related to management. Circulation. 2004;109(4):551-6. PMid:14757684

Xu H, Li X, Adams H, Kubena K, Guo S. Etiology of metabolic syndrome and dietary intervention. Int J Mole Sci. 2019;20(1):128. PMid:30602666

Ordovas JM, Corella D. Metabolic syndrome pathophysiology: The role of adipose tissue: New strategies to prevent cardiovascular risk in chronic kidney disease. Kidney Int. 2008;74:S10-4.

World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: World Health Organization; 1999.

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment PANEL III) final report. Circulation. 2002;106(25):3143-421. PMid:12485966

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome. Circulation. 2005;112(17):2735-52. https://doi. org/10.1161/CIRCULATIONAHA.105.169404

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome. Circulation. 2009;120(16):1640-5. PMid:16157765

Rochlani Y, Pothineni NV, Kovelamudi S, Mehta JL. Metabolic syndrome: Pathophysiology, management, and modulation by natural compounds. Ther Adv Cardiovasc Dis. 2017;11(8):215- 25. PMid:28639538

Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018;20(2):12. PMid:29480368

Al-Rubeaan K, Bawazeer N, Al Farsi Y, Youssef AM, Al-Yahya AA, AlQumaidi H, et al. Prevalence of metabolic syndrome in Saudi Arabia a cross sectional study. BMC Endocr Disord. 2018;18(1):16. PMid:29506520

Ford ES. Prevalence of the metabolic syndrome defined by the international diabetes federation among adults in the US. Diabetes Care. 2005;28(11):2745-9. PMid:16249550

Schillaci G, Pirro M, Vaudo G, Gemelli F, Marchesi S, Porcellati C, et al. Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol. 2004;43(10):1817- 22. PMid:15145106

Cuspidi C, Meani S, Fusi V, Severgnini B, Valerio C, Catini E, et al. Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens. 2004;22(10):1991-8. PMid:15361772

Yanai H, Tomono Y, Ito K, Furutani N, Yoshida H, Tada N. The underlying mechanisms for development of hypertension in the metabolic syndrome. Nutr J. 2008;7:10. PMid:18416854

Engeli S, Gorzelniak K, Kreutz R, Runkel N, Distler A, Sharma AM. Co-expression of renin-angiotensin system genes in human adipose tissue. J Hypertens. 1999;17(4):555-60. PMid:10404958

De Kloet AD, Krause EG, Woods SC. The renin angiotensin system and the metabolic syndrome. Physiol Behav. 2010;100(5):525- 34. PMid:20381510

Mulé G, Cottone S, Nardi E, Andronico G, Cerasola G. Metabolic syndrome in subjects with essential hypertension: Relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol. 2006;54(2):173-94. PMid:16778751

Catharina AS, Modolo R, Ritter AM, Sabbatini AR, Lopes HF, Junior HM, et al. Metabolic syndrome-related features in controlled and resistant hypertensive subjects. Arq Bras Cardiol. 2018;110(6):514-21. PMid:30226908

Van Vark LC, Bertrand M, Akkerhuis KM, Brugts JJ, Fox K, Mourad JJ, et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: A meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients. Eur Heart J. 2012;33(16):2088-97. PMid:22511654

Yakubova A, Thorrez L, Svetlichnyy D, Zwarts L, Vulsteke V, Laenen G, et al. ACE-inhibition induces a cardioprotective transcriptional response in the metabolic syndrome heart. Sci Rep. 2018;8(1):16169. s41598-018-34547-9 PMid:30385846

Gallagher EJ, LeRoith D, Karnieli E. The metabolic syndrome-from insulin resistance to obesity and diabetes. Endocrinol Metab Clin North Am. 2008;37(3):559-79. PMid:18775352

Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension: The task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension. J Hypertens. 2018;36(10):1953-2041. PMid:30499924

Schwab M, editor. Sandwich ELISA BT Encyclopedia of Cancer. Berlin, Heidelberg: Springer; 2011. p. 3334. 24. Lott JA, Turner K. Evaluation of trinder’s glucose oxidase method for measuring glucose in serum and urine. Clin Chem. 1975;21(12):1754-60. PMid:1237363

Allain CC, Poon LS, Chan CS, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20(4):470-5. PMid:4818200

Lopes-Virella MF, Stone P, Ellis S, Colwell JA. Cholesterol determination in high-density lipoproteins separated by three different methods. Clin Chem. 1977;23(5):882-4. PMid:192488

Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem. 1982;28(10):2077-80.

Yang S, Hwang JS, Park HK, Lee HS, Kim HS, Kim EY, et al. Serum lipid concentrations, prevalence of dyslipidemia, and percentage eligible for pharmacological treatment of Korean children and adolescents; data from the Korea National health and nutrition examination survey IV (2007-2009). PLoS One. 2012;7(12):e49253. PMid:23251338

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502 PMid:4337382

Misra A. Revisions of cutoffs of body mass index to define overweight and obesity are needed for the Asian-ethnic groups. Int J Obes Relat Metab Disord. 2003;27(11):1294-6. PMid:14574337

World Health Organization. Physical Status: The Use of and Interpretation of Anthropometry, Report of a WHO Expert Committee. Geneva: World Health Organization; 1995.

Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304. PMid:19067533

Er LK, Wu S, Chou HH, Hsu LA, Teng MS, Sun YC, et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals. PLoS One. 2016;11(3):e0149731. PMid:26930652

Thota RN, Abbott KA, Ferguson JJ, Veysey M, Lucock M, Niblett S, et al. InsuTAG: A novel physiologically relevant predictor for insulin resistance and metabolic syndrome. Sci Rep. 2017;7(1):15204.

Dobiás̆ová M, Frohlich J. The plasma parameter log (TG/ HDL-C) as an atherogenic index: Correlation with lipoprotein particle size and esterification rate inapob-lipoprotein-depleted plasma (FERHDL). Clin Biochem. 2001;34(7):583-8. PMid:11738396

Bhardwaj S, Bhattacharjee J, Bhatnagar MK, Tyagi SC. Atherogenic index of plasma, castelli risk index and atherogenic coefficient-new parameters in assessing cardiovascular risk. Int J Pharm Biol Sci. 2013;3(3):359-64.

Sharma AM. Is there a rationale for angiotensin blockade in the management of obesity hypertension? Hypertension. 2004;44(1):12-9. PMid:15173127

Wong C, Marwick TH. Obesity cardiomyopathy: Diagnosis and therapeutic implications. Nat Clin Pract Cardiovasc Med. 2007;4(9):480-90. PMid:17712361

Israili ZH, Lyoussi B, Hernández-Hernández R, Velasco M. Metabolic syndrome: Treatment of hypertensive patients. Am J Ther. 2007;14(4):386-402. PMid:17667215

Miguel-Carrasco JL, Zambrano S, Blanca AJ, Mate A, Vázquez CM. Captopril reduces cardiac inflammatory markers in spontaneously hypertensive rats by inactivation of NF-kB. J Inflamm (Lond). 2010;7:21. PMid:20462420

Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145-53. PMid:10639539

Nevelsteen I, Bito V, Van der Mieren G, Vanderper A, Van den Bergh A, Sipido KR, et al. ACE-inhibition, but not weight reduction restores cardiomyocyte response to β-adrenergic stimulation in the metabolic syndrome. BMC Cardiovasc Disord. 2013;13:51. PMid:23848952

Van der Mieren G, Nevelsteen I, Vanderper A, Oosterlinck W, Flameng W, Herijgers P. Angiotensin-converting enzyme inhibition and food restriction restore delayed preconditioning in diabetic mice. Cardiovasc Diabetol. 2013;12(1):1-8.

Cesari M, Kritchevsky SB, Atkinson HH, Penninx BW, Di Bari M, Tracy RP, et al. Angiotensin-converting enzyme inhibition and novel cardiovascular risk biomarkers: Results from the trial of angiotensin converting enzyme inhibition and novel cardiovascular risk factors (TRAIN) study. Am Heart J. 2009;157(2):334.e1-8. PMid:19185642

Thamer M, Ray NF, Taylor T. Association between antihypertensive drug use and hypoglycemia: A case-control study of diabetic users of insulin or sulfonylureas. Clin Ther. 1999;21(8):1387-400. PMid:10485510

Herings RM, De Boer A, Stricker BH, Leufkens HG, Porsius A. Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme. Lancet. 1995;345(8959):1195-8. PMid:7739305

Putnam K, Shoemaker R, Yiannikouris F, Cassis LA. The renin-angiotensin system: A target of and contributor to dyslipidemias, altered glucose homeostasis, and hypertension of the metabolic syndrome. Am J Physiol Heart Circ Physiol. 2012;302(6):H1219- 30. PMid:22227126

Fogari R, Zoppi A, Preti P, Fogari E, Malamani G, Mugellini A. Differential effects of ACE-inhibition and angiotensin II antagonism on fibrinolysis and insulin sensitivity in hypertensive postmenopausal women. Am J Hypertens. 2001;14(9 Pt 1):921- 6. PMid:11587159

Gans RO, Bilo HJ, Nauta JJ, Popp-Snijders C, Heine RJ, Donker AJ. The effect of angiotensin-l converting enzyme inhibition on insulin action in healthy volunteers. Eur J Clin Invest. 1991;21(5):527-33. PMid:1752291

Lind L, Pollare T, Berne C, Lithell H. Long-term metabolic effects of antihypertensive drugs. Am Heart J. 1994;128(6 Pt 1):1177- 83. PMid:7985599

Pepine CJ, Cooper-DeHoff RM. Cardiovascular therapies and risk for development of diabetes. J Am Coll Cardiol. 2004;44(3):509-12. PMid:15358012

Furberg CD, Wright JT, Davis BR, Cutler JA, Alderman M, Black H, et al. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Am Med Assoc. 2002;288(23):2981-97. PMid:12479763

Roncal CA, Reungjui S, Sánchez-Lozada LG, Mu W, Sautin YY, Nakagawa T, et al. Combination of captopril and allopurinol retards fructose-induced metabolic syndrome. Am J Nephrol. 2009;30(5):399-404. PMid:19696478

Zreikat HH, Harpe SE, Slattum PW, Mays DP, Essah PA, Cheang KI. Effect of Renin-Angiotensin system inhibition on cardiovascular events in older hypertensive patients with metabolic syndrome. Metabolism. 2014;63(3):392-9. PMid:24393433

Anichkov DA, Shostak NA, Schastnaya OV. Comparison of rilmenidine and lisinopril on ambulatory blood pressure and plasma lipid and glucose levels in hypertensive women with metabolic syndrome. Curr Med Res Opin. 2005;21(1):1139. PMid:15881482

Bitkin EC, Boyraz M, Taşkın N, Akçay A, Ulucan K, Akyol MB, et al. Effects of ACE inhibitors on insulin resistance and lipid profile in children with metabolic syndrome. J Clin Res Pediatr Endocrinol. 2013;5(3):164-9. PMid:24072084

Khan BV, Sola S, Lauten WB, Natarajan R, Hooper WC, Menon RG, et al. Quinapril, an ACE inhibitor, reduces markers of oxidative stress in the metabolic syndrome. Diabetes Care. 2004;27(7):1712-5. PMid:15220251

Kriketos AD, Furler SM, Gan SK, Poynten AM, Chisholm DJ, Campbell LV. Multiple indexes of lipid availability are independently related to whole body insulin action in healthy humans. J Clin Endocrinol Metab. 2003;88(2):793-8. PMid:12574215

Mingrone G, DeGaetano A, Greco AV, Capristo E, Benedetti G, Castagneto M, et al. Reversibility of insulin resistance in obese diabetic patients: Role of plasma lipids. Diabetologia. 1997;40(5):599-605. PMid:9165230

Kahn HS, Valdez R. Metabolic risks identified by the combination of enlarged waist and elevated triacylglycerol concentration. Am J Clin Nutr. 2003;78(5):928-34. PMid:14594778

McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139(10):802-9. PMid:14623617

Koca TT, Tugan CB, Seyithanoglu M, Kocyigit BF. The clinical importance of the plasma atherogenic index, other lipid indexes, and urinary sodium and potassium excretion in patients with stroke. Eur J Med. 2019;51(2):172-6. PMid:31258359

Dobiásová M. Atherogenic index of plasma [log (triglycerides/ HDL-cholesterol)]: Theoretical and practical implications. Clin Chem. 2004;50(7):1113-5. PMid:15229146

Lippi G, Montagnana M, Salvagno GL, Targher G, Guidi GC. Epidemiological association between uric acid concentration in plasma, lipoprotein (a), and the traditional lipid profile. Clin Cardiol. 2010;33(2):E76-80. PMid:20043336

Dobiasova M, Urbanova Z, Samanek M. Relations between particle size of HDL and LDL lipoproteins and cholesterol esterification rate. Physiol Res. 2005;54(2):159-65 PMid:15544423

Tan MH, Johns D, Glazer NB. Pioglitazone reduces atherogenic index of plasma in patients with Type 2 diabetes. Clin Chem. 2004;50(7):1184-8.

Bhardwaj S, Misra A, Misra R, Goel K, Bhatt SP, Rastogi K, et al. High prevalence of abdominal, intra-abdominal and subcutaneous adiposity and clustering of risk factors among urban Asian Indians in North India. PLoS One. 2011;6(9):e24362. PMid:21949711

Ranjit PM, Guntuku GS, Pothineni RB. New atherogenic indices: Assessment of cardio vascular risk in post menopausal dyslipidemia. Asian J Med Sci. 2015;6(6):25-32.

Sami Khaza M. Atherogenic index of plasma (AIP) as a parameter in predicting cardiovascular risk in males compared to the conventional dyslipidemic indices (cholesterol ratios). Kerbala J Med. 2013;6(1):1506-13.

Nwagha UI, Igwe J. Atherogenic index of plasma: A significant indicator for the onset of Atherosclerosis during menopause in hypertensive females of South East Nigeria. Int J Med Health Dev. 2005;10(2):67-71.

Nwagha UI, Ikekpeazu EJ, Ejezie FE, Neboh EE, Maduka IC. Atherogenic index of plasma as useful predictor of cardiovascular risk among postmenopausal women in Enugu, Nigeria. Afr Health Sci. 2010;10(3):248-52. PMid:21327136

Zhang X, Zhang X, Li X, Feng J, Chen X. Association of metabolic syndrome with atherogenic index of plasma in an urban Chinese population: A 15-year prospective study. Nutr Metab Cardiovasc Dis. 2019;29(11):1214-9.

Li Z, Huang Q, Sun L, Bao T, Dai Z. Atherogenic index in Type 2 diabetes and its relationship with chronic microvascular complications. Int J Endocrinol. 2018;2018:1765835. PMid:30627157

Al Shawaf E, Al-Ozairi E, Al-Asfar F, Mohammad A, Al-Beloushi S, Devarajan S, et al. Atherogenic index of plasma (AIP) a tool to assess changes in cardiovascular disease risk post laparoscopic sleeve gastrectomy. J Diabetes Res. 2020;2020:2091341.

Li YW, Kao TW, Chang PK, Chen WL, Wu LW. Atherogenic index of plasma as predictors for metabolic syndrome, hypertension and diabetes mellitus in Taiwan citizens: A 9-year longitudinal study. Sci Rep. 2021;11(1):9900. s41598-021-89307-z

Luptáková L, Siváková D, Cvíčelová M, Wsólová L, Danková Z, Michnová A, et al. Power of biomarkers and their relative contributions to metabolic syndrome in Slovak adult women. Ann Hum Biol. 2013;40(2):132-8. PMid:23215737

Da Luz PL, Favarato D, Faria-Neto Junior JR, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427- 32. PMid:18719750

Cai G, Shi G, Xue S, Lu W. The atherogenic index of plasma is a strong and independent predictor for coronary artery disease in the Chinese han population. Medicine (Baltimore). 2017;96(37):e8058. PMid:28906400

Olamoyegun MA, Oluyombo R, Asaolu SO. Evaluation of dyslipidemia, lipid ratios, and atherogenic index as cardiovascular risk factors among semi-urban dwellers in Nigeria. Ann Afr Med. 2016;15(4):194-9. PMid:27853034

Ray S, Talukdar A, Sonthalia N, Saha M, Kundu S, Khanra D, et al. Serum lipoprotein ratios as markers of insulin resistance: A study among non-diabetic acute coronary syndrome patients with impaired fasting glucose. Indian J Med Res. 2015;141(1):62- 7. PMid:25857496

Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014;13:146. PMid:25326814

Vasques AC, Novaes FS, De Oliveira MS, Souza JR, Yamanaka A, Pareja JC, et al. TyG index performs better than HOMA in a Brazilian population: A hyperglycemic clamp validated study. Diabetes Res Clin Pract. 2011;93(3):e98-100. PMid:21665314

Zhu B, Wang J, Chen K, Yan W, Wang A, Wang W, et al. A high triglyceride glucose index is more closely associated with hypertension than lipid or glycemic parameters in elderly individuals: A cross-sectional survey from the reaction study. Cardiovasc Diabetol. 2020;19(1):112. PMid:32664945

Navarro-González D, Sánchez-Íñigo L, Pastrana-Delgado J, Fernández-Montero A, Martinez JA. Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The vascular-metabolic CUN cohort. Prev Med. 2016;86:99-105. PMid:26854766

Sánchez-García A, Rodríguez-Gutiérrez R, Mancillas-Adame L, González-Nava V, Díaz González-Colmenero A, Solis RC, et al. Diagnostic accuracy of the triglyceride and glucose index for insulin resistance: A systematic review. Int J Endocrinol. 2020;2020:4678526. PMid:32256572

Khan SH, Sobia F, Niazi NK, Manzoor SM, Fazal N, Ahmad F. Metabolic clustering of risk factors: Evaluation of triglyceride-glucose index (TyG index) for evaluation of insulin resistance. Diabetol Metab Syndr. 2018;10:74. PMid:30323862

Mao Q, Zhou D, Li Y, Wang Y, Xu SC, Zhao XH. The triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-st-segment elevation acute coronary syndrome. Dis Markers. 2019;2019:6891537. PMid:31281548

Da Silva A, Caldas AP, Hermsdorff HH, Bersch-Ferreira ÂC, Torreglosa CR, Weber B, et al. Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care. Cardiovasc Diabetol. 2019;18(1):89. PMid:31296225

Shi W, Xing L, Jing L, Tian Y, Yan H, Sun Q, et al. Value of triglyceride-glucose index for the estimation of ischemic stroke risk: Insights from a general population. Nutr Metab Cardiovasc Dis. 2020;30(2):245-53. PMid:31744716

Tirosh A, Shai I, Bitzur R, Kochba I, Tekes-Manova D, Israeli E, et al. Changes in triglyceride levels over time and risk of Type 2 diabetes in young men. Diabetes Care. 2008;31(10):2032-7. PMid:18591400

Li Y, You A, Tomlinson B, Yue L, Zhao K, Fan H, et al. Insulin resistance surrogates predict hypertension plus hyperuricemia. J Diabetes Investig. 2021;12(11):2046-53. PMid:33982885

Raimi TH, Dele-Ojo BF, Dada SA, Fadare JO, Ajayi DD, Ajayi EA, et al. Triglyceride-Glucose index and related parameters predicted metabolic syndrome in Nigerians. Metab Syndr Relat Disord. 2021;19(2):76-82. PMid:33170086

Bala C, Gheorghe-Fronea O, Pop D, Pop C, Caloian B, Comsa H, et al. The association between six surrogate insulin resistance indexes and hypertension: A population-based study. Metab Syndr Relat Disord. 2019;17(6):328-33. PMid:31034338

Laaksonen DE, Niskanen L, Nyyssönen K, Lakka TA, Laukkanen JA, Salonen JT. Dyslipidaemia as a predictor of hypertension in middle-aged men. Eur Heart J. 2008;29(20):2561-8. PMid:18308688

Masuo K, Mikami H, Ogihara T, Tuck ML. Weight reduction and pharmacologic treatment in obese hypertensives. Am J Hypertens. 2001;14(6):530-8. PMid:11411732

Kucukseymen S, Neisius U, Rodriguez J, Tsao CW, Nezafat R. Negative synergism of diabetes mellitus and obesity in patients with heart failure with preserved ejection fraction: A cardiovascular magnetic resonance study. Int J Cardiovasc Imaging. 2020;36(10):2027-38. PMid:32533279

Zhou M, Zhu L, Cui X, Feng L, Zhao X, He S, et al. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance but not of β cell function in a Chinese population with different glucose tolerance status. Lipids Health Dis. 2016;15:104. PMid:27267043




How to Cite

Zainal AA, Chalaby LA. Renin-angiotensin System Blocking Antihypertensive Therapy Effect on Surrogate Glycemic and Lipid Markers in Metabolic Syndrome Patients. Open Access Maced J Med Sci [Internet]. 2022 Jun. 29 [cited 2023 Dec. 6];10(A):1104-15. Available from:

Similar Articles

You may also start an advanced similarity search for this article.