arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2008-14-2-116-124arthyper-1199Research ArticleПРИГЛАШЕНИЕ К ДИСКУССИИDISCUSSIONКардиометаболический синдром: насколько важна в реальной клинической практике активация PPARг-рецепторов?Cardiometabolic syndrome: How important is PPARy receptor activation for clinical practice?БарсуковА.BarsukovA.noemail@neicon.ruВоенно-медицинская академияРоссияRussian Military Medical AcademyRussian Federation200828042008142116124Copyright © Барсуков А., 20082008Барсуков А.Barsukov A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1199

Резюме Взаимодействие генетических и внешнесредовых факторов, метаболических и сосудистых нарушений увеличивает риск общей смертности, почечной дисфункции и кардиоваскулярных осложнений. Инсулинорезистентность играет ключевую роль в развитии метаболического синдрома. Установлена четкая связь между активностью ренин-ангиотензин-альдостероновой системы (РААС) и метаболическими факторами сердечно-сосудистого риска. Интенсивно изучается роль рецепторов, активируемых пролифератором пероксисом г (PPARг), в жировом и углеводном обмене. Влияние тиазолидиндионов на кардиоваскулярный прогноз у пациентов с метаболическим синдромом имеет противоречивый характер и требует дальнейшего изучения. Плейотропные эффекты средств-блокаторов РААС играют важную роль в лечении больных высокого сердечно-сосудистого риска. Наличие у телмисартана уникальных свойств частичного агониста PPARг-рецепторов расширяет перспективы рациональной фармакотерапии артериальной гипертензии у пациентов с кардиометаболическим синдромом.

Resume Interaction of genetic and environmental factors, metabolic and vascular disturbances increases the risk of total mortality, renal dysfunction, cardiovascular complications. Insulin resistance plays the key role in metabolic syndrome development. Connection of renin-angiotensin-aldosterone system (RAAS) and metabolic risk factors has been carefully studied. Peroxisome proliferator-activated receptors г (PPARг) role in fatty and carbohydrate metabolism is being studied intensively nowadays. Thiazolidinediones impact on cardio-vascular prognosis is controversial, and needs subsequent research. Pleiotropic effects of RAAS-blockers play important role in treatment of high risk patients. Telmisartan, being a partial PPARг-agonist, extends perspective rational pharmacotherapy of hypertension in patients with metabolic syndrome.

кардиометаболический синдроминсулинорезистентностьренин-ангиотензин-альдостеро-новая систематиазолидиндионтелмисартанPPARг-рецепторReferencesAlberti K.G. et al. Metabolic syndrome - a new world-wide definition. A consensus Statement from the International Diabetes Federation. Diabet Med 2006; 23: 469-480.Alberti K.G. et al. Metabolic syndrome - a new world-wide definition. A consensus Statement from the International Diabetes Federation. Diabet Med 2006; 23: 469-480.Bakris G., Weston W.M., Rappaport E.B. et al. Rosiglitazone produces long-term reductions in urinary albumin excretion in type 2 diabetes. Diabetologia 1999; 42 (suppl. 1): A230.Bakris G., Weston W.M., Rappaport E.B. et al. Rosiglitazone produces long-term reductions in urinary albumin excretion in type 2 diabetes. Diabetologia 1999; 42 (suppl. 1): A230.Banerji M.A. et al. Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects. Am J Physiol 1997; 273: E425-432.Banerji M.A. et al. Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects. Am J Physiol 1997; 273: E425-432.Banos G. et al. Vascular reactivity and effect of serum in a rat model of hypertriglvceridemia and hypertension. Am J Hypertens 1997;10:379-388. "Banos G. et al. Vascular reactivity and effect of serum in a rat model of hypertriglvceridemia and hypertension. Am J Hypertens 1997;10:379-388. "Barnett A.H. et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351: 1952-1961.Barnett A.H. et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351: 1952-1961.Baron A.D. et al. Insulin and the vasculature - old actors, new roles. J Invest Med 1996; 44: 406-412.Baron A.D. et al. Insulin and the vasculature - old actors, new roles. J Invest Med 1996; 44: 406-412.Benndorf R.A., Boger R.H. Pleiotropic effects of telmisartan: still more to come? J Hypertens 2008; 26 (5): 854-856.Benndorf R.A., Boger R.H. Pleiotropic effects of telmisartan: still more to come? J Hypertens 2008; 26 (5): 854-856.Benson S.C., Igochi R., Ho C.I. et al. Inhibition of cardiovascular cell proliferation by angiotensin receptor blockers: are all molecules the same? J Hypertens 2008; 26 (5): 973-980.Benson S.C., Igochi R., Ho C.I. et al. Inhibition of cardiovascular cell proliferation by angiotensin receptor blockers: are all molecules the same? J Hypertens 2008; 26 (5): 973-980.Brunner H.R. et al. Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 1972; 286: 441-449.Brunner H.R. et al. Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 1972; 286: 441-449.Chen J. et al. The metabolic syndrome and chronic kidney diseasein US Adults. Annals Intern Med 2004; 140 (3): 167-175.Chen J. et al. The metabolic syndrome and chronic kidney diseasein US Adults. Annals Intern Med 2004; 140 (3): 167-175.Deedwania P.C., Fonseca V.A. Diabetes, prediabetes andcardiovascular risk: shifting the paradigm. Am J Med. 2005; 118:939-947.Deedwania P.C., Fonseca V.A. Diabetes, prediabetes andcardiovascular risk: shifting the paradigm. Am J Med. 2005; 118:939-947.DeFronzo R.A., Ferrannini E. Insulin resistance. A multifacetedsyndrome responsible for NIDDM, obesity, hypertension, dyslipidemiaand atherosclerotic cardiovascular disease. Diabetes Care 1991; 14:173-194.DeFronzo R.A., Ferrannini E. Insulin resistance. A multifacetedsyndrome responsible for NIDDM, obesity, hypertension, dyslipidemiaand atherosclerotic cardiovascular disease. Diabetes Care 1991; 14:173-194.Desvergne B., Wahli W. 1999 Peroxisome proliferator-activated receptors: nuclear control of metabolism. Endocrinol Rev. 1999;20:649-688.Desvergne B., Wahli W. 1999 Peroxisome proliferator-activated receptors: nuclear control of metabolism. Endocrinol Rev. 1999;20:649-688.Desvergne В., L. Michalik and W. Wahli. Be Fit or Be Sick: Peroxisome Proliferator-Activated Receptors Are Down the Road. Molecular Endocrinol 2004; 18 (6): 1321-1332 .Desvergne В., L. Michalik and W. Wahli. Be Fit or Be Sick: Peroxisome Proliferator-Activated Receptors Are Down the Road. Molecular Endocrinol 2004; 18 (6): 1321-1332 .Egan B.M. et al. Renin and aldosterone are higher and the hyperinsulinemic effect of salt restriction greater in subjects with risk factors clustering. Am J Hypertens 1994; 7: 886-893.Egan B.M. et al. Renin and aldosterone are higher and the hyperinsulinemic effect of salt restriction greater in subjects with risk factors clustering. Am J Hypertens 1994; 7: 886-893.El-Atat F.A. et al. Diabetes, hypertension and cardiovascular derangements: Update on the pathophysiology and management. Curr Hypertens Rep 2004; 6: 215-223.El-Atat F.A. et al. Diabetes, hypertension and cardiovascular derangements: Update on the pathophysiology and management. Curr Hypertens Rep 2004; 6: 215-223.Engeli S., Sharma A.M. The rennin-angiotensin system and natriuretic peptides in obesity-associated hypertension. J Mod Med 2001;79:21-29.Engeli S., Sharma A.M. The rennin-angiotensin system and natriuretic peptides in obesity-associated hypertension. J Mod Med 2001;79:21-29.Engeli S., Sharma A.M. Emerging concepts in the pathophysiology and treatment of obesitv-associated hypertension. Curr Opin Cardiol 2002; 17: 355-359.Engeli S., Sharma A.M. Emerging concepts in the pathophysiology and treatment of obesitv-associated hypertension. Curr Opin Cardiol 2002; 17: 355-359.Evans R.M. et al. PPARs and the complex journey to obesity. Nat Med 2004; 10: 355-361.Evans R.M. et al. PPARs and the complex journey to obesity. Nat Med 2004; 10: 355-361.Ferrannini E. et al. Insulin resistance in essential hypertension. New Engl J Med 1987; 317: 350-357.Ferrannini E. et al. Insulin resistance in essential hypertension. New Engl J Med 1987; 317: 350-357.Franks P.W., Olsson T. Metabolic syndrome and early death: getting to the heart of the problem. Hypertension 2007; 49: 10-12.Franks P.W., Olsson T. Metabolic syndrome and early death: getting to the heart of the problem. Hypertension 2007; 49: 10-12.Gibbons G.H., Dzau V.J. The emerging concept of vascular remodeling. New Engl J Med 1994; 330: 1431-1438.Gibbons G.H., Dzau V.J. The emerging concept of vascular remodeling. New Engl J Med 1994; 330: 1431-1438.Goodfriend T.L. et al. Plasma aldosterone, plasma lipoproteins, obesity and insulin resistance in humans. Prostaglandins Leukot Essent Fatty Acids 1999; 60: 401-405.Goodfriend T.L. et al. Plasma aldosterone, plasma lipoproteins, obesity and insulin resistance in humans. Prostaglandins Leukot Essent Fatty Acids 1999; 60: 401-405.Govindarajan G. et al. Obesity and hypertension: A clinical update. In eds, Ray R., Schiffrin E., Sowers J.R. Molecular Mechanisms in Hypertension. Taylor and Francis Pub, London. 2006: 397-406.Govindarajan G. et al. Obesity and hypertension: A clinical update. In eds, Ray R., Schiffrin E., Sowers J.R. Molecular Mechanisms in Hypertension. Taylor and Francis Pub, London. 2006: 397-406.Graf K., Xi X.P., Hsueh W.A., Law R.E. Troglitazone inhibits angiotensin II induced DNA synthesis and migration in vascular smooth muscle cells. FEBS Lett 1997; 400:119-121.Graf K., Xi X.P., Hsueh W.A., Law R.E. Troglitazone inhibits angiotensin II induced DNA synthesis and migration in vascular smooth muscle cells. FEBS Lett 1997; 400:119-121.Grundy S.M. et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-2752.Grundy S.M. et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-2752.Guzic T.J., Hoch N.E., Brown K.A. et al. Role of T cell in the genesis of angiotensin II induced hypertension and vascular dysfunction. J Exp Med 2007; 204: 2449-2460.Guzic T.J., Hoch N.E., Brown K.A. et al. Role of T cell in the genesis of angiotensin II induced hypertension and vascular dysfunction. J Exp Med 2007; 204: 2449-2460.He W., Barak Y., Hevener A. et al. Adipose-specific peroxisome proliferator-activated receptor knockout causes insulin resistance in fat and liver but not in muscle. Proc Natl Acad Sci USA 2003; 100: 15712-15717.He W., Barak Y., Hevener A. et al. Adipose-specific peroxisome proliferator-activated receptor knockout causes insulin resistance in fat and liver but not in muscle. Proc Natl Acad Sci USA 2003; 100: 15712-15717.Hong S.J., Shim W.J., Choi J.I. et al. Comparison of effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent implantation in hypertensive patients. Am J Cardiol 2007; 100: 1625-1629.Hong S.J., Shim W.J., Choi J.I. et al. Comparison of effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent implantation in hypertensive patients. Am J Cardiol 2007; 100: 1625-1629.Hopfner R.L., Gopalakrishnan V. Endothelin: emerging role in diabetic vascular complications. Diabetologia 1999; 42: 1383-1394.Hopfner R.L., Gopalakrishnan V. Endothelin: emerging role in diabetic vascular complications. Diabetologia 1999; 42: 1383-1394.Hsueh W.A., Bruemmer D. Peroxisome proliferator-activated receptor: implications for cardiovascular disease. Hypertension 2004; 43: 297-305.Hsueh W.A., Bruemmer D. Peroxisome proliferator-activated receptor: implications for cardiovascular disease. Hypertension 2004; 43: 297-305.Ikejima H. et al. Effects of telmisartan, a unique angiotensin receptor blocker with selective peroxisome proliferator-activated receptor-gamma-modulating activity, on nitric oxide bioavailability and athe rosclerotic change. J Hypertens 2008; 26 (5): 964-72Ikejima H. et al. Effects of telmisartan, a unique angiotensin receptor blocker with selective peroxisome proliferator-activated receptor-gamma-modulating activity, on nitric oxide bioavailability and athe rosclerotic change. J Hypertens 2008; 26 (5): 964-72Jacob S. et al. Effects of trandolapril and verapamil on glucose transport in insulin-resistant rat skeletal muscle. Metabolism 1996; 45:535-541.Jacob S. et al. Effects of trandolapril and verapamil on glucose transport in insulin-resistant rat skeletal muscle. Metabolism 1996; 45:535-541.Kendall D.M., Sobel B.E., Coulson A.M. et al. The insulin resistance syndrome and coronary artery disease. Coron Artery Dis 2003; 14: 335-348.Kendall D.M., Sobel B.E., Coulson A.M. et al. The insulin resistance syndrome and coronary artery disease. Coron Artery Dis 2003; 14: 335-348.Kintscher U., Lyon C.J., Law R.E. Angiotensin II, PPAR-gamma and atherosclerosis. Front Biosci. 2004; 9: 359-369.Kintscher U., Lyon C.J., Law R.E. Angiotensin II, PPAR-gamma and atherosclerosis. Front Biosci. 2004; 9: 359-369.Lehmann J.M., Moore L.B. Smith-Oliver. An antidiabetic thiazolidinedione is a high affinity ligand for perosixome proliferator-activated receptor (PPAR). J Biol Chem 1995; 270: 12953-12956.Lehmann J.M., Moore L.B. Smith-Oliver. An antidiabetic thiazolidinedione is a high affinity ligand for perosixome proliferator-activated receptor (PPAR). J Biol Chem 1995; 270: 12953-12956.Lind L. et al. Metabolic cardiovascular risk factors and the rennin-aldosterone system in essential hypertension. J Hum Hypertens 1992;6:27-29.Lind L. et al. Metabolic cardiovascular risk factors and the rennin-aldosterone system in essential hypertension. J Hum Hypertens 1992;6:27-29.Lind L. et al. Insulin resistance in essential hypertension is related to plasma renin activity. J Hum Hypertens 1998; 12: 379-382.Lind L. et al. Insulin resistance in essential hypertension is related to plasma renin activity. J Hum Hypertens 1998; 12: 379-382.Linden Daniel. Growth Hormone and PPARa in the Regulation of Lipoprotein Metabolism. Department of Physiology. Goteborg University. Goteborg. 2002.Linden Daniel. Growth Hormone and PPARa in the Regulation of Lipoprotein Metabolism. Department of Physiology. Goteborg University. Goteborg. 2002.Lindholm L.H., Persson M., Alanpovic P. et al. Metabolic outcome during 1 year in newly detected hypertensives: results in the antihypertensive treatment and lipid profile in the North of Sweden efficacy evaluation (ALPINE-study). J Hypertens 2003; 21: 1563-1574.Lindholm L.H., Persson M., Alanpovic P. et al. Metabolic outcome during 1 year in newly detected hypertensives: results in the antihypertensive treatment and lipid profile in the North of Sweden efficacy evaluation (ALPINE-study). J Hypertens 2003; 21: 1563-1574.Luscher T.F., Barton M. Endothelins and endothelin receptor antagonists: therapeutic considerations for a novel class of cardiovascular drugs. Circulation 2000; 102: 2434-2440.Luscher T.F., Barton M. Endothelins and endothelin receptor antagonists: therapeutic considerations for a novel class of cardiovascular drugs. Circulation 2000; 102: 2434-2440.Lutchman G. et al. The effects of discontinuing pioglitazone in patients with nonalcoholic steatohepatitis. Hepatology 2007.Lutchman G. et al. The effects of discontinuing pioglitazone in patients with nonalcoholic steatohepatitis. Hepatology 2007.Mancia G. et al. Metabolic syndrome in the Pressioni Arteriose Monitorate E Lolo Associazioni (PAMELA) study: daily life blood pressure, cardiac damage and prognosis. Hypertension 2007; 49: 40-47.Mancia G. et al. Metabolic syndrome in the Pressioni Arteriose Monitorate E Lolo Associazioni (PAMELA) study: daily life blood pressure, cardiac damage and prognosis. Hypertension 2007; 49: 40-47.Marx N. et al. Effect of rosiglitazone treatment on soluble CD40L in patients with type 2 diabetes and coronary artery disease. Circulation 2003; 107: 1954-1957.Marx N. et al. Effect of rosiglitazone treatment on soluble CD40L in patients with type 2 diabetes and coronary artery disease. Circulation 2003; 107: 1954-1957.Marx N. et al. Peroxisome proliferator-activated receptors and atherogenesis: regulators of gene expression in vascular cells Circ Res 2004;94:1168-1178.Marx N. et al. Peroxisome proliferator-activated receptors and atherogenesis: regulators of gene expression in vascular cells Circ Res 2004;94:1168-1178.McFarlane S.I. et al. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001; 86: 713-718.McFarlane S.I. et al. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001; 86: 713-718.McFarlane S.I. et al. Mechanisms by which angiotensin-converting enzyme inhibitors prevent diabetes and cardiovascular disease. Am J Cardiol 2003; 91: 30H-37H.McFarlane S.I. et al. Mechanisms by which angiotensin-converting enzyme inhibitors prevent diabetes and cardiovascular disease. Am J Cardiol 2003; 91: 30H-37H.Morgan D.A. et al. Renal sympathetic nerve activity is increased in obese Zucker rats. Hypertension 1995; 25: 834-843.Morgan D.A. et al. Renal sympathetic nerve activity is increased in obese Zucker rats. Hypertension 1995; 25: 834-843.Morris R.S. et al. Prorenin is elevated in polycystic ovary syndrome and may reflect hyperandrogenism. Fertil Steril 1995; 64: 1099-1103.Morris R.S. et al. Prorenin is elevated in polycystic ovary syndrome and may reflect hyperandrogenism. Fertil Steril 1995; 64: 1099-1103.Nakamura Y., Ohya Y., Onaka U., Fujii K., Abe I., Fujishima M. Inhibitory action of insulin-sensitizing agents on calcium channels in smooth muscle cells from resistance arteries of guinea-pig. Br J Pharmacol. 1998; 123: 675-682.Nakamura Y., Ohya Y., Onaka U., Fujii K., Abe I., Fujishima M. Inhibitory action of insulin-sensitizing agents on calcium channels in smooth muscle cells from resistance arteries of guinea-pig. Br J Pharmacol. 1998; 123: 675-682.Nawano M. et al. Imidapril, an angiotensin-converting enzyme inhibitor, improves insulin sensitivity by enhancing signal transduction via insulin receptor substrate proteins and improving vascular resistance in the Zucker fatty rat. Metabolism 1999; 48: 1248-1255.Nawano M. et al. Imidapril, an angiotensin-converting enzyme inhibitor, improves insulin sensitivity by enhancing signal transduction via insulin receptor substrate proteins and improving vascular resistance in the Zucker fatty rat. Metabolism 1999; 48: 1248-1255.Nissen S.E., Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. New Engl J Med 2007; 356 (24): 2457-2471.Nissen S.E., Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. New Engl J Med 2007; 356 (24): 2457-2471.Phillips G.B. et al. Serum sex hormone levels and renin-sodium profile in men with hypertension. Am J Hypertens 1995; 8: 626-629.Phillips G.B. et al. Serum sex hormone levels and renin-sodium profile in men with hypertension. Am J Hypertens 1995; 8: 626-629.Piatti P.M. et al. Hypertriglyceridemia and hyperinsulinemia are potent inducers of endothelin-1 release in humans. Diabetes 1996; 45:316-321.Piatti P.M. et al. Hypertriglyceridemia and hyperinsulinemia are potent inducers of endothelin-1 release in humans. Diabetes 1996; 45:316-321.Psaty B.M., Furberg C.D. Rosiglitazone and cardiovascular risk. New Engl J Med 2007; 356 (24): 2522-2524.Psaty B.M., Furberg C.D. Rosiglitazone and cardiovascular risk. New Engl J Med 2007; 356 (24): 2522-2524.Robinson J.G. Should we use PPAR agonists to reduce cardiovascular risk? PPAR Res 2008; 2008: 891425.Robinson J.G. Should we use PPAR agonists to reduce cardiovascular risk? PPAR Res 2008; 2008: 891425.Safaridis P.A., Bakris G.L. Review: Insulin and endothelin: an interplay contributing to hypertension development? J Clin Endocrinol Metab 2007; 92: 379-385.Safaridis P.A., Bakris G.L. Review: Insulin and endothelin: an interplay contributing to hypertension development? J Clin Endocrinol Metab 2007; 92: 379-385.Saltiel A.R., Olefsky J.M. Thiazolidinediones in the treatment of insulin resistance and type II diabetes. Diabetes 1996; 45: 1661-1669.Saltiel A.R., Olefsky J.M. Thiazolidinediones in the treatment of insulin resistance and type II diabetes. Diabetes 1996; 45: 1661-1669.Sartori C., Scherrer U. Insulin, nitric oxide and the sympathetic nervous system: at the crossroads of metabolic and cardiovascular regulation. J Hypertens 1999; 17: 1517-1525.Sartori C., Scherrer U. Insulin, nitric oxide and the sympathetic nervous system: at the crossroads of metabolic and cardiovascular regulation. J Hypertens 1999; 17: 1517-1525.Savage D., Tan G.D., Acerini C.L. at al. Human metabolic syndrome resulting from dominant-negative mutations in the nuclear receptor PPAR. Diabetes 2003; 52: 910-917.Savage D., Tan G.D., Acerini C.L. at al. Human metabolic syndrome resulting from dominant-negative mutations in the nuclear receptor PPAR. Diabetes 2003; 52: 910-917.Schindler C. The metabolic syndrome as an endocrine disease: is there an effective pharmacotherapeutic strategy optimally targeting the pathogenesis? Ther Adv Cardiovasc Dis 2007; 1(1): 7-26.Schindler C. The metabolic syndrome as an endocrine disease: is there an effective pharmacotherapeutic strategy optimally targeting the pathogenesis? Ther Adv Cardiovasc Dis 2007; 1(1): 7-26.Schupp M. et al. Angiotensin type 1 receptor blockers induce peroxisome proliferator-activated receptor-gamma activity. Circulation 2004;109:2054-2057.Schupp M. et al. Angiotensin type 1 receptor blockers induce peroxisome proliferator-activated receptor-gamma activity. Circulation 2004;109:2054-2057.Sharma A.M. et al. Angiotensin blockade prevents type 2 diabetes by formation of fat cells. Hypertension 2002; 40: 609-611.Sharma A.M. et al. Angiotensin blockade prevents type 2 diabetes by formation of fat cells. Hypertension 2002; 40: 609-611.Sharma A.M. et al. Is the a rational for angiotensin blockade in the management of obesity hypertension? Hypertension 2004; 44: 12-19.Sharma A.M. et al. Is the a rational for angiotensin blockade in the management of obesity hypertension? Hypertension 2004; 44: 12-19.Shen D.C. et al. Resistance to insulin stimulated glucose' uptake in patients with hypertension. J Clin Endocrinol Metab 1988; 66: 580-583.Shen D.C. et al. Resistance to insulin stimulated glucose' uptake in patients with hypertension. J Clin Endocrinol Metab 1988; 66: 580-583.Sookoian S., Pirola C.J. Genetics of the cardiometabolic syndrome: new insights and therapeutic implication. Ther Adv Cardiovasc Dis 2007; 1(1): 37-47.Sookoian S., Pirola C.J. Genetics of the cardiometabolic syndrome: new insights and therapeutic implication. Ther Adv Cardiovasc Dis 2007; 1(1): 37-47.Sowers J.R. et al. Diabetes, hypertension and cardiovascular disease: an update. Hypertension 2001; 37: 1053-1059.Sowers J.R. et al. Diabetes, hypertension and cardiovascular disease: an update. Hypertension 2001; 37: 1053-1059.Sowers J.R. et al. Insulin resistance and hypertension. Am J Physiol Heart Circ Physiol 2004; 286: H1597-1602.Sowers J.R. et al. Insulin resistance and hypertension. Am J Physiol Heart Circ Physiol 2004; 286: H1597-1602.Sowers J.R., Frolich E.D. Insulin and Insulin resistance: impact on blood pressure and cardiovascular disease. Med Clin North Am 2004; 88: 63-82.Sowers J.R., Frolich E.D. Insulin and Insulin resistance: impact on blood pressure and cardiovascular disease. Med Clin North Am 2004; 88: 63-82.Sugawara A., Takeuchi K., Uruno A. at al. Negative regulation of rat thromboxane receptor gene by 15-deoxy-D12, 14-PGJ2 and troglitazone by activating PPAR-g in vascular smooth muscle cells. J Am Soc Nephrol. 1998; 9: 358A.Sugawara A., Takeuchi K., Uruno A. at al. Negative regulation of rat thromboxane receptor gene by 15-deoxy-D12, 14-PGJ2 and troglitazone by activating PPAR-g in vascular smooth muscle cells. J Am Soc Nephrol. 1998; 9: 358A.Tooke J.E., Hannemann M.M. Adverse endothelial funct ion and the insulin resistance syndrome. J Intern Med 2000; 247: 425-431.Tooke J.E., Hannemann M.M. Adverse endothelial funct ion and the insulin resistance syndrome. J Intern Med 2000; 247: 425-431.Tripathy D. et al. Elevation of free fatty acids induces inflammation and impairs vascular reactivity in healthy subjects. Diabetes 2003; 52: 2882-2887.Tripathy D. et al. Elevation of free fatty acids induces inflammation and impairs vascular reactivity in healthy subjects. Diabetes 2003; 52: 2882-2887.Walczak R., Tontonoz P. PPARadigms and PPARadoxes: expanding roles for PPAR in the control of lipid metabolism. J Lipid Res. 2002;43:177-186.Walczak R., Tontonoz P. PPARadigms and PPARadoxes: expanding roles for PPAR in the control of lipid metabolism. J Lipid Res. 2002;43:177-186.Wang X.L., Oosterhof J., Duarte N. Peroxisome proliferator-activated receptor C161 T polymorphism and coronary artery disease. Cardiovas Res. 1998; 44: 588-594Wang X.L., Oosterhof J., Duarte N. Peroxisome proliferator-activated receptor C161 T polymorphism and coronary artery disease. Cardiovas Res. 1998; 44: 588-594Whaley-Connell A., Pavey B.S., Claudhary К. et al. Renin-angiotensin-aldosterone system intervention in the cardiometabolic syndrome and cardio-renal protection. Ther Adv Cardiovasc Dis 2007; 1(1): 27-35.Whaley-Connell A., Pavey B.S., Claudhary К. et al. Renin-angiotensin-aldosterone system intervention in the cardiometabolic syndrome and cardio-renal protection. Ther Adv Cardiovasc Dis 2007; 1(1): 27-35.Widlansky M.E., Gokce N., Keaney J.F.Jr. et al. The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42: 1149-1160.Widlansky M.E., Gokce N., Keaney J.F.Jr. et al. The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42: 1149-1160.Yki-Jarvinen H. Thiazolidinediones. New Engl J Med 2004; 351:1106-1118.Yki-Jarvinen H. Thiazolidinediones. New Engl J Med 2004; 351:1106-1118.Yusuf S., Teo K.K., Pogue J. et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008; 358 (15): 1547-59.Yusuf S., Teo K.K., Pogue J. et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008; 358 (15): 1547-59.

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