Updated 07 July 2014

Hypertension, diabetes & the X-syndrome

If you have hypertension, you are at risk of suffering from elevated blood cholesterol levels as well as from diabetes.


If you have hypertension, you are at risk of suffering from elevated blood cholesterol levels as well as from diabetes. These symptoms - leading to an increased risk for heart disease - are all part of a metabolic syndrome known as Syndrome X.

The cholesterol levels and glucose levels of all people with hypertension should be checked, and all symptoms should be well-controlled.

Type 2 diabetes is often part of a Metabolic Syndrome (or X syndrome) that also includes high blood pressure and other risk factors for heart disease. The problem is that the glucose levels might be managed dilingently, but not the blood pressure and blood cholesterol levels, or vice versa.

Type 2 diabetes, common in people over 25, has a genetic origin, explains Dr Magda Conradie of the Metabolic Unit at the Tygerberg Academic Hospital in the Western Cape.

The initial problem is often not an insulin deficiency, but quite the opposite. Initially the pancreas produces enough insulin, but the action of the insulin is insufficient. To compensate, the pancreas produces more and more insulin, but as soon as the pancreas tires, a relative insulin shortage develops.

The problem doesn’t stop there ...

A decade ago researchers discovered that most patients suffering from type 2 diabetes also have high blood pressure and high cholesterol levels, and are consequently more prone to die from heart disease or a stroke. About 80% of people with type 2 diabetes die because of heart problems, and not because of glucose-related complications.

This implies that many patients with type 2 diabetes are indeed suffering from Metabolic Syndrome, but their high blood pressure and high blood cholesterol levels are either not diagnosed or not treated effectively enough.

Blood pressure is only controlled well if it is maintained at or below 144/82 mm Hg. It is absolutely essential for doctors to treat the glucose part of Metabolic Syndrome as well as properly controlling high blood pressure and the other risk factors for heart disease.

It has also become clear that Metabolic Syndrome can cause damage for many years prior to being diagnosed.

By the time the diabetes part is diagnosed, the patient already has a degree of pancreas failure. The first signs can be detected early by means of a glucose intolerance test.

With healthy eating habits, regular exercise, and the effective control of glucose levels, high blood pressure, high blood cholesterol, an alert doctor and patient, the progression of type 2 diabetes can be slowed down.

Who’s at risk for Syndrome X?

You are at risk for type 2 diabetes or Metabolic syndrome X, if you answer yes to one or more of these questions:

  • Does you brother, sister, mother or father suffer from diabetes?
  • Are you overweight, especially around the waist?
  • Is your body apple shaped, making you look like you don’t have a waist, even though you aren’t overweight
  • Is your stomach measurement more than 100cm?
  • Are you older than 45?
  • Do you have high blood pressure?
  • Are your blood cholesterol levels high?

Watch out for the following symptoms for diabetes:

  • A continual thirst
  • Excessive urination
  • Extreme hunger
  • Recurring fungal infections in men and women.

(Reviewed by Dr Magda Conradie and Nelmarie Geusteyn, specialists at the Metabolic Unit, department of Endocrinology, University of Stellenbosch and Tygerberg Hospital.)

Read more:
Primary Hypertension


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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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