Scholze et al. BMC Public Health 2010, 10:529 http://www.biomedcentral.com/1471-2458/10/529 savings is likely to depend on risk group. Patients with hypertension and four other components of MetS will demonstrate greater reductions in the incidence of cardiovascular events and new cases of type 2 diabetes and their associated costs as a result of treatment with newer antihypertensives compared to patients with hypertension only. Cost-effectiveness studies, asses- sing long-term costs and outcomes, will be required to demonstrate the incremental costs and benefits of new versus old antihypertensives for patients with hypertension and MetS. Studies have already demon- strated the cost-effectiveness of ARBs and ACE-inhi- bitors in patients at increased risk of diabetes and heart failure [54]. Conclusion The results of this study show that hypertensive patients with MetS are associated with higher costs of care com- pared to those without due to the increase in incident cardiovascular events and prevalent cases of type 2 dia- betes. The resource implications of MetS rise linearly with each additional MetS component. This burden is forecast to rise in the future as a result of the aging population and an increase in the components of the syndrome. Prevention and appropriate treatment of MetS is likely to lead to a reduction in costs of care. Newer antihypertensive medications provide better con- trol of blood pressure leading to reduced incidence of cardiovascular disease and type 2 diabetes. These bene- fits will be more marked in those hypertensive subjects who have a high number of MetS components clustered together. Following guidelines set out for this special group of patients, which advocate the use of newer anti- hypertensives, are likely to lead to longer-term economic benefits for the health service and quality of life improvement for patients. List of abbreviations ACE: Angiotensin Converting Enzyme; ARB: Angiotensin II receptor blocker; ATP III: Adult Treatment Panel III of the United States National Cholesterol Education Program; CAGR: compound annual growth rate; HDL: high density lipoprotein; MetS: metabolic syndrome; NHANES: (United States) National Health and Nutritional Examination Survey. Author details 1Department of Medicine, Outpatient Clinic, CCM, Charite- Universitatsmedizin Berlin, Luisenstrasse 11-13, 10117 Berlin, Germany. 2Servicio de Cardiología, Policlínica Gipuzkoa, San Sebastián, Spain. 3Professor of Internal Medicine, Department of Internal Medicine and Public Health, Division of Internal Medicine, Hypertension & Cardiovascular Prevention Center, University of L’Aquila, San Salvatore Hospital, L’Aquila, Italy. 4Independent Health Economist, Manchester, UK. 5Independent Health Economist, Boston, USA. 6Head of Statistics and Data Management, MRC Tropical Disease Research Unit, Banjul, Gambia. 7Bayer Schering Pharma AG, Global Health Economics & Outcomes Research, Berlin, Germany. Page 10 of 12 Authors’ contributions KU, JS, EA, CF, SL, WS and DJ were involved in conception and design. SL, WS and DJ were involved in the acquisition of data and analysis. KU, JS, EA and CF were involved in interpretation of data. SL, WS and DJ drafted the manuscript. KU, JS, EA and CF were involved in revising it critically for important intellectual content. All authors approved the final version to be published. Competing interests This project was funded by Bayer Schering Pharma AG. Received: 11 February 2010 Accepted: 2 September 2010 Published: 2 September 2010 References 1. Lawes CM, Vander HS, Rodgers A: Global burden of blood-pressure- related disease, 2001. Lancet 2008, 371:1513-1518. 2. Groves T: Pandemic obesity in Europe. BMJ 2006, 333, 1081-1com. 3. Krauss RM, Winston M, Fletcher RN, Grundy SM: Obesity: impact of cardiovascular disease. Circulation 1998, 98:1472-1476. 4. Redon J, Cifkova R, Laurent S, Nilsson P, Narkiewicz K, Erdine S, et al: Mechanisms of hypertension in the cardiometabolic syndrome. J Hypertens 2009, 27:441-451. 5. Ford ES: Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005, 28:1769-1778. 6. Galassi A, Reynolds K, He J: Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med 2006, 119:812-819. 7. Sattar N, Gaw A, Scherbakova O, Ford I, O’Reilly DS, Haffner SM, et al: Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003, 108:414-419. 8. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683-689. 9. Schillaci G, Pirro M, Pucci G, Mannarino MR, Gemelli F, Siepi D, et al: Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women. Hypertension 2006, 47:881-886. 10. Andreadis EA, Tsourous GI, Tzavara CK, Georgiopoulos DX, Katsanou PM, Marakomichelakis GE, et al: Metabolic syndrome and incident cardiovascular morbidity and mortality in a Mediterranean hypertensive population. Am J Hypertens 2007, 20:558-564. 11. Pierdomenico SD, Lapenna D, Di Tommaso R, Di Carlo S, Caldarella MP, Neri M, et al: Prognostic Relevance of Metabolic Syndrome in Hypertensive Patients at Low-to-Medium Risk. Am J Hypertens 2007, 20:1291-1296. 12. Segura J, Banegas JR, Garcia-Donaire JA, Rodriguez-Artalejo F, de la Cruz JJ, Praga M, et al: Should hypertension guidelines be changed for hypertensive patients with the metabolic syndrome? J Clin Hypertens (Greenwich ) 2007, 9:595-600. 13. Schillaci G, Pirro M, Vaudo G, Gemelli F, Marchesi S, Porcellati C: Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol 2004, %19(43):1817-1822. 14. Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16:434-444. 15. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al: 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007, 28:1462-1536. 16. Redon J, Cifkova R, Laurent S, Nilsson P, Narkiewicz K, Erdine S, et al: The metabolic syndrome in hypertension: European society of hypertension position statement. J Hypertens 2008, 26:1891-1900. 17. Barrios V, Escobar C, Calderon A, Llisterri JL, Alegria E, Muniz J, et al: Prevalence of the metabolic syndrome in patients with hypertension treated in general practice in Spain: an assessment of blood pressure