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Dyslipidemia: One of the Main Comorbidities Associated with Hypertension

Mindray 2021-06-13

Global Prevalence of Hypertension

Hypertension, also known as high or raised blood pressure, is a condition in which the artery walls have persistently raised pressure. It has been reported that one in four men and one in five women have raised blood pressure.[1] An estimated 1.13 billion people worldwide have hypertension. Hypertension is a major modifiable risk factor for cardiovascular disease (CVD), and accounts for approximately 45% of global CVD morbidity and mortality.[2] It is also a major cause of premature death worldwide.

Figure 1. Global prevalence of raised blood pressure [3]

Age-standardized prevalence of raised blood pressure in adults aged 18 years and over, comparable estimates, 2014

Dyslipidemia – A Common Complication of Hypertension

Hypertension is known to be associated with alterations in lipid metabolism, which gives rise to abnormalities in serum lipid and lipoprotein levels. The serum levels of TC, TG, and LDL are higher while HDL levels are lower in hypertensive subjects compared to normotensive subjects, to a statistically significant degree.[4]

Various epidemiological studies have shown the prevalence of the co-existence of hypertension and dyslipidemia, in the range of 15% to 31%.[5]

One study analyzed 371,221 patients and found that nearly one third (30.7%) of all patients had both hypertension and dyslipidemia. Among patients with diabetes mellitus, almost two thirds (66.3%) of patients also had hypertension and dyslipidemia, which is more than twice the rate (23.8%) of concomitant hypertension and dyslipidemia observed in the nondiabetic population.[6]

Table 1. Demographic Characteristics of Patients with lsolated or Concomitant Hypertension and Dyslipidemia among 311, 321 Nondiabetic Patients*
Characteristic Hypertension Only Dyslipidemia Only Hypertension and Dyslipidemia All Others (No Hypertension or Dyslipidemia)
Age, y (n= 67, 544 [21.7])+ (n= 17, 838 [5.7]) (n=74, 106 [23.8]) (n=151, 833 [48.8])+
< 45 10, 459 (15.5) 2954 (16.6) 4772 (6.4) 47, 332 (31.2)
45-64 27, 686 (41.0) 9404 (52.7) 33, 201 (44.8) 55, 780 (36.7)
65-74 14, 582 (21.6) 3563 (20.0) 22, 320 (30.1) 19, 750 (13.0)
≥ 75 14, 815 (21.9) 1917 (10.7) 13, 813 (18.6) 28, 971 (19.1)
Age, mean (SD) 60.2 (15.0) 56.5 (13.0) 62.6 (11.9) 53.2 (16.8)
Male sex 64, 226 (95.1) 16, 338 (91.6) 71, 390 (96.3) 124, 072 (81.7)
Table 2. Demographic Characteristics of Patients with lsolated or Concomitant Hypertension and Dyslipidemia among 59, 900 Patients With Diabetes Mellitus*
Characteristic Hypertension Only Dyslipidemia Only Hypertension and Dyslipidemia All Others (No Hypertension or Dyslipidemia)
Age, y (n= 12, 150 [20.3]) (n= 3162 [5.3]) (n= 39, 697 [66.3]) (n= 4891 [8.2])
< 45 630 (5.2) 263 (8.3) 1519 (3.8) 502(10.3)
45-64 4425 (36.4) 1503 (47.5) 17, 919 (45.1) 1985 (40.6)
65-74 3503 (28.8) 910 (28.8) 13, 275 (33.4) 1318 (26.9)
≥ 75 3592 (29.6) 486 (15.4) 6984 (17.6) 1086 (22.2)
Age, mean (SD) 65.5 (12.5) 60.9 (12.1) 63.5 (10.8) 62.3 (13.8)
Male sex 11, 827 (97.3) 3024 (95.6) 38, 661 (97.4) 4642 (94.9)

*Data are given as number (percentage) unless otherwise indicated.
+Age was missing in 2 patients.

This study also found that the proportions of all cardio vascular comorbidities were statistically significantly higher in patients with concomitant hypertension and dyslipidemia compared with patients with isolated hypertension or dyslipidemia. Among patients with both hypertension and dyslipidemia, the proportion of patients with myocardial infarction (MI) was generally 2 to 3 times the prevalence among patients with isolated conditions.[6]

It is well-established that hypertension and dyslipidemia are the two major risk factors for CVD. The co-existence of the two risk factors has more than an additive adverse impact on the vascular endothelium, which results in enhanced atherosclerosis, leading to CVD. Thus, the risk of CVD associated with the presence of concomitant hypertension and dyslipidemia is typically greater than the sum of the CVD risks for hypertension and dyslipidemia alone.[7]

Age-adjusted CAD death rates

Figure 2. Age-adjusted CDA death rate of different serum cholesterol and systolic BP levels [8]

Global Hypertension Practice Guidelines [9]

Laboratory investigations

Sodium, potassium, serum creatinine and estimated glomerular filtration rate (eGFR), lipid profile, and fasting glucose.

Management of hypertension comorbidities

In addition to BP control, the therapeutic strategy should include lifestyle changes, body weight control, and the effective treatment of other risk factors to reduce the residual cardiovascular risk.

LDL-cholesterol should be reduced according to risk profile

(1) An LDL-C reduction of >50% from baseline and <70 mg/dL (1.8 mmol/L) in hypertension and CVD, CKD, DM or no CVD and high-risk patients.
(2) An LDL-C reduction of >50% from baseline and <100 mg/dL (2.6 mmol/L) in moderate-risk patients.
(3) <115 mg/dL (3 mmol/L) in low-risk patients.

Conclusion

Dyslipidemia often occurs concomitantly in hypertensive patients, and concomitant hypertension and dyslipidemia result in significantly increased CVD risk. According to global hypertension practice guidelines, hypertensive patients need measurement of blood pressure and lipid profile at regular intervals to prevent cardiovascular disease, stroke, and other comorbidities.

References

[1] WHO. A global brief on hypertension: Silent killer, global public health crisis (WHO/DCO/WHD/2013.2). World Health Orgnization; 2013.
[2] Alma J. Adler, Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure, GLOBAL HEART, VOL. 10, NO. 2, June 2015: 111-122.
[3] WHO. GLOBAL NCD TARGET REDUCE HIGH BLOOD PRESSURE WHO/NMH/NMA/16.195, September 2016.
[4] Kamrun Nahar Choudhury, Serum lipid profile and its association with hypertension in Bangladesh Vascular Health and Risk Management 2014: 10 327–332.
[5] Jamshed J. Dalal, LIPITENSION: Interplay between dyslipidemia and hypertension. Indian J Endocrinol Metab. 2012, Mar-Apr,16(2): 240-245.
[6] Michael L. Johnson, PhD; Prevalence of comorbid hypertension and dyslipidemia and associated cardiovascular disease. Am J Manag Care. 2004,10: 926-932).
[7] Borghi C. Interactions between hypercholesterolemia and hypertension: implicationsfor therapy. 2002; 11: 489-496.
[8] J D Neaton,D Wentworth,et al. Arch Intern Med Actions. 1992 Jan;152(1):56-64.
[9] Thomas Unger, Claudio Borghi, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines.

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