title: Dyslipidemic hypertension: distinctive features and cardiovascular risk in a prospective population-based study.
abstract: BACKGROUND
  The prevalence, features, and risk of cardiovascular disease (CVD) in dyslipidemic hypertension (DH) was investigated in a prospective population-based study. Dyslipidemic hypertension was defined in terms of blood pressure, plasma triglycerides, and HDL-cholesterol consistent with the metabolic syndrome criteria of the National Cholesterol Education Program guidelines. High-normal or hypertensive values not meeting the other two criteria were designated as "simple hypertensives" (SH).
  
  
  METHODS
  A sample of 2225 men and women and free of CVD at baseline were followed up for a mean of 4.1 years. The proportions of DH, SH, and normotensives were 16%, 37%, and 47%, respectively. All persons with DH had metabolic syndrome by definition, whereas metabolic syndrome formed 44.6% of SH. Fatal and nonfatal CVD, diagnosed by clinical findings and Minnesota coding of resting electrocardiograms, developed in 166 subjects.
  
  
  RESULTS
  Compared to SH, sex- and age-standardized individuals with DH had significantly higher body mass index, apolipoprotein B, fasting insulin, glucose, and C-reactive protein levels, had higher prevalence of impaired fasting glucose and metabolic syndrome. Cox regression analysis revealed a 1.57-fold higher (confidence interval 1.08-2.28) hazard ratio (HR) for CVD in DH than in SH, after adjustment for sex, age, LDL-cholesterol, and smoking status. The sex- and age-adjusted HR of DH was furthermore 1.45-fold higher than the remaining subjects with metabolic syndrome (P = .096). Among persons with DH, age, presence of diabetes, and pulse pressure proved to be independent predictors for CVD. High LDL-cholesterol levels and fasting hyperinsulinemia were associated with borderline significantly elevated relative risks among dyslipidemic hypertensives.
  
  
  CONCLUSIONS
  Dyslipidemic hypertension, prevailing in 1 of every 6 adults, implicates characteristic features, confers excess CVD risk compared to the remainder of hypertensives and carries half the attributable cardiovascular risk due to metabolic syndrome.
authors.affiliation: Turkish Society of Cardiology, Biology Department, Nisbetiye cad. 37/24 Etiler, 80630 Istanbul, Turkey. tkd@tkd.org.tr
authors.forename: Altan
authors.initials: A
authors.lastname: Onat
authors.forename: Gülay
authors.initials: G
authors.lastname: Hergenç
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sari
authors.forename: Serdar
authors.initials: S
authors.lastname: Türkmen
authors.forename: Günay
authors.initials: G
authors.lastname: Can
authors.forename: Vedat
authors.initials: V
authors.lastname: Sansoy
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology