LDL cholesterol and global risk stratification in referred hypertensive patients.
BACKGROUND
Global risk status more than BP values per se drive nowadays treatment decisions and increasing emphasis is given to the role of lipid control in hypertension (HT). However, the distribution of circulating low density lipoproteins (LDL) levels as a function of risk profile and lipid-lowering treatment in hypertensive patients is unclear.


METHODS
We analysed 1196 patients (677 males, age range: 20-80 years) referred to our Hypertension Unit with treatment history and a complete dataset (systolic blood pressure levels, being on anti-hypertensive treatment or not, total and high density lipoproteins (HDL) cholesterol, smoking status, sex, age) for 10-year absolute coronary heart disease (CHD) risk stratification by National Cholesterol Education Program (NCEP)/ATP III guidelines. LDL cholesterol <25.9 mmol/L (100 mg/dL) was the target for high-risk patients (vascular diseases, diabetes, hypertension with multiple risk factors at CHD risk >20%/10 years). LDL <33.6 mmol/L (130 mg/dL) and 41.4 mmol/L (160 mg/dL) were the thresholds for intermediate (10-20%/10 years) and low (<10%/10 years) CHD risk.


RESULTS
At referral, 78% of high-risk patients were above target LDL and, overall, 56% had LDL cholesterol above the desired risk-specific thresholds. Lipid-lowering treatment was prescribed in 19% in whom LDL was actually higher than the untreated group.


CONCLUSIONS
LDL cholesterol was out of target in most of a large series of referred high-risk hypertensive patients and LDL levels were largely unsatisfactory even in those undergoing lipid-lowering treatment. The data show the intensive effort still needed to implement global risk-oriented prevention strategies in hypertensive populations.
Pedrinelli
Roberto
R
Dipartimento Cardio Toracico, Università Di Pisa, Pisa, Italy. r.pedrinelli@med.unipi.it
Esposti
Ezio Degli
ED
Dell'Omo
Giulia
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors