Dyslipidemic hypertension: Distinctive features and cardiovascular risk in a prospective population-based study

• Published in: American journal of hypertension 2005-03, Vol.18 (3), p.409-416
• Main Authors: Onat, Altan, Hergenç, Gülay, Sarı, Ibrahim, Türkmen, Serdar, Can, Günay, Sansoy, Vedat
• Format: Article
• Language: English
• Subjects: Adult; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular disease; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; dyslipidemic hypertension; Female; Fundamental and applied biological sciences. Psychology; Hemodynamics. Rheology; Humans; Hyperlipidemias - epidemiology; hypertension; Hypertension - epidemiology; Insulin Resistance; Male; Medical sciences; metabolic syndrome; Metabolic Syndrome - epidemiology; Middle Aged; Prevalence; Prospective Studies; Risk Factors; Turkey - epidemiology; Vertebrates: cardiovascular system
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2004.10.017

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). 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. 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. 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.