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


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Onat A., Hergenc G., Sari I., Turkmen S., Can G. , Sansoy V.

American Journal of Hypertension, vol.18, no.3, pp.409-416, 2005 (Journal Indexed in SCI Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 18 Issue: 3
  • Publication Date: 2005
  • Doi Number: 10.1016/j.amjhyper.2004.10.017
  • Title of Journal : American Journal of Hypertension
  • Page Numbers: pp.409-416
  • Keywords: cardiovascular disease, dyslipidemic hypertension, hypertension, insulin resistance, metabolic syndrome, FAMILIAL COMBINED HYPERLIPIDEMIA, CORONARY HEART-DISEASE, LOW-CHOLESTEROL LEVELS, BLOOD-PRESSURE, METABOLIC SYNDROME, INSULIN, UTAH, APOLIPOPROTEIN, IMPACT

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. © 2005 American Journal of Hypertension, Ltd.