Hypertension and lipids: lipid factors in the hypertension syndrome.

Cardiovascular risk factors are identified as physiologic, biochemical, and behavioral, and include hypertension, lipid abnormalities, and hyperglycemia. These factors constitute the "cardiovascular dysmetabolic syndrome" and damage the vascular endothelium by increasing concentrations of reactive molecular species, ultimately increasing cardiovascular morbidity and mortality. Multiple risk factors, particularly hypertension and hypercholesterolemia, often coexist in the same individual. Low-density lipoprotein cholesterol has been demonstrated to upregulate the AT(1) receptor, leading to increases in blood pressure. Treatment of hypercholesterolemia with medications, such as the hydroxymethylglutaryl coenzyme A reductase inhibitors or statins that decrease AT(1) receptor expression and activation, reduce not only cholesterol but blood pressure as well. Treatment of hypertension with angiotensin-converting enzyme inhibitors may also reduce cholesterol. Recognition and identification of multiple risk factors and appropriate treatment in a manner that minimizes excessive oxidative stress is critical to the maintenance of normal endothelial cell function and cardiovascular risk reduction.