Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension (ESH), "LIPIGEN Centre" of the Italian Society for the Study of Atherosclerosis (SISA), IRCCS-INRCA, Ancona, Italy.
Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", Ancona, Italy.
Adv Ther. 2019 Jun;36(6):1426-1437. doi: 10.1007/s12325-019-00941-6. Epub 2019 Apr 5.
We evaluated the prevalence and control of dyslipidemia in a wide sample of patients referred to our ESH "Hypertension Excellence Centre" for high blood pressure (BP). Furthermore, we evaluated the role of adiposity on the serum lipid profile.
Observational study on 1219 consecutive outpatients with valid ambulatory BP monitoring (ABPM) referred for high BP. Patients with body mass index (BMI) ≥ 25 kg/m were defined as overweight/obese (OW/OB). Dyslipidemia and the control rates of low-density lipoprotein cholesterol (LDLc) were defined according to the 2016 ESC/EAS Guidelines.
Mean age: 56.5 ± 13.7 years. Male prevalence: 55.6%. OW/OB patients were 70.2%. The prevalence of dyslipidemia was 91.1%. Lipid-lowering drugs were taken by 23.1% of patients. Patients with controlled LDLc comprised 28.5%, while BP was controlled in 41.6% of patients. Only 12.4% of patients had both 24-h BP and LDLc controlled at the same time. The higher the cardiovascular (CV) risk was, the lower was the rate of LDLc control (p < 0.001). Patients in secondary prevention had worse LDLc control than patients in primary prevention (OR 3.5 for uncontrolled LDLc, p < 0.001). OW/OB showed a more atherogenic lipid profile, characterized by lower high-density lipoprotein cholesterol (HDLc) (p < 0.001), higher non-HDLc (p = 0.006), higher triglycerides (p < 0.001), higher non-HDLc/HDLc (p < 0.001) and higher (non-HDLc + non-LDLc) (p < 0.001).
Dyslipidemia is still too often neglected in hypertensives, especially in patients at higher CV risk. OW/OB hypertensives have a "double-trouble" atherogenic lipid pattern likely driven by adiposity. We encourage a comprehensive evaluation of the lipid profile in all hypertensives, especially if they are OW/OB, to correctly assess their CV risk and improve their management.
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我们评估了在我们 ESH“高血压卓越中心”就诊的高血压患者中血脂异常的患病率和控制率。此外，我们还评估了肥胖对血脂谱的影响。
对 1219 例有有效动态血压监测（ABPM）的连续门诊患者进行观察性研究，这些患者因高血压就诊。BMI≥25 kg/m 的患者被定义为超重/肥胖（OW/OB）。根据 2016 ESC/EAS 指南，定义血脂异常和低密度脂蛋白胆固醇（LDLc）的控制率。
平均年龄为 56.5±13.7 岁。男性患病率为 55.6%。OW/OB 患者为 70.2%。血脂异常的患病率为 91.1%。23.1%的患者服用降脂药物。控制 LDLc 的患者占 28.5%，而血压控制在 41.6%的患者。只有 12.4%的患者同时控制了 24 小时血压和 LDLc。心血管（CV）风险越高，LDLc 控制率越低（p<0.001）。二级预防患者的 LDLc 控制较一级预防患者差（未控制 LDLc 的 OR 为 3.5，p<0.001）。OW/OB 表现出更具动脉粥样硬化的血脂谱，其特点是高密度脂蛋白胆固醇（HDLc）降低（p<0.001），非高密度脂蛋白胆固醇（non-HDLc）升高（p=0.006），甘油三酯升高（p<0.001），非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇升高（p<0.001）和（非高密度脂蛋白胆固醇+非 LDLc）升高（p<0.001）。
高血压患者中血脂异常仍然经常被忽视，尤其是在心血管风险较高的患者中。OW/OB 高血压患者具有动脉粥样硬化的血脂谱“双重问题”，这可能是由肥胖引起的。我们鼓励对所有高血压患者进行全面的血脂评估，特别是如果他们超重/肥胖，以正确评估他们的心血管风险并改善他们的管理。
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