Dyslipidemia and hypertension – what to worry about more?

Authors: Jan Václavík
Authors‘ workplace: I. interní klinika - kardiologická LF UP a FN Olomouc
Published in: Vnitř Lék 2018; 64(4): 395-401
Category: Reviews


Dyslipidemia is present in every other patient with arterial hypertension. With increasing blood pressure and cholesterol levels, the risk of cardiovascular events increases proportionally. Treatment of dyslipidemia appears to lower cardiovascular mortality to a greater extent than treatment of hypertension. A significant proportion of patients with dyslipidemia indicated for drug therapy are not treated at all or treated insufficiently and do not reach the target values. Concurrent treatment of hypertension and dyslipidemia reduces the incidence of cardiovascular events significantly more than treating only one of these diseases. An even better efficacy of combined treatment of hypertension and dyslipidemia can be achieved by improving patient adherence using fixed drug combinations.

Key words:
arterial hypertension – cardiovascular events – dyslipidemia – fixed combinations –treatment


1. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31(7): 1281–1357. Dostupné z DOI: <http://dx.doi.org/10.1097/01.hjh.0000431740.32696.cc>.

2. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representati). Eur Heart J 2016; 37(29): 2315–2381. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw106>.

3. Widimský J, Filipovský J, Ceral J et al. Doporučení pro diagnostiku a léčbu arteriální hypertenze ČSH 2017. Hypertenze Kardiovask Prevence 2018; 7(Supplementum): 1–19.

4. Thoenes M, Bramlage P, Zhong S et al. Hypertension control and cardiometabolic risk: a regional perspective. Cardiol Res Pract 2012; 2012: 925046. Dostupné z DOI: <http://dx.doi.org/10.1155/2012/925046>.

5. Wohlfahrt P, Krajčoviechová A, Bruthans J et al. Hypertension and hypercholesterolemia in the Czech population. Vnitř Lék 2016; 62(11): 863–867.

6. Lewington S, Clarke R, Qizilbash N et al. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360(9349): 1903–1913. Erratum in Lancet 2003; 361(9362): 1060.

7. Rapsomaniki E, Timmis A, George J et al. Blood pressure and incidence of twelve cardiovascular diseases: Lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet 2014; 383(9932): 1899–1911. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(14)60685–1>.

8. Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2224–2260. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(12)61766–8>.

9. Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension 2017; pii: HYP.0000000000000065. <http://dx.doi.org/10.1161/HYP.0000000000000065>.

10. Muntner P, Carey RM, Gidding S et al. Potential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. J Am Coll Cardiol 2018; 71(2): 109–118. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2017.10.073>.

11. Collins R, Reith C, Emberson J et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016; 388(10059): 2532–2561. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(16)31357–5>. Erratum in Department of Error. [Lancet 2017].

12. Neaton JD, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992; 152(1): 56–64.

13. Zhang X, Patel A, Horibe H et al. Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Int J Epidemiol 2003; 32(4): 563–572.

14. Jackson R, Lawes CMM, Bennett DA et al. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet 2005; 365(9457): 434–441. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(05)17833–7>.

15. Hradec J, Bultas J, Kmínek A et al. Jak se léčí statiny v České republice? Výsledky průzkumu STEP. Cor Vasa 2011; 53(10): 527–534.

16. Grover SA, Coupal L, Kaouache M et al. Preventing cardiovascular disease among Canadians: what are the potential benefits of treating hypertension or dyslipidemia? Can J Cardiol 2007; 23(6): 467–473.

17. Emberson J, Whincup P, Morris R et al. Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. Eur Heart J 2004; 25(6): 484–491. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ehj.2003.11.012>.

18. Ference B, Ference T, Brook RD et al. A naturally randomized trial comparing the effect of long-term exposure to lower LDL-C, lower SBP, or both on the risk of cardiovascular disease. ESC Congress 2016. Rome; 2016. FP Number: 3163.

19. Kolandaivelu K, Leiden BB, O’Gara PT et al. Non-adherence to cardiovascular medications. Eur Heart J 2014; 35(46): 3267–3276. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehu364>.

20. Jin J, Sklar GE, Min Sen Oh V et al. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag 2008; 4(1): 269–286.

21. Fung V, Huang J, Brand R et al. Hypertension treatment in a medicare population: Adherence and systolic blood pressure control. Clin Ther 2007; 29(5): 972–984. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clinthera.2007.05.010>.

22. Chapman RH, Benner JS, Petrilla AA et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med 2005; 165(10): 1147–1152. Dostupné z DOI: <http://dx.doi.org/10.1001/archinte.165.10.1147>.

23. Bangalore S, Kamalakkannan G, Parkar S et al. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med 2007; 120(8): 713–719. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2006.08.033>.

24. Egan BM, Bandyopadhyay D, Shaftman SR et al. Initial monotherapy and combination therapy and hypertension control the first year. Hypertension 2012; 59(6): 1124–1131. Dostupné z DOI: <http://dx.doi.org/10.1161/HYPERTENSIONAHA.112.194167>.

25. Thom S, Poulter N, Field J et al. Effects of a Fixed-Dose Combination Strategy on Adherence and Risk Factors in Patients With or at High Risk of CVD. JAMA 2013; 310(9): 918. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2013.277064>. Erratum in JAMA 2013; 310(14): 1507.

26. Lewington S, Whitlock G, Clarke R et al. [Prospective Studies Collaboration]. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370(9602): 1829–1839. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(07)61778–4>. Erratum in Lancet. 2008; 372(9635): 292.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 4

2018 Issue 4

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account