Management of hypercholesterolemia in the hypertensive patient
Michael D. Cressman, DOAddress reprint requests to Department of Heart and Hypertension, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Measurement of serum total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) is recommended in the comprehensive evaluation of hypertensive patients. The prevalence of hypercholesterolemia is higher in hypertensive compared to normotensive individuals and the cardiovascular risk associated with high blood pressure is increased when hypercholesterolemia is present. Diuretics and/or beta blockers may increase TC, triglyceride (TG), and very low-density lipoprotein-cholesterol (VLDL-C) levels and/or reduce HDL-C levels, but it is not certain if these changes in blood lipids and lipoproteins decrease the benefits of the blood pressure reduction that they produce. Blood pressure and blood cholesterol levels may be reduced through dietary modification and low-fat diets blunt the changes n i lipids and lipoproteins induced by diuretics or beta blockers. Despite these changes, many hypertensive patients require lipid-lowering drugs to reduce low-density lipotrotein-cholesterol (LDL-C) levels to an acceptable range. Lipid lowering drugs may produce bothersome side effects and/or increase the cost of medical therapy considerably. However, several lipid lowering drugs have been shown to reduce primary CHD incidence in middle-aged men with hypercholesterolemia.