Synergistic actions of hypertension and dyslipidemia on endothelial function

1
Synergistic actions of hypertension and
dyslipidemia on endothelial function
Implications for treatment
Statins
Dyslipidemia
Synergistic loss in endothelialfunction
Synergistic increase in endothelialfunction
Antihypertensives
Hypertension
Mason RP et al. Circulation. 2004109(suppl
II)II-34-41. Mason RP et al. ATVB.
2003232155-63.
2
High prevalence of multiple CV risk factorsin
hypertensive adults
Behavioral Risk Factor Surveillance System, 1999
80
73
US adults18 yrs with additional risk factors
()
60
42
40
35
22
20
12
0
High cholesterollevel
Diabetes
Obesity
Smoking
1 otherCV riskfactors
Percentages are weighted to state population
estimates and age adjusted to the 2000 US
standard population using 4 age groups
Greenlund KJ et al. Arch Intern Med.
2004164181-8.
3
Prevalence of hypertension and dyslipidemiaincrea
ses with age
Kaiser Permanente Medical Care Program, Northern
California, 2001
Hypertension
Dyslipidemia
Both
70
70
Men
Women
60
60
50
50
Prevalence()
40
40
30
30
20
20
10
10
0
0
Age (yrs)
Age (yrs)
Selby JV et al. Am J Manag Care. 200410(2 part
2)163-70.
4
Dyslipidemia in hypertensive adults High
prevalence, insufficient treatment
Genetic Epidemiology Network of Arteriopathy
(GENOA) study
100
Prevalence
Treatment
Control
80
60
Hypertensivesubjects()
78.4
64.7
40
49.5
56.7
20
25.5
16.4
8.1
8.6
7.3
5.8
4.1
3.8
0
Women
Men
Women
Men
African American(n 1286)
White(n 1070)
OMeara JG et al. Arch Intern Med.
20041641313-8.
5
Number of antihypertensive agents neededto
achieve systolic BP control
SBP achieved(mm Hg)
Trial
ALLHAT
138
IDNT
138
RENAAL
141
UKPDS
144
ABCD
132
MDRD
132
HOT
138
AASK
128

INVEST
131
4
3
2
1
Number of BP medications
Bakris et al. Am J Kidney Dis. 200036646-61.
ALLHAT. JAMA. 20022882981-97. Berl et al. Ann
Intern Med. 2003138542-9. Bakris et al. Arch
Inten Med. 20031631555-65. Wright et al. JAMA.
20022882421-31. Pepine et al. JAMA.
200329802805-16.
50 patients required 3 Average per patient
6
Gemini LDL-C and BP goal achievementby
multiple-risk patients
90
82.1
80
65.5
70
57.7
60
Patientsat goal()
50
40
30
20
10
0
LDL-C goal(NCEP ATP III)
BP goal(JNC VI)
Both LDL-Cand BP goals
NCEP ATP III. JAMA. 20012852486-97. JNC VI.
Arch Int Med. 19971572413-46. Blank R et al. J
Am Coll Cardiol. 200443(suppl A)447A.
N 1220