Current Hypertension Reports

, Volume 8, Issue 6, pp 489–496 | Cite as

Management of hypertension and dyslipidemia

Article

Abstract

Cardiovascular disease, the leading cause of death in the United States and other developed societies, can be managed with intensive risk factor modification, including treatment of hypertension and dyslipidemia. Evidence for reduction of cardiovascular morbidity and mortality is summarized in evidence-based guidelines, primarily for hypertension in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and for dyslipidemia in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Many medications exist for treatment of hypertension and a limited number for dyslipidemia; the cornerstone of therapy for both remains lifestyle modification, including dietary interventions. Despite guidelines, control rates of concomitant hypertension and dyslipidemia remain low. Patient adherence may affect achievement of recommended goals of therapy for dyslipidemia and hypertension. Effective education and communication may improve overall achievement of treatment goals.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Heart Association: Heart disease and stroke statistics —2006 update. http://circ.ahajournals.org. Accessed January 11, 2006.Google Scholar
  2. 2.
    Chobanian AV, Bakris GL, Black HR, et al.: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003, 289:2560–2572.PubMedCrossRefGoogle Scholar
  3. 3.
    Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults: Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.CrossRefGoogle Scholar
  4. 4.
    Hobbs FD, Gensini G, Mancini GB, et al.: Can combining different risk interventions into a single formulation contribute to improved cardiovascular disease risk reduction? Rationale and design for an international, open-label program to assess the effectiveness of a single pill (amlodipine/ atorvastatin) to attain recommended target levels for blood pressure and lipids (The JEWEL Program). Int J Cardiol 2006, 110:242–250.PubMedCrossRefGoogle Scholar
  5. 5.
    Mason RP: A rationale for combination therapy in risk factor management: a mechanistic perspective. Am J Med 2005, 118(Suppl 12A):54–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Halperin RO, Sesso HD, Ma J, et al.: Dyslipidemia and the risk of incident hypertension in men. Hypertension 2006, 47:45–50.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Meara JG, Kardia SL, Armon JJ, et al.: Ethnic and sex differences in the prevalence, treatment, and control of dyslipidemia among hypertensive adults in the GENOA study. Arch Intern Med 2004, 164:1313–1318. The GENOA study highlights the importance of recognizing and treating dyslipidemia in hypertensive adults.PubMedCrossRefGoogle Scholar
  8. 8.
    Staessen JA, Wang JG, Thijs L: Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens 2003, 21:1055–1076.PubMedCrossRefGoogle Scholar
  9. 9.
    Hoffman and Hoffman PR: World Health Organization press release, October 18, 2002. http://www.hoffmanpr.com/clientsun-agencies/who.shtml. Accessed August 12, 2006.Google Scholar
  10. 10.
    Ezzati M, Lopez AD, Rogers A, et al.: Selected major risk factors and global and regional burden of disease. Lancet 2002, 360:1347–1360.PubMedCrossRefGoogle Scholar
  11. 11.
    National Center for Health Statistics: www.cdc.gov/nchs/. Accessed August 12, 2006.Google Scholar
  12. 12.
    Greenlund KJ, Zheng ZJ, Keenan NL, et al.: Trends in selfreported multiple cardiovascular disease risk factors among adults in the United States, 1991–1999. Arch Intern Med 2004, 164:181–188.PubMedCrossRefGoogle Scholar
  13. 13.
    Pettitt D, Karter AJ, Peng TY, et al.: The impact of concurrent dyslipidemia and diabetes on hypertension management and goal attainment. Poster presentation at 26th Annual Meeting of the Society of General Internal Medicine. Vancouver: April 30–May 3, 2003.Google Scholar
  14. 14.
    Greenlund KJ, Croft JB, Mensah GA: Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999–2000. Arch Intern Med 2004, 164:2113–2118.PubMedCrossRefGoogle Scholar
  15. 15.
    Kennel WB: Importance of hypertension as a major risk factor in cardiovascular disease. In Hypertension Pathophysiology and Treatment. Edited by Genest J, Koiw E, Kuchel O. New York: McGraw-Hill; 1977:888–910.Google Scholar
  16. 16.
    Ross R: Atherosclerosis—an inflammatory disease [review]. N Engl J Med 1999, 340:115–126.PubMedCrossRefGoogle Scholar
  17. 17.
    Libby P: The vascular biology of atherosclerosis. In Heart Disease: A Textbook of Cardiovascular Medicine, edn 6. Edited by Braunwald E, Zipes DP, Libby P. Philadelphia: WB Saunders, Co.; 2001:995–1009.Google Scholar
  18. 18.
    Libby P, Ridker PM, Maseri A: Inflammation and atherosclerosis. Circulation 2002, 105:1135–1143.PubMedCrossRefGoogle Scholar
  19. 19.
    Taylor WR: Hypertensive vascular disease and inflammation: mechanical and humoral mechanisms. Curr Hypertens Rep 1999, 1:96–101.PubMedGoogle Scholar
  20. 20.
    Alberti KG, Zimmet P, Shaw J: Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006, 23:469–480. This important consensus statement from the International Diabetes Federation reviews current evidence on the metabolic syndrome and provides a strategy to reduce the long-term risk of cardiovascular diseases.PubMedCrossRefGoogle Scholar
  21. 21.
    Ford ES: Risks for all-cause mortality, cardiovascular disease and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005, 28:1769–1778. This paper provides a summary of the evidence on the metabolic syndrome and provides estimates of relative risk for cardiovascular disease and diabetes as well as all-cause mortality. It concludes that further research is needed to establish the use of the metabolic syndrome to determine risk for cardiovascular disease and diabetes in various population subgroups.PubMedCrossRefGoogle Scholar
  22. 22.
    Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.PubMedCrossRefGoogle Scholar
  23. 23.
    Williams B, Poulter NR, Brown MJ, et al.: Guidelines for the management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004, 18:139–185.PubMedCrossRefGoogle Scholar
  24. 24.
    Davis BR, Furberg CD, Wright JT, et al. for the ALLHAT Collaborative Research Group: ALLHAT: setting the record straight. Ann Intern Med 2004, 141:39–46.PubMedGoogle Scholar
  25. 25.
    Douglas JG, Bakris GL, Epstein M, et al.: Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 2003, 163:525–541.PubMedCrossRefGoogle Scholar
  26. 26.
    Windhauser MM, Ernst DB, Karanja NM, et al.: Translating the Dietary Approaches to Stop Hypertension diet from research to practice: dietary and behavior change techniques. DASH Collaborative Research Group. J Am Dietetic Assoc 1999, 99(8 Suppl):S90-S95.CrossRefGoogle Scholar
  27. 27.
    Julius S, Nesbitt SD, Egan BM, et al.: Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 2006, 354:1685–1697. Prehypertension was established in the JNC 7 report. The TROPHY study provides evidence for the treatment of prehypertension and the reduction in the risk of incident hypertension with an angiotensin-receptor blocker.PubMedCrossRefGoogle Scholar
  28. 28.
    Bakris GL, Fonseca V, Katholi RE, et al.: Metabolic effects of carvedilol versus metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 2004, 292:2227–2236.PubMedCrossRefGoogle Scholar
  29. 29.
    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, 152:56–64.PubMedCrossRefGoogle Scholar
  30. 30.
    The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002, 288:2998–3007.CrossRefGoogle Scholar
  31. 31.
    Sever PS, Dahlof B, Poulter NR, et al.: Rationale, design, methods and baseline demography of participants of the Anglo-Scandinavian Cardiac Outcomes Trial. ASCOT investigators. J Hypertens 2001, 19:1139–1147.PubMedCrossRefGoogle Scholar
  32. 32.
    Sever PS, Dahlof B, Poulter NR, et al.: ASCOT investigators: Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003, 361:1149–1158.PubMedCrossRefGoogle Scholar
  33. 33.
    Ferdinand KC, Clark LT, Watson KE, et al.: Comparison of efficacy and safety of rosuvastatin versus atorvastatin in African-American patients in a six-week trial. Am J Cardiol 2006, 97:229–235.PubMedCrossRefGoogle Scholar
  34. 34.
    Keech A, Simes RJ, Barter P, et al.: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomized control trial. Lancet 2005, 366:1849–1861.PubMedCrossRefGoogle Scholar
  35. 35.
    Hajjar I, Kotchen TA: Trends in prevalence, awareness, treatment and control of hypertension in the United States, 1988–2000. JAMA 2003, 290:199–206.PubMedCrossRefGoogle Scholar
  36. 36.
    Ford ES, Mokdad AH, Giles WH, Mensah GA: Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among US adults: findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation 2003, 107:2185–2189.PubMedCrossRefGoogle Scholar
  37. 37.
    Prevention of stroke by antihypertensive drug treatment in older persons with systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991, 265:3255–3264.CrossRefGoogle Scholar
  38. 38.
    Angus DC, Linde-Zwirble WT, Tam SW, et al.: Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart failure. Circulation 2005,112:3745–3753.PubMedCrossRefGoogle Scholar
  39. 39.
    Haynes RB, McDonald HP, Garg AX: Helping patients follow prescribed treatment: clinical applications. JAMA 2002, 288:2880–2883.PubMedCrossRefGoogle Scholar
  40. 40.
    Vermeire E, Hearnshaw H, Van Royen P, Denekens J: Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 2001, 26:331–342.PubMedCrossRefGoogle Scholar
  41. 41.
    Miller NH, Hill M, Kottke T, Ockene IS: The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. Circulation 1997, 95:1085–1090.PubMedGoogle Scholar
  42. 42.
    Elliott WJ: Compliance—and improving it—in hypertension. Manag Care 2003, 12(8 suppl Hypertension):56–61.PubMedGoogle Scholar
  43. 43.
    Dezii CM: A retrospective study of the persistence with single-pill combination therapy versus concurrent two-pill therapy in patients with hypertension. Manag Care 2000, 9(9suppl):2–6.PubMedGoogle Scholar
  44. 44.
    McDonald HP, Garg AX, Haynes RB: Interventions to enhance patient adherence to medication prescriptions: a scientific review. JAMA 2002, 288:2868–2879.PubMedCrossRefGoogle Scholar
  45. 45.
    DiGregorio GJ, Barbieri EJ: Handbook of Commonly Prescribed Drugs. Willow Grove: Medical Surveillance, Inc.; 2005.Google Scholar
  46. 46.
    Kaplan NM, Rose BD: Indications for use of specific antihypertensive drugs. www.uptodate.com. Accessed August 12, 2006.Google Scholar

Copyright information

© Current Science Inc. 2006

Authors and Affiliations

  1. 1.Association of Black Cardiologists, Inc.AtlantaUSA

Personalised recommendations