Blood pressure and cholesterol control in hypertensive hypercholesterolemic patients: national health and nutrition examination surveys 1988-2010

Abstract

Background: Hypertension doubles coronary heart disease (CHD) risk. Treating hypertension only reduces CHD risk ≈25%. Treating hypercholesterolemia in hypertensive patients reduces residual CHD risk >35%.

Methods and results: To assess progress in concurrent hypertension and hypercholesterolemia control, National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2004, and 2005 to 2010 were analyzed. Hypertension was defined by blood pressure ≥140/≥90 mm Hg, current medication treatment, and 2-told hypertension status; blood pressure <140/<90 defined control. Hypercholesterolemia was defined by ATP III criteria based on 10-year CHD risk, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol; values below diagnostic thresholds defined control. Across surveys, 60.7% to 64.3% of hypertensives were hypercholesterolemic. From 1988 to 1994 to 2005 to 2010, control of LDL-C rose (9.2% [95% confidence interval (CI), 6.6%-11.9%] to 45.4% [95% CI, 42.6%-48.3%]), concomitant hypertension and LDL-C (5.0% [95% CI, 3.3%-6.7%] to 30.7% [95% CI, 27.9%-33.4%]), and combined hypertension, LDL-C, and non-high-density lipoprotein cholesterol (1.8% [95% CI, 0.4%-3.2%] to 26.9% [95% CI, 24.4%-29.5%]). By multivariable logistic regression, factors associated with concomitant hypertension, LDL-C, and non-high-density lipoprotein cholesterol control (odds ratio [95% CI]) were statin (10.7 [8.1-14.3]) and antihypertensive (3.32 [2.45-4.50]) medications, age (0.77 [0.69-0.88]/10-year increase), ≥2 healthcare visits/yr (1.90 [1.26-2.87]), black race (0.59 [0.44-0.80]), Hispanic ethnicity (0.62 [0.43-0.90]), cardiovascular disease (0.44 [0.34-0.56]), and diabetes mellitus (0.54 [0.42-0.70]).

Conclusions: Despite progress, opportunities for improving concomitant hypertension and hypercholesterolemia control persist. Prescribing antihypertensive and antihyperlipidemic medications to achieve treatment goals, especially for older, minority, diabetic, and cardiovascular disease patients, and accessing healthcare at least biannually could improve concurrent risk factor control and CHD prevention.

Keywords: cardiovascular diseases; coronary disease; hypercholesterolemia; hypertension; prevention & control.

Figure 1

The flow diagram depicts the process for deriving the subject sample for the present analysis of the NHANES database for 1988–1994 and 1999–2010 subdivided into 1999–2004 and 2005–2010.

Figure 2

Hypertension and hypercholesterolemia control (mean, standard error) (A) ATPIII cholesterol goals, BP <140/<90, (B) Same as A except BP <130/<80 for diabetes/CKD, (C) Control BP <140/<90 and non-HDL-C (ATPIII goals) in patients with and without LDL-C. All comparisons between time periods are significant at p<0.01 except hypertension control between 1988–1994 and 1999–2004 in 2A, 2B, and 2C (Htn with LDL [mean values for risk factor control and p-values are provided in Supplemental Table 2]).

Figure 3

Multivariable odds ratios and 95% CI are depicted for clinical variables independently associated with control of LDL-C alone and with BP and non-HDL-C for three NHANES periods separately and combined. 95% CIs not crossing the line of identity (1.0) are significant.

Figure 4

Hypertension and hypercholesterolemia control in men and women by Framingham 10-yr CHD risk score categories (FRS) (mean, standard error) (A) FRS categories by sex in NHANES 1999–2004 and 2005–2010 (B) Non-HDL-C control (ATP III goals) in men and women by FRS (C) BP <140/<90 and non-HDL-C control in men and women by FRS categories. *p<0.01 for distribution across FRS categories in men vs women; †p<0.01 men vs. women within FRS category.