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Review
. 2025 Mar;32(2):151-163.
doi: 10.1007/s40292-024-00700-x. Epub 2025 Feb 25.

2024 consensus document of the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC): update on LDL cholesterol lowering in patients with arterial hypertension

Maria Lorenza Muiesan  1 , Agostino Virdis  2 , Giuliano Tocci  3 , Claudio Borghi  4   5 , Arrigo F G Cicero  4   5 , Claudio Ferri  6 , Matteo Pirro  7 , Alberto Corsini  8 , Massimo Volpe  3   9
Affiliations
Review

2024 consensus document of the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC): update on LDL cholesterol lowering in patients with arterial hypertension

Maria Lorenza Muiesan et al. High Blood Press Cardiovasc Prev. 2025 Mar.

Abstract

Hypertension and hypercholesterolemia often occur in the same individuals, increasing the risk of major cardiovascular (CV) outcomes, including myocardial infarction, stroke, CV death, as well as other CV complications. Concomitant management of these condition now represent a crucial step to reduce individual global CV risk and improve CV disease prevention in daily clinical practice. Given the high prevalence of hypertension and hypercholesterolemia in general population and their impact on health status, several pharmacological options are currently available to achieve the recommended therapeutic targets. These drugs, mostly including statins, ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors and inclisiran, can be used either in monotherapies or in combination therapies, with different clinical indications, therapeutic efficacy and tolerability profile. Decision among different drug classes and dosages, as well as choice between monotherapy or combination therapy (fixed or free), largely depend on individual global CV risk profile and therapeutic targets of low-density lipoprotein (LDL) cholesterol levels to be achieved under pharmacological therapy. The present consensus document represents an update of the previous document published on 2022 and endorsed by the Italian Society of Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC). Here we propose a novel paradigm for the treatment of the patients with hypertension and hypercholesterolemia at high or very high cardiovascular risk. In addition, the pharmacological properties, and the clinical efficacy of novel agents recently approved for a tailored therapy of hypercholesterolemia in patients with atherosclerotic CV disease, including PCSK9 inhibitors and bempedoic acid, will be summarized.

Keywords: Bempedoic acid; Blood pressure; Cardiovascular mortality; Cardiovascular risk; Dyslipidaemia; Ezetimibe; Hypertension; Inclisiran; Low-density lipoprotein cholesterol; PCSK9i; Statins; Total cholesterol.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: No request to local Ethic Committee has been made, given the descriptive nature of the manuscript (systematic review). Human and animal rights: This article does not contain any studies involving human participants performed by any of the authors. All procedures performed in clinical trials discussed in this manuscript and involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the clinical trials, according to the study protocols.

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