For men with dyslipidemia, blood pressure poorly predicts ischemic heart disease risk, according to a report in the August issue of Hypertension. Many patients with high blood pressure have the metabolic syndrome X, characterized by high plasma triglycerides (TG), low HDL cholesterol, and abnormalities in glucose metabolism, the authors explain. Among these patients, blood pressure treatment appears to have little impact on the morbidity and mortality of ischemic heart disease.
Dr. Jorgen Jeppesen, of Copenhagen University Hospital, Denmark, used data from the Copenhagen Male Study of 2906 men to evaluate the ability of blood pressure to predict ischemic heart disease in men with high TG/low HDL cholesterol. Two hundred twenty-nine men had a first ischemic heart disease event during the 8-year study.
Both the absolute and relative risks of ischemic heart disease were independent of systolic and diastolic blood pressure among men with high TG/low HDL cholesterol, the investigators note.
In contrast, the rest of the population experienced a steady increase in ischemic heart disease risk with increasing systolic or diastolic blood pressure, the report indicates.
Men taking antihypertensive medications faced a significantly higher risk of ischemic heart disease than did those not taking such medications, the researchers observe, though ischemic heart disease risk remained independent of systolic blood pressure among men with high TG/low HDL cholesterol.
The major new finding in the study of middle-aged and elderly white men who were free of overt cardiovascular diseases at baseline was that the risk of ischemic heart disease in subjects with high TG/low HDL cholesterol was not directly related to the level of systolic or diastolic blood pressure. The previously described U-shaped relationship between risk of ischemic heart disease and level of treated diastolic blood pressure was only found in men with high TG/low HDL cholesterol.
The results suggest that in hypertensive subjects with high TG/low HDL cholesterol, it may be more important to normalize high TG/low HDL cholesterol and the other components in the metabolic syndrome X to lower risk of ischemic heart disease than to normalize blood pressure. Hypertension 2000;36:226-232