Prevalence of dyslipidemia and its association with blood pressure control in Iranian hypertensive patients: insights from STEPS 2021

BACKGROUND: Given the association between dyslipidemia and hypertension and their significant impact on cardiovascular diseases (CVDs) in Middle Eastern countries, coordinated monitoring of these risk factors across the region is essential. This study aimed to assess the prevalence of dyslipidemia among hypertensive Iranians and explore its association with hypertension control. METHODS: Data from the Iranian STEPwise Approach to Non-communicable Disease (NCD) Risk Factor Surveillance (STEPS) 2021 survey, including questionnaires, physical measurements, laboratory tests, from a total of 5,997 participants, were analyzed. Hypertension was defined as the current use of antihypertensive medication or blood pressure ≥ 140/90 mmHg. Lipid markers, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), Non-HDL-C, and triglycerides (TG), were evaluated using the National Cholesterol Education Program Adult Treatment Panel III 2004 criteria. Associations between lipid markers and uncontrolled hypertension were assessed using a multivariable modified Poisson regression model, with results presented as adjusted prevalence ratio (APR) and 95% confidence interval (CI). All analyses were conducted utilizing STATA software version 14.2. RESULTS: The prevalence of dyslipidemia among hypertensive Iranian adults was 86.4% [95% CI: 85.0, 87.6], with the most common abnormalities being low HDL-C 71.3% [95% CI: 69.6, 72.9], followed by hypertriglyceridemia 48.4% [95% CI: 46.5, 50.2], hypercholesterolemia 24.9% [95% CI: 23.3, 26.6], and high LDL-C 18.8% [95% CI: 17.3, 20.3]. In the multivariable model, TC, LDL-C, Non-HDL-C, TC/HDL-C, and LDL-C/HDL-C were significantly associated with uncontrolled hypertension in both males and females. Each 1 mmol/L increase in LDL-C was associated with a higher prevalence of uncontrolled hypertension by 1.07 [95% CI: 1.04, 1.09] in males and 1.05 [95% CI: 1.03, 1.07] in females; Non-HDL-C by 1.06 [95% CI: 1.04, 1.08] in males and 1.05 [95% CI: 1.03, 1.07] in females; TC by 1.06 [95% CI: 1.04, 1.08] in males and 1.05 [95% CI: 1.03, 1.07] in females; and TG by 1.02 [95% CI: 1.00, 1.03] in males. CONCLUSIONS: Dyslipidemia is highly prevalent among hypertensive Iranian adults and may be associated with poor blood pressure control. In particular, low HDL-C emerged as the most frequent lipid abnormality and should be carefully assessed and managed as part of integrated, preventive hypertension care.