Key result
Elevated serum cholesterol increased the 15-year risk of new-onset stable hypertension in patients with high-normal blood pressure compared to normal cholesterol.
Why the study?
Does elevated serum cholesterol and high plasma renin activity increase the risk of developing stable hypertension in young patients with high-normal blood pressure?
Cohort (n=86)
Does elevated serum cholesterol and high plasma renin activity increase the risk of developing stable hypertension in young patients with high-normal blood pressure?
Hypercholesterolemia and high plasma renin activity interact to significantly increase the long-term risk of developing stable hypertension in young patients with high-normal blood pressure.
Answers are grounded in this paper and cite their sources.
Elevated cholesterol was associated with higher hypertension risk in high-normal BP; hypothesis-generating and should not yet change practice.
OBJECTIVES: To investigate the possible interactions between serum cholesterol levels and the renin-angiotensin system on the development of stable hypertension in subjects with high-normal blood pressure (BP). BACKGROUND: Hypercholesterolemia increases angiotensin-II type 1 (AT1) receptor density and pressor responsiveness to angiotensin II, and has been reported to contribute to the development of hypertension. The effects of elevated serum cholesterol levels on BP control might be exaggerated by concomitant activation of the renin-angiotensin system, and their combination might contribute to the development of stable hypertension. METHODS: We investigated the relationship between serum cholesterol levels, plasma renin activity (PRA) and the long-term development of hypertension in 66 young (age < 45 years) patients with high-normal BP and elevated (> 200 mg/dl, n = 46: HC) or normal (</=200 mg/dl, n = 20: NC) serum cholesterol levels and in 20 normotensive, normocholesterolemic controls (C). The main outcome measure was the prospective evaluation of the 15-year incidence of stable hypertension in the different populations. RESULTS: New-onset hypertension was higher in patients with high-normal BP and HC when compared to NC patients [relative risk (RR) = 1.9; 95% confidence interval (CI), 1.1-4.3, P < 0.001] and control subjects (RR = 3.1; 95% CI = 1.4-5.3, P < 0.001). High PRA increased the overall rate of hypertension in both HC and NC. The interaction between HC and PRA was more evident in patients with borderline high cholesterol levels (200-240 mg/dl) where the adjusted relative risk of new onset of hypertension was 2.17 (95% CI 1.2-3.74; P < 0.05) in high PRA subjects and 1.17 (95% CI 0.67-2.23; P = 0.87) in subjects with normal PRA. CONCLUSION: We support the hypothesis that the presence of hypercholesterolemia can promote the development of stable hypertension through its interaction with the circulating renin-angiotensin system in patients with high-normal blood pressure.
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Borghi et al. (2007) conducted a cohort in High-normal blood pressure (n=86). Elevated serum cholesterol (> 200 mg/dl) vs. Normal serum cholesterol (≤200 mg/dl) was evaluated on 15-year incidence of stable hypertension (RR 1.9, 95% CI 1.1-4.3, p=<0.001). Elevated serum cholesterol increased the 15-year risk of new-onset stable hypertension in patients with high-normal blood pressure compared to normal cholesterol.
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