Management of Hypertension and Dyslipidemia for Primary Prevention of Cardiovascular Disease
Authors: Panniyammakal Jeemon, Rajeev Gupta, Churchill Onen, Alma Adler, Thomas Gaziano, Dorairaj Prabhakaran, Neil Poulter
New new findings are highlighted about the global burden of high blood pressure (BP) and lipids, discussing changing thresholds and targets for BP- and lipid-lowering therapies in the context of newly available evidence from randomized controlled trials (RCTs) and meta-analyses of RCTs, paying particular attention to (1) the adverse effect on blood glucose associated with statin therapy and statin-induced diabetes; (2) the role of ezetimibe in reducing low-density lipoprotein (LDL) cholesterol; and (3) the uncertainty about the risks of aspirin in primary prevention of CVD. Elevated BP and total cholesterol levels remain leading physiological risk factors for ischemic heart disease (IHD) and stroke. Although proven, cost-effective, and acceptable medical and lifestyle interventions exist to prevent and treat hypertension and dyslipidemia, uptake remains unacceptably low in all countries, particularly in resource-poor settings. Guidelines for BP control recommend nonpharmacological measures to lower BP (including salt reduction and weight loss) and to reduce overall CVD risk (including smoking cessation and cholesterol lowering).