Dyslipidemic Hypertension Among Turkish Adults

The cohort 2000/01 of the Turkish Adult Risk Factor Study was investigated cross-sectionally with respect to dyslipidemic hypertension (DH) with the purpose of assessing its extent and the excess burden of coronary heart disease (CHD) risk it imparted among Turkish adults. The population sample and methodology of the ongoing study had previously been published. Individuals with a systolic pressure < 130, a diastolic pressure <85 mmHg and not being on antihypertensive medication were designated as normotensive. Of the remaining hypertensive participants, DH was considered in those having values of blood pressure, plasma triglyceride and HDL-cholesterol consistent with the metabolic syndrome criteria of the recent NCEP guidelines, whereas those exhibiting high-normal or hypertensive values but not meeting criteria of both triglycerides and HDL-cholesterol wer designated as "simple hypertensives" or, briefly, as hypertensives. DH was found in 20% of men and 21% of women among a cohort of 1860 persons in whom fasting triglyceride measurements were available, and constituted 35% of all hypertensives. As compared to simple hypertensives, DH was characterized by higher values of waist circumference, fasting serum insulin, apolipoprotein (apo) B, nonHDL-cholesterol and total/HDL-cholesterol ratio. Male DH formed 5/8th and female DH 4/9th of all subjects with MS. Age-adjusted likelihood of CHD was 65% higher in men but only 18% higher in women than simple hypertensives. DH was estimated to be the mechanism underlying one of each 3 cases of CHD in Turkey. One of two alternatives in DH, either a level of total cholesterol >200 mg/dl (or of apo B'nin ?130 mg/dl or CRP'nin ?4 mg/L) allowed to determine the likelihood of prevalent CHD with a total diagnostic accuracy of 50% or more. We conclude that DH, estimated to be inherent in over 5 million Turkish adults, adds a substantial excess CHD risk even to that of simple hypertension. The use of high total cholesterol values in DH may serve as a simple screening test to differentiate those subjects with DH at high risk.