Risk factor clustering in hypertensive patients: impact of the reports of NCEP-II and second joint task force on coronary prevention on JNC-VI guidelines

Introduction. Although the association of hypertension with established ris k factors has been noted in several population studies, the recent redefini tion of dyslipidaemia, hypertension and diabetes calls for reassessment of the prevalence and pattern of risk factor clusters in essential hypertensio n. Objective. To analyse the risk factor profile of Israeli patients with esse ntial hypertension seen by primary care physicians and in hypertension spec ialty clinics, based on current definitions of dyslipidaemia hypertension a nd diabetes and TNC-VI guidelines for the assessment of risk factors, Design and Setting, We analysed the risk profile of 324 Israeli hypertensiv e subjects using the JNC-VI risk table and risk grouping. A total of 122 co nsecutive patients were recruited from primary care clinics and 212 consecu tive patients were recruited from a hospital based hypertension clinic. Results. Amongst hypertensive individuals with no known target organ damage , only 1.5% had no risk factors other than hypertension, whereas all hypert ensives with coronary artery disease had additional risk factors. Of the si x listed major JNC-VI risk factors (smoking, dyslipidaemia, diabetes, age, sex. family history of cardiovascular disease), hypertensive subjects witho ut coronary artery disease (coronary artery disease-negative) had 3.02 +/- 0.10 risk factors, whereas hypertensive subjects with coronary artery disea se (coronary artery disease positive) had 3.6 +/- 0.07 risk factors other t han hypertension (P < 0.01). Dyslipidaemia defined by NCEP-II criteria was the most common associated risk factor identified in 93% of coronary artery disease-positive and 77% of the coronary artery disease-negative hypertens ive subjects. The most common dyslipidaemic abnormality was an increased LD L cholesterol (79.2% of the cohort), followed by hypertriglyceridaemia (31. 7%) and low HDL cholesterol(22.3%). Nevertheless. in nearly half of the cor onary artery disease-negative patients, LDL cholesterol concentrations were within 30 mg dL(-1) of the target levels. The most common dyslipidaemic va riant was isolated hypercholesterolaemia (42%), whereas the syndrome X dysl ipidaemic combination of hypertriglyceridaemia and low HDL was strikingly u ncommon, observed in 2.8% of the coronary artery disease-positive and 0.8% of the coronary artery disease-negative patients. Conclusions. (i) JNC-VI group risk A patients (no risk factors) comprise a very small minority in this cohort (< 5%); (ii) dyslipidaemia is exceedingl y common with mild hypercholesterolaemia being the most prevalent variant a nd hypertriglyceridaemia with low HDL the least common form.