Impact of lipid and ACE inhibitor therapy on cardiovascular disease and metabolic abnormalities in the diabetic and hypertensive patient.

Abstract

Hypertension is often accompanied by a variety of metabolic abnormalities. These metabolic abnormalities include insulin resistance, dyslipidemia and abnormalities of the coagulation-fibrinolytic system predisposing to a procoagulent state. The nexus for all of these abnormalities may be central (visceral) obesity. The dyslipidemia accompanying hypertension consists of low HDL cholesterol, elevated triglyceride levels and an abnormal more atherogenic LDL cholesterol particle. Dyslipidemia interacts with associated hemodynamic (ie, hypertension) and metabolic (ie, increased platelet aggregation and PAI-1 levels) in a multiplicative manner potentiating cardiovascular and renal disease. Accordingly, lipid therapy should be aggressive to attenuate these medical complications of essential hypertension.