Hypercholesterolaemia and its potential role in the presentation and exacerbation of hypertension

Hypertension is a major cardiovascular risk factor and its pathogenesis remains elusive. For a long time, hypertension and dyslipidaemia have been viewed as independent but synergistic cardiovascular risk factors increasing the risk of premature atherosclerosis. Recently, a growing body of evidence has indicated that hypercholesterolaemia promotes impairment in several mechanisms implicated in blood pressure control such as nitric oxide bioavailability, renin-angiotensin activity, the sympathetic nervous system, sodium and fluid homeostasis and ion transport/signal transduction. Moreover, recent clinical studies have pointed out a beneficial effect of cholesterol-lowering treatment in reducing blood pressure to a small but significant degree. Our assumption is that depending on the complex inter-relationships between genetic background and life style, hypercholesterolaemia may be a trigger to blood pressure elevation. An integrated approach to the treatment of hypertension and dyslipidaemia can, therefore, maximise both blood pressure control and prevention of cardiovascular disease. In this review, we discuss recent important data from our and other groups, demonstrating the clinical evidence of the hypertensinogenic effects of hypercholesterolaemia, and the biological mechanisms which underlie them.