What is the blood lipid target for people with high blood pressure? "Expert consensus" tells you

Huazi has told many people with high blood pressure that while controlling blood pressure, they should also pay attention to controlling blood lipids, because high blood pressure can damage the intima of the arteries, and low-density lipoprotein cholesterol (LDL-C) in blood lipids can enter the arteries from the damaged intima, causing atherosclerosis.

Atherosclerosis is the "culprit" of cardiovascular and cerebrovascular diseases such as coronary heart disease, myocardial infarction, and cerebral infarction, so strengthening the control of blood pressure and blood lipids can prevent the occurrence of serious diseases. So how much blood lipids should be controlled for people with high blood pressure?

1. Blood lipid targets for patients with hypertension In the "Expert Consensus on Comprehensive Management of Blood Pressure and Blood Lipids in Chinese Patients with Hypertension", it is proposed that hypertensive patients have different requirements for LDL-C levels in blood lipids when facing different risks.

1. When LDL-C level is controlled below 3.4mmol/L

It is just simple hypertension, and the blood pressure value is lower than 160/100 mmHg, without any other risk factors.

2. When LDL-C level is controlled below 2.6mmol/L

Having hypertension and 1 to 2 of the following risk factors: blood pressure higher than 160/100 mmHg, smoking, older age (male over 45 years old, female over 55 years old), high-density lipoprotein cholesterol (HDL-C) lower than 1.0 mmol/L, body mass index (BMI) greater than 28, and a family history of premature cardiovascular disease.

3. When LDL-C level is controlled below 1.8mmol/L

Those who have three of the risk factors listed in item 2 above; or those who have one of the following factors: hypertension combined with diabetes, hyperlipidemia (LDL-C>4.9mmol/L), chronic kidney disease stage 3 or 4, atherosclerotic cardiovascular disease (coronary heart disease, myocardial infarction, cerebral infarction), etc.

4. When LDL-C level is controlled below 1.4mmol/L

Patients with atherosclerotic cardiovascular disease and at least two of the following factors: history of premature coronary heart disease, hyperlipidemia, diabetes, chronic kidney disease stage 3 or 4, smoking, etc.

2. Statins are the "main force" of lipid-lowering therapy. Statins are the first choice of lipid-lowering drugs. For initial treatment, you can choose a moderate-intensity statin. Check blood lipids in the fifth week after starting treatment. If the LDL-C level meets the standard, continue long-term maintenance treatment. If the LDL-C level does not meet the standard, it is not recommended to increase the dose of statins, but it is recommended to use it in combination with other lipid-lowering drugs.

When moderate-intensity statins cannot achieve the target LDL-C, cholesterol absorption inhibitors (ezetimibe) are usually used in combination. If LDL-C still cannot reach the target after using the maximum tolerated dose of statins combined with ezetimibe, PCSK9 inhibitors (evolocumab, alirocumab) can be used in combination to further lower LDL-C levels.

For high-risk patients with arteriosclerotic cardiovascular disease who have not used statins but whose LDL-C levels have reached the target, it is still recommended to start statin treatment to further reduce the LDL-C level by 30% to 40%. The lower the LDL-C level, the stronger the effect of cardiovascular protection.

However, in order to avoid possible potential risks, it is not recommended to lower the LDL-C level to below 1.0mmol/L.

While controlling blood lipids, blood pressure should also be actively controlled. It is usually recommended to control blood pressure at around 130/80 mmHg, but for elderly patients over 75 years old, the blood pressure target can be relaxed to around 140/90 mmHg.

3. Lifestyle intervention is also required during drug treatment 1. Strictly quit smoking: Smoking is an important risk factor for cardiovascular disease. Strictly quitting smoking is beneficial to the prevention of atherosclerotic cardiovascular disease. Not only should you not smoke, but you should also pay attention to staying away from the harm of secondhand smoke.

2. Control your weight: Keep your body mass index (BMI) below 24. Men’s waist circumference should be less than 90 cm, and women’s waist circumference should be less than 85 cm.

3. Healthy diet: Do not drink alcohol, limit salt intake (less than 5 grams per day), eat more whole grains, fruits, vegetables and other foods with dietary fiber. Choose vegetable oils with more unsaturated fatty acids (such as olive oil) for cooking, and do not use animal oils with more saturated fatty acids. Eat a handful of nuts every day to increase the intake of trace elements such as magnesium, calcium, and potassium.

4. Healthy lifestyle: Do more than 30 minutes of moderate-intensity aerobic exercise every day, get enough sleep, participate in more social activities, and reduce mental stress.

To sum up, people with high blood pressure should control blood lipids while controlling blood pressure. The most important indicator of blood lipids is low-density lipoprotein cholesterol (LDL-C). When facing different dangerous situations, the control requirements for LDL-C levels are different. The doctor needs to assess the risk and use the drug under the guidance of the doctor. If you have any questions about the use of the drug, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.