Evaluation of serum lipid profile in patients with hypertension living in a coastal region of Bangladesh.

Serum lipid levels are greatly controlled by genetic and environmental factors. When investigating the relationship between lipid disturbances and hypertension it is necessary to use local data on blood lipid profile in each region. Unfortunately, there is no literature reporting the lipid profile in hypertensive patients in coastal region of Bangladesh. The present study was conducted as a case-control study with 100 hypertensive patients as cases and equal number of normotensive individuals as controls. Socio-demographic, anthropometric and clinical data of both patients and controls were collected. Serum lipid parameters were analyzed biochemically. Independent sample t-test, Chi-Square test and Pearson's correlation test were done for the statistical analysis using the statistical software package SPSS. Our study found that serum total cholesterol (TC), triglyceride (TG), LDL, VLDL, TC/HDL, LDL/HDL were significantly higher (p<0.05) whereas the level of HDL cholesterol was significantly lower in hypertensive patients as compared to control subjects (p<0.05). Pearson's correlation analysis reveals that HDL cholesterol was inversely correlated with systolic and diastolic blood pressure in both patient and control groups. But serum TC, TG, LDL and HDL cholesterol were directly correlated with systolic and diastolic blood pressure in both groups. This study explored that hypertensive patients have higher level of TC, TG, LDL and VLDL cholesterol but lower level of HDL cholesterol than the normotensive subjects. Routine investigation of lipid profile in hypertensive patients may help to prevent further aggravation and risks of coronary artery diseases.

Resistant hypertension: underlying causes and treatment.

Resistant hypertension (RH) is defined as failure to achieve goal blood pressure while receiving a 3 drug regimen at optimal doses that includes a diuretic. The exact prevalence of resistant hypertension is unknown which may vary from 5% to 50%. Patient or clinician-related factors contributing to resistant hypertension include patient's non-adherence to antihypertensive therapy, White-coat effect and pseudo-hypertension and life style factors (Obesity, alcohol, smoking, dietary sodium etc). Several drugs may induce pre-existing hypertension where non-steroidal anti-inflammatory drugs are usually the most common due to their frequent use; whereas oral contraceptives, sympathomimetics (decongestants, anorectics), adrenal steroids and antineoplastic drugs targeting the vascular endothelial growth factor (VEGF) pathway has a good deal of contribution to resistant hypertension. Most common secondary causes of resistant hypertension are obstructive sleep apnea, renal artery stenosis, renal parenchymal disease, and primary aldosteronism while some uncommon causes such as pheochromocytoma, Cushing's disease, thyroid and parathyroid dysfunction; and aortic coarctation also contribute to resistant hypertension. Both pharmacological and non-pharmacological treatments are available for the management of resistant hypertension. This article reviews the prevalence, symptoms, causes and treatment of resistant hypertension.