Beyond lipid levels: unraveling the hypertensive factor in familial hypercholesterolemia. The HELLAS-FH registry.

Arterial hypertension (AH) and familial hypercholesterolemia (FH) are major risk factors for atherosclerotic cardiovascular disease (ASCVD). The extent to which the coexistence of AH and FH amplifies the ASCVD risk is not well known. We aimed to explore the effect of AH on the prevalence of ASCVD in patients with FH. This was a cross-sectional analysis from the HELLAS-FH registry. A total of 2367 adults with heterozygous FH were studied. Out of these, 602 (25.4%) patients had AH. Patients with AH were more likely to have additional ASCVD risk factors (diabetes, smoking, obesity, elevated triglycerides and reduced high-density lipoprotein cholesterol levels) compared with patients without AH. Patients with AH had significantly higher prevalence of established coronary artery disease (CAD) (44 vs 14%, p < 0.001), premature CAD (39 vs 13%, p < 0.001), stroke (6 vs 2%, p < 0.001), and peripheral artery disease (6 vs 1%, p < 0.001) compared with those without after adjustment for major ASCVD risk factors. Systolic blood pressure (SBP) was significantly associated with increased odds of established CAD per 1 mmHg [odds ratio (OR) 1.075; 95% CI 1.001-1.153; p = 0.048], stroke (OR 1.023; 95% CI 1.004-1.042; p = 0.019) and PAD (OR 1.022; 95% CI 1.002-1.041; p = 0.028), while diastolic blood pressure showed no significant association with these outcomes. In conclusion, AH is associated with higher ASCVD risk factor burden and increased prevalence of ASCVD in patients with FH.