LDL Cholesterol Goals for Patients with Hypertension

Risk Stratification for Determining LDL Goals

The European Society of Cardiology recommends that for hypertensive patients at low or moderate cardiovascular risk, the LDL cholesterol target is <5 mmol/L (<190 mg/dL) for total cholesterol and <3 mmol/L (<115 mg/dL) for LDL cholesterol 1
For hypertensive patients at high cardiovascular risk, an LDL cholesterol goal of <2.5 mmol/L (<100 mg/dL) is recommended by the European Society of Cardiology 1
High-risk status is typically defined by the presence of multiple risk factors, target organ damage, or diabetes without end-organ damage, according to the American College of Cardiology and the American Heart Association 3, 4
When LDL-lowering therapy is employed in high-risk patients, the intensity should be sufficient to achieve at least a 30-40% reduction in LDL-C levels, as recommended by the American Heart Association 5

Established cardiovascular disease, severe chronic kidney disease, or diabetes with target organ damage are factors that define very high-risk status in hypertensive patients, according to the European Society of Cardiology 1, 2
Multiple major risk factors, especially poorly controlled hypertension, are also factors that define very high-risk status in hypertensive patients, as stated by the American Heart Association 4

The European Society of Cardiology recommends that statin therapy should be initiated for hypertensive patients at high or very high cardiovascular risk 1
Therapeutic lifestyle changes remain an essential modality in clinical management for all hypertensive patients regardless of LDL-C level, according to the American Heart Association 5

Clinical trials have demonstrated significant reductions in cardiovascular events with statin therapy in high-risk patients, as reported by the American College of Cardiology 3, 7
Evidence suggests that additional benefit may be obtained by reducing LDL-C to substantially below 100 mg/dL, with no apparent threshold below which no further benefit is achieved, according to the American Heart Association 4, 5