Lipid Profile Abnormalities as Predictors of Uncontrolled Hypertension and Cardiovascular Risk in Adults with Primary Hypertension: An Observational Cohort Study

Abstract

Background: Dyslipidemia frequently coexists with primary hypertension, potentially contributing to inadequate blood pressure control and increased cardiovascular risk.

Objective: To evaluate the association of lipid profile abnormalities with uncontrolled hypertension and cardiovascular outcomes in adults with primary hypertension.

Methods: This single-center observational cohort study included 120 adults with primary hypertension at Rashid Latif Khan University Medical College, Lahore, Pakistan, from March 2025 to March 2026. Baseline lipid profiles were evaluated in relation to subsequent blood pressure control. Multivariable logistic regression assessed independent associations, while cardiovascular events and exploratory predictive performance were also examined.

Results: Uncontrolled hypertension was observed in 68 participants (56.7%). Compared with controlled participants, those with uncontrolled hypertension exhibited higher low-density lipoprotein cholesterol (135.8 vs. 110.2 mg/dL), triglycerides (176.4 vs. 146.6 mg/dL), and lower high-density lipoprotein cholesterol (44.6 vs. 50.9 mg/dL). Adjusted analyses demonstrated significant associations with LDL-C (adjusted odds ratio [aOR] 1.54 per 10 mg/dL; 95% CI 1.23–1.94), triglycerides (aOR 1.64 per 50 mg/dL; 95% CI 1.07–2.53), and HDL-C (aOR 0.51 per 10 mg/dL; 95% CI 0.28–0.95). Eleven participants (9.2%) experienced major cardiovascular events. Incorporating lipid parameters into clinical prediction models increased the apparent area under the curve from 0.802 to 0.894.

Conclusion: Lipid profile abnormalities were independently associated with uncontrolled hypertension and improved apparent model discrimination. Larger prospective studies with external validation are required to establish their clinical predictive utility.