Abnormal low-density lipoprotein subfraction profile in patients with untreated hypertension

Background: Low-density lipoprotein (LDL) consists of a heterogeneous group of particles of varying size and electrophoretic mobility. A predominance of small, more mobile particles is a risk factor for cardiovascular disease. Aim: To investigate the hypothesis that untreated patients with essential hypertension in the absence of vascular disease may exhibit abnormalities of LDL subfractions. Setting: Specialist hypertension clinic. Design: Cross-sectional study. Methods: Following disc polyacrylamide gel electrophoresis, the mean (LDL locus) and heterogeneity (LDL spread) of mobility was recorded in 41 patients (mean age 52.6 years, 24 men) presenting with untreated essential hypertension (in the absence of vascular disease or diabetes mellitus) and in 45 healthy controls (age 56.9 years, 22 men) recruited from primary-care lists. Results: Although there were no significant differences in total, low- or high-density lipoprotein cholesterol concentrations, LDL locus was significantly greater in the hypertensive group: mean (95%Cl) 36.7 (35.7-37.6) vs. 34.8 (34.1-35.5), p=0.002. LDL locus was significantly elevated even in hypertensives with triglyceride concentrations below the median (< 1.25 mmol/l). LDL spread was also greater in the hypertensive group, but not significantly: 5.6 (5.2-6.0) vs. 3.5 (5.3-5.8), P=0.10. Discussion: Hypertensive patients have a preponderance of smaller LDL subfractions. This dyslipidaemia is not readily detected by conventional lipid assays.