Association of Atherogenic Lipid Profile with Blood Pressure Control in Adults with Essential Hypertension: a Cross-Sectional Study

Abstract

Background: Routine lipid panels contain information that can be integrated into atherogenic indices, but the relation of these composite measures to contemporaneous blood pressure control in established essential hypertension has not been fully resolved.

Objective: To determine whether conventional lipid fractions and calculated atherogenic indices differ according to blood pressure control and to quantify their independent associations with uncontrolled hypertension.

Methods: We performed an analytical cross-sectional investigation of 100 adults with essential hypertension recruited consecutively at Rashid Latif Khan University Medical College, Lahore, Pakistan, from January 2025 through February 2026. Office blood pressure below both 140 mmHg systolic and 90 mmHg diastolic defined the controlled group. Fasting total cholesterol, LDL-C, HDL-C, and triglycerides were measured, after which non-HDL-C, TG/HDL-C, Castelli indices I and II, the atherogenic coefficient, and the atherogenic index of plasma (AIP) were derived. Between-group testing, correlation analysis, multivariable logistic regression, and receiver operating characteristic analysis were used.

Results: Fifty-four participants were men, and 46 were women; 55 participants (55.0%) had uncontrolled blood pressure. Compared with the controlled group, the uncontrolled group had higher triglycerides (187.6 vs 143.2 mg/dL), lower HDL-C (39.9 vs 46.8 mg/dL), greater TG/HDL-C (4.95 vs 3.16), and greater AIP (0.33 vs 0.13; all p<0.001). AIP showed the largest correlation with systolic pressure (r=0.51, p<0.001). In adjusted analysis, a 0.1-unit rise in AIP corresponded to an adjusted odds ratio of 1.53 (95% CI 1.20–1.94) for uncontrolled hypertension. Its ROC AUC was 0.79.

Conclusion: Uncontrolled hypertension in this cohort clustered with a more atherogenic lipid phenotype. Indices incorporating triglycerides and HDL-C, especially AIP and TG/HDL-C, conveyed stronger cross-sectional discrimination than LDL-C alone and may complement routine cardiometabolic assessment.