High Cholesterol and Hypertension: Pathophysiological and Clinical Implications Review

Abstract

Hypertension is one of the leading causes of global morbidity and mortality, with a steadily increasing prevalence, particularly in low- and middle-income countries. In Indonesia, the prevalence of hypertension among individuals over 25 years old is reported at 34%. Lifestyle factors such as excessive salt intake and obesity, scientific evidence highlights the significant role of metabolic factors particularly hypercholesterolemia in the pathogenesis of hypertension. This review explores the relationship between hypercholesterolemia and hypertension from pathophysiological, clinical, and preventive perspectives, as well as therapeutic implications. This study is a literature review of scientific articles discussing the association between lipid profiles, especially LDL, and the mechanisms underlying elevated blood pressure and its related cardiovascular complications. Hypercholesterolemia, through increased LDL levels, may induce atherosclerosis, endothelial dysfunction, and chronic inflammation, all of which contribute to impaired blood pressure regulation. The coexistence of elevated cholesterol and hypertension significantly increases the risk of coronary artery disease, stroke, and renal impairment. The sympathetic nervous system and the renin–angiotensin–aldosteron system (RAAS) play central roles in these mechanisms, alongside other metabolic and hormonal disturbances. Hypertension and hypercholesterolemia are closely linked through overlapping vascular and metabolic pathways that reinforce each other. Effective prevention and management require a comprehensive, evidence-based approach, including pharmacological therapy, nutritional education, and regular physical activity. An integrative understanding of this relationship is essential for developing more targeted strategies to reduce the long-term burden of cardiovascular disease.