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852 was low in all groups.2 The National Health and Nutrition Examination Survey from 1988 to 2010 reported that 60.7% to 64.3% of patients with hypertension had also hypercholesterolemia.3 The same study showed that the prevalence of patients with well ‐controlled hypertension and dyslipidemia increased from 3% to 35% in years from 1988 to 2010.3 These findings demonstrate that the preva‐ lence of concomitant hypertension and hyper‐ cholesterolemia is very high in the global pop‐ ulation, but also that large percentage of treat‐ ed patients remain uncontrolled.1-3 One should also keep in mind that these studies used the def‐ inition of dyslipidemias from older guidelines, which are currently different and very strict.4 According to the authors of the guidelines, the goals of the risk factor management are no smok‐ ing, total cholesterol of 4 mmol/l or lower, and systolic blood pressure of 120 mm Hg or low‐ er.4 The target value for low ‐density lipoprotein (LDL) in primary prevention in individuals with low risk is less than 3 mmol/l, in those at mod‐ erate risk, less than 2.6 mmol/l, and at high risk, less than 1.8 mml/l.4 Considering the average age, mean blood pressure, and total cholesterol level of the participants in the current Polish study,1 it is clear that majority of study participants were at high or very high cardiovascular risk, which further implied that target LDL level should be less than 1.8 mmol/l.4 This low LDL cutoff value used in the present study probably could explain a somewhat higher percentage of dyslipidemias, as well as uncontrolled dyslipidemias in the Pol‐ ish study in comparison with studies performed in the United States years ago.2,3 Niklas et al1 analyzed the potential reasons that could have been responsible for well ‐controlled arterial hypertension and hypercholesterol‐ emia, separately and together. They showed that Arterial hypertension and hypercholesterolemia constitute a dangerous combination that is fre‐ quently seen in clinical practice despite a wide range of medications that are available for both conditions. Both represent important modifi‐ able risk factors for cardiovascular disease and one could expect that their control should not constitute a significant clinical problem. How‐ ever, quite the opposite is evident from every‐ day clinical practice. This raises the question why the management of these modifiable risk factors is that difficult in the modern era of very potent drugs for blood pressure control and lipid low‐ ering. Does the main issue lie in their potency, cost ‐effectiveness ratio, compliance, or perhaps something else? The current Polish multicenter national health survey by Niklas et al1 published in this issue of Polish Archives of Internal Medicine (Pol Arch Intern Med), which included 6170 participants, showed that age ‐standardized prevalence of co‐ existing hypertension and hypercholesterolemia was 34.6%, and the prevalence of concomitant hy‐ percholesterolemia in patients with hypertension was 69.7%.1 Age ‐standardized control of hyper‐ tension, hypercholesterolemia, and both condi‐ tions in the entire study group was 24.3%, 11.2%, and 5.4%, respectively.1 Interestingly, among pa‐ tients with both conditions, the highest control rate of hypertension, hypercholesterolemia, and both hypertension and hypercholesterolemia was reported in the group with the oldest patients, namely, older than 80 years of age (37.7%, 29.2%, and 17%, respectively).1 The National Health and Nutrition Examination Survey from 2001 to 2002 demonstrated that the overall prevalence of hypertension, hypercholesterolemia, and their combination was 30%, 47%, and 18%, respective‐ ly.2 Control of hypertension and hypercholester‐ olemia was achieved in only 9% of patients and EDITORIAL

Combination of hypertension and hypercholesterolemia: do we have an adequate response?