Introduction <p>Hypertension and hypercholesterolemia are endemic key risk factors influencing cardiovascular prognosis.</p> Aim <p>Our study aimed to detect the co-occurrence of these two risk factors in medical practices and to determine the rate of guideline-compliant medical treatment.</p> Methods <p>We conducted a nationwide survey in German outpatient medical facilities. Data on the prevalence, control, and management of hypertension and hypercholesterolemia were collected using an anonymized questionnaire and analyzed. Results are presented as numbers and percentages for categorical variables, and as means with standard deviations (SD) for continuous variables.</p> Results <p>A total of 5,020 questionnaires from 534 German physicians were analyzed. Hypertension and hypercholesterolemia were concurrently diagnosed in 56% of patients. Despite antihypertensive therapy, only 53% of hypertensive patients achieved controlled office blood pressure values (&lt; 140/90 mmHg). Nevertheless, physicians rated blood pressure control as adequate in 77% of cases; one-third of these patients had uncontrolled OBP. Fewer than 26% of patients with arterial hypertension received a combination therapy recommended by current clinical guidelines. 1,079 out of 4,287 hypertensive patients were treated with monotherapy only. Among patients at high cardiovascular risk (e.g., with a history of myocardial infarction), 10% achieved the recommended LDL cholesterol target of &lt; 55&#xa0;mg/dl, while 8% had LDL levels ≥ 160&#xa0;mg/dl.</p> Conclusion <p>These findings suggest a persistent gap between evidence-based guidelines and their implementation in everyday practice. These data are largely consistent with findings from previous decades, indicating that insufficient progress has likely occurred in improving disease control at the population level.</p> Graphical Abstract <p>Schematic overview of the study workflow and principal findings</p>