Add-on-Statin Extended Release Nicotinic Acid/Laropiprant but Not the Switch to High-Dose Rosuvastatin Lowers Blood Pressure: An Open-Label Randomized Study

Abstract

Introduction. Nicotinic acid (NA) and statins have been associated with reductions in blood pressure (BP). Patients and Methods. We recruited 68 normotensive and hypertensive dyslipidemic patients who were treated with a conventional statin dose and had not achieved lipid targets. Patients were randomized to switch to high-dose rosuvastatin (40 mg/day) or to add-on current statin treatment with extended release (ER) NA/laropiprant (1000/20 mg/day for the first 4 weeks followed by 2000/40 mg/day for the next 8 weeks) for 3 months. Results. Switching to rosuvastatin 40 mg/day was not associated with significant BP alterations. In contrast, the addition of ER-NA/laropiprant to current statin treatment resulted in a 7% reduction of systolic BP (from 134 ± 12 to 125 ± 10 mmHg, P < .001 versus baseline and P = .01 versus rosuvastatin group) and a 5% reduction of diastolic BP (from 81 ± 9 to 77 ± 6 mmHg, P = .009 versus baseline and P = .01 versus rosuvastatin group). These reductions were significant only in the subgroup of hypertensives and were independent of the hypolipidemic effects of ER-NA/laropiprant. Conclusions. Contrary to the switch to high-dose rosuvastatin, the addition of ER-NA/laropiprant to statin treatment was associated with significant reductions in both systolic and diastolic BP.

Statins and Niacin: The End of Residual Risk Therapy?

“…In 1613 patients with primary hypercholesterolaemia or mixed dyslipidaemia, extended-release niacin (ERN) use was associated with signifi cant reductions in systolic ( p < 0.05) and diastolic ( p < 0.001) blood pressure [ 21 ]. Similar results were shown when ERN/laropiprant was added to statin treatment in 68 normotensive and hypertensive dyslipidaemic patients who were treated with a conventional statin dose and had not achieved lipid targets [ 22 ]. In addition, niacin exerts anti-infl ammatory and anti-oxidant properties [ 23 , 24 ].…”

Nicotinic acid/laropiprant reduces platelet count but increases mean platelet volume in patients with primary dyslipidemia

“…The reported increase in MPV was similar in the subgroup of patients receiving compared to patients not receiving antiplatelet therapy, even though the small study population does not allow us to clarify aspirin's or clopidogrel's effect. Noteworthy, taking into consideration the fact that ER-NA/laropiprant treatment lowers BP and elevates HDL-C, it comes as a surprise that ER-NA/laropiprant did not result in MPV reduction, as both hypertension and low HDL-C levels have been directly correlated with increased MPV levels [ 16 , 28 – 30 ]. But how did ER-NA/laropiprant increase MPV?…”

Comparison of switch to the highest dose of rosuvastatin vs. add-on nicotinic acid vs. add-on fenofibrate for mixed dyslipidaemia

“…NA possesses broad spectrum lipid‐modifying properties, as it decreases the levels of both LDL‐C and TGs (by approximately 5–20 and 20–50% respectively). Furthermore, NA comprises the most effective currently available treatment for raising HDL‐C levels and exerts a number of pleiotropic effects . The launch of a newer fixed combination of extended release (ER) NA with laropiprant (LRPT) seems to mitigate both the intensity and frequency of flushing (.…”