Additive effects of Simvastatin beyond its effects on LDL cholesterol in hypertensive type 2 diabetic patients

Tonolo, Giancarlo; Melis, Maria Grazia; Formato, Marilena; Angius, M. F.; Carboni, A.; Brizzi, Patrizia; Ciccarese, M.; Cherchi, Gian Mario; Maioli, Mario

doi:10.1046/j.1365-2362.2000.00735.x

Cited by 129 publications

(72 citation statements)

References 53 publications

(60 reference statements)

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“…52 The potential effects of simvastatin on BP and urinary albumin excretion beyond its capacity to lower serum cholesterol were evaluated in 26 microalbuminuric hypertensive type II diabetic patients (diastolic BP consistently 490 ando100 mm Hg; plasma LDL-C43.9 and o6.5 mmol/l (4151 and o251 mg/dl)). 53 In random order, these patients received simvastatin (20 mg/day) or cholestyramine (6 g three times a day) for a period of 10 months, and after 3 months of wash-out (crossover), the sequence was reversed for an additional 10 months. Simvastatin and cholestyramine were equally effective in reducing TC and LDL-C.…”

Section: Do Lipid Abnormalities Predict the Risk For Hypertension?mentioning

confidence: 99%

“…These findings are indicative of an antihypertensive effect of simvastatin independently of its cholesterol-lowering capacity. 53 In a randomised, double-blinded, cross-over study, 54 22 patients with isolated systolic hypertension (ISH) received 3 months of atorvastatin therapy (80 mg/day, that is, intensive hypolipidaemic treatment) and 3 months of placebo treatment. Besides a 48% decrease in LDL-C levels, atorvastatin reduced brachial systolic BP (14872 vs 15473 mm Hg in the placebo group, P ¼ 0.03), mean BP (10772 mm Hg vs 11172, P ¼ 0.04) and diastolic BP (8172 vs 8371 mm Hg, P ¼ 0.04).…”

Section: Do Lipid Abnormalities Predict the Risk For Hypertension?mentioning

confidence: 99%

“…127 Renal function, hypertension, lipids and statins The association between renal function and hypertension is well established. 6,36,[38][39][40]53 This association may also be influenced by lipid changes occurring in patients with renal disease and who also have a raised BP, as discussed above. 6,36,[38][39][40]53 The contribution of lipids to the renal functionhypertension association may at least in part explain why statins exert beneficial effects on both renal function and hypertension.…”

mentioning

confidence: 99%

“…6,36,[38][39][40]53 This association may also be influenced by lipid changes occurring in patients with renal disease and who also have a raised BP, as discussed above. 6,36,[38][39][40]53 The contribution of lipids to the renal functionhypertension association may at least in part explain why statins exert beneficial effects on both renal function and hypertension. 6,36,[38][39][40]53,128 It is also relevant that recent trials have shown that aggressive treatment with statins improves serum creatinine and urate levels.…”

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confidence: 99%

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Statins: another class of antihypertensive agents?

et al. 2006

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The assessment of global cardiovascular risk is an essential step in the management of atherosclerotic disease prevention. Among the risk factors to be addressed are hypertension and hyperlipidaemia; these commonly coexist. A neutral or lipid-friendly antihypertensive agent is probably useful in the presence of lipid abnormalities. Similarly, statins have been shown to decrease cardiovascular risk in hypertensive patients. There is also experimental and clinical evidence that statins have blood pressure (BP)-lowering effects. In this review, we discuss the beneficial effects of statins on BP, and provide an overview of the underlying pathophysiology. We also consider the evidence justifying the use of statins in the management of hypertensive patients.

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Section: Do Lipid Abnormalities Predict the Risk For Hypertension?mentioning

confidence: 99%

Section: Do Lipid Abnormalities Predict the Risk For Hypertension?mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Statins: another class of antihypertensive agents?

et al. 2006

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“…These data are consistent with experimental data and retrospective studies in humans suggesting that statin use may reduce blood pressure, [13][14][15][16][17]25,26 possibly independent of their effects on serum cholesterol. 27 However, three previous blinded, randomized studies that included a total of 480 patients found no significant effect of statins on blood pressure, 18,28,29 although the confidence limits for the individual studies did not exclude a moderate antihypertensive effect of statin treatment.…”

Section: Discussionmentioning

confidence: 98%

Effect of pravastatin on blood pressure in people with cardiovascular disease

et al. 2006

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Experimental evidence and several small studies in humans suggest that HMG-CoA (3-hydroxy 3-methylglutaryl coenzyme A) reductase inhibitors (statins) reduce blood pressure, perhaps through effects on endothelial function or by reducing inflammation. We tested the hypothesis that pravastatin would reduce blood pressure at 3 months and the risk of developing new hypertension over a follow-up period of 5 years. This was a post hoc subgroup analysis of a randomized double-blind placebo-controlled trial of pravastatin 40 mg daily vs placebo in 4159 participants with previous myocardial infarction and total plasma cholesterol o240 mg/dl (6.2 mmol/l). The primary outcome was the unadjusted change in mean arterial pressure (MAP) from baseline to 3 months. We also considered systolic and diastolic blood pressure (SBP and DBP) and pulse pressure. Analysis of covariance was used to calculate the adjusted effect of treatment on change in these outcomes at 3, 6, 12 and 24 months postrandomization, after controlling for potential confounders. Logistic regression was used to calculate the adjusted effect of treatment on incident hypertension (blood pressure X140/90 in those without known hypertension at baseline). This analysis included 4126/4159 (99.2%) participants for whom blood pressure was measured at baseline and during at least one follow-up visit. Median duration of follow-up was 57.8 months. The unadjusted and adjusted change in MAP, SBP, DBP or pulse pressure from baseline was not significantly different for pravastatin or placebo recipients at 3, 6, 12 or 24 months after randomization, or at last follow-up. Pravastatin did not reduce the adjusted risk of incident systolic hypertension (odds ratio 0.99, 95% CI 0.80-1.23), or incident diastolic hypertension (odds ratio 0.97, 95% CI 0.73-1.27). In summary, pravastatin 40 mg daily did not reduce blood pressure in survivors of myocardial infarction without overt hypercholesterolaemia.

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Interactions Between the Renin-Angiotensin System and Dyslipidemia

Singh

Mehta²

2003

Arch Intern Med

102

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Dyslipidemia and hypertension are frequently observed in patients with ischemic heart disease. Studies from a number of laboratories suggest up-regulation of different components of the renin-angiotensin system (RAS) in patients with hypertension and atherosclerosis. Lipid accumulation in the blood vessels enhances the expression of RAS components; on the other hand, activation of RAS stimulates accumulation of low-density lipoproteins, particularly the oxidatively modified form, in the blood vessels. This concept of cross-talk between dyslipidemia and RAS activation has been proven in laboratory-based studies. Clinical trials also suggest that blockade of dyslipidemia and RAS may have a synergistic salutary effect on the outcome of patients with hypertension and/or manifestations of atherosclerosis. This concept needs to be evaluated in large clinical studies.

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Additive effects of Simvastatin beyond its effects on LDL cholesterol in hypertensive type 2 diabetic patients

Cited by 129 publications

References 53 publications

Statins: another class of antihypertensive agents?

Statins: another class of antihypertensive agents?

Effect of pravastatin on blood pressure in people with cardiovascular disease

Interactions Between the Renin-Angiotensin System and Dyslipidemia

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