Do Statins Reduce Blood Pressure?

Abstract

Abstract-A meta-analysis was performed of the effect of 3hydroxy3methylglutaryl-coenzyme A reductase inhibitors (statins) on blood pressure in humans including the randomized, controlled trials of statin therapy (20 trials and 828 patients) in which concomitant antihypertensive treatment (if any) remained unchanged throughout the study. A total of 291 and 272 patients were given a statin or placebo, respectively, in parallel group trials, whereas 265 took part in crossover trials receiving a statin and placebo (or probucol, in 1 trial). Systolic blood pressure was significantly lower in patients on statin than in those on placebo or control hypolipidemic drug (mean difference: Ϫ1.9 mm Hg; 95% CI: Ϫ3.8 to Ϫ0.1). The effect was greater when the analysis was restricted to studies with a baseline systolic blood pressure Ͼ130 mm Hg (⌬ systolic blood pressure: Ϫ4.0; 95% CI: Ϫ5.8 to Ϫ2.2 mm Hg). There was a trend for lower diastolic blood pressure in patients receiving statin therapy compared with control: Ϫ0.9 mm Hg (95% CI: Ϫ2.0 to 0.2) overall and Ϫ1.2 mm Hg (95% CI: Ϫ2.6 to 0.1) in studies with a baseline diastolic blood pressure Ͼ80 mm Hg. In general, the higher the baseline blood pressure, the greater the effect of statins on blood pressure (Pϭ0.066 for systolic blood pressure and Pϭ0.023 for diastolic blood pressure). The blood pressure response to statins was unrelated to age, changes in serum cholesterol, or length of the trial. In conclusion, statin therapy has a relatively small but statistically significant and clinically meaningful effect on blood pressure. Key Words: blood pressure Ⅲ hypertension, arterial Ⅲ hypercholesterolemia Ⅲ drug therapy Ⅲ statins Ⅲ meta-analysis H igh blood pressure (BP) is common in hypercholesterolemic and in diabetic patients and powerfully contributes to the increase in cardiovascular risk. 1 The prescription of both antihypertensive and cholesterol-lowering drugs is generally required for these patients. Inhibitors of 3hydroxy3methylglutaryl-coenzyme A reductase (statins) are the most effective and widely used cholesterol-lowering drugs in industrialized countries. 2 They significantly reduce the risk of cardiovascular events and death in both primary and secondary prevention of cardiovascular disease. 3,4 Although the long-term benefit by statin treatment is largely attributed to their cholesterol-lowering action, increasing attention focuses on additional actions of these substances, which are independent from 3hydroxy3methylglutaryl-coenzyme A reductase inhibition 5 and might help explain why part of the benefit in terms of cardiovascular protection is already seen shortly after the initiation of therapy. 6,7 Very few relatively small studies have investigated the antihypertensive effect of statins in patients with hypertension associated with hypercholesterolemia. 8 -10 The results of 2 recently published large statin studies, albeit not designed to answer this question, have attracted the interest on this subject. 11,12 Many other studies, also not specifically aimed at ...

Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women

“…The Iranian dietary pattern, however, was significantly associated with dyslipidemia (OR ¼ 1.73, 95%CI: 1.02-2.99). 5 Furthermore, Strazzullo et al 31 in a meta-analysis of randomized, controlled trials highlighted that statin therapy has a relatively small but clinically meaningful effect on blood pressure.…”

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

“…However, the 4.3 mmHg systolic and 1.6 mmHg reduction in diastolic blood pressure was unexpected. There is limited short-term trial evidence that atorvastatin treatment may reduce blood pressure in hypertensive and dyslipidaemic patients [30][31][32][33], possibly by improving endothelium-dependent vascular function [34]. A single uncontrolled trial [35] in patients with type 2 diabetes showed a 10 mmHg reduction in diastolic blood pressure, but this may partly be explained by habituation and regression to the mean.…”

Response to Upregulation of Nitric Oxide, Inhibition of Oxidative Stress, and Antihypertensive Effects of Statins

“…2 This ability of statins was indeed the basis for one of the explanations that we proposed for the relatively small but clinically meaningful antihypertensive effect of these drugs in humans. 3 We share Zhou's considerations and recollect the experimental evidence in support of the concept that genetic or acquired susceptibility to the blood pressure effects of excess salt intake might partly operate through an imbalance between NO bioavailability and oxygen free radical production (see Reference 4 for review). Of course, this imbalance is not unique to hypertension (nor to salt-sensitive hypertension) in as much as it also occurs in such metabolic disorders as dyslipidemia or diabetes, which, in turn, tend to cluster with high blood pressure.…”