Antihypertensive Effects of Statins: A Meta‐Analysis of Prospective Controlled Studies

Abstract

In experimental studies, statins have been shown to lower blood pressure through increased nitric oxide bioavailability and improved arterial compliance. The clinical significance of this effect remains poorly documented. The authors performed a meta-analysis of the effect of statins on systolic blood pressure (SBP) and diastolic blood pressure (DBP) including prospective randomized, controlled trials of statin therapy. EMBASE and MEDLINE searches for studies in which patients were randomized to treatment with a statin plus standard treatment (or placebo) vs standard treatment (or placebo) were conducted. Studies that provided data on SBP and DBP values before the initiation of the treatment and at the end of the follow-up period were included. A total of 40 studies with 51 comparison groups examining 22,511 controls and 22,602 patients taking statins were examined. Mean SBP in the statin group decreased by 2.62 mm Hg (95% confidence interval [CI], À3.41 to À1.84; P<.001) and DBP by 0.94 mm Hg (95% CI, À1.31 to À0.57; P<.001). In studies including hypertensive patients, the decrease in blood pressures with statins was slightly greater (SBP, À3.07 mm Hg; 95% CI, À4.00 to À2.15 and DBP, 1.04; 95% CI, À1.47 to À0.61). Similarly, statins effectively reduced SBP in diabetic patients. In this large meta-analysis of prospective controlled studies, the authors found a small but statistically significant reduction of SBP in patients taking statins. The decrease in blood pressure may contribute to the pleiotro-pic effect of statins in reducing cardiovascular risk. J Clin Hypertens (Greenwich). 2013;15:310-320. ª2013 Wiley Periodicals Inc. Statins have pleiotropic effects such as improving endothelial-dependent vasodilation, increasing bio-availability of nitric oxide, and reducing levels of endothelin-1 (potent vasoconstrictor). 1 Statins also downregulate expression of angiotensin type 1 receptors , decrease expression of NAD(P)H oxidase subunit p22phox, and reduce free radical release in the vasculature 2 and have been shown to improve arterial compliance. 3 These pleiotropic effects may directly lower blood pressure (BP) in addition to lowering cholesterol levels. 3 Previous studies report a positive correlation between BP and cholesterol levels. Indirect evidence from several trials investigating cholesterol-lowering regimens suggests that lowering cholesterol may simultaneously reduce BP by between 2 mm Hg and 5 mm Hg. 4 However, conflicting results have been reported with respect to BP-lowering effects of statins in humans. 4 The present study was designed to systematically review prospective random-ized trials and assess the antihypertensive effects of statins. MATERIALS AND METHODS Search Strategy We systematically searched the electronic databases MEDLINE, PubMed, EMBASE, and the Cochrane Library for Central Register of Clinical Trials using the MESH terms statins, HMG-CoA enzyme inhibitors, hypertension, blood pressure, and the names of individual statin agents. We limited our search to studies in humans and pee...

Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup

“…15 A meta-analysis of antihypertensive effects of statins by Alexandros et al also showed a significant reduction in SBP and DBP in patients taking statins. 16 However in the present study, such results were not observed with respect to DBP in either group (Figure 2). At 16 weeks, comparison was done between Group-I and Group-II.…”

Blood pressure lowering effect of statin drugs with an application to rosuvastatin

“…Mean changes in SBP and DBP from baseline were then the key outcomes of in- The additive blood pressure lowering effect of statin therapy was considered to be the results of pleiotropic effect of statins. [4,15] There have been a growing number of evidence from both in vitro and animal studies that statins show pleiotropic effect such as increasing bioavailability of nitric oxide, improving endothelial-dependent vasodilation and reducing levels of endothelin-1, leading to reducing cardiovascular risk. [7,8,15,16] This phenomenon is deemed to be clinically important as hypertension and hyperlipidemia often co-exist within single patient and reducing cardiovascular risk would eventually lead to reduction in morbidity and mortality in patients.…”

OPTIMAL ORGANOPROTECTION, CONTROL OF bLOOD PRESSURE AND METAbOLIC DISORDER WITH THE FIxED COMbINATION OF LISINOPRIL, AMLODIPINE AND ROSUVASTATIN IN SYSTEMIC HYPERTENSION

“…По-видимому, это объяснимо уси-лением гипотензивного потенциала ста тинами [26]. Снижение АД было подтверждено данными СМАД, причем во всех группах исходной терапии отмечено положительное влияние на вариабельность АД фик-сированной комбинации лизиноприл+амлодипин+ розувастатин, что можно рассматривать как важную составляющую в коррекции SHATS синдрома (systemic hemodynamic atherothrombotic syndrome) [27].…”