Are statins effective for simultaneously treating dyslipidemias and hypertension?

Abstract

Abstract3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are unequivocally useful for lowering cholesterol levels in patients with dyslipidemias characterized by elevations in total and/or low-density lipoprotein cholesterol. The beneficial effects of statins to lower serum cholesterol translate into significant reductions in cardiovascular morbidity and mortality. In addition to lowering cholesterol levels, statins have other biological effects relevant to cardiovascular homeostasis including anti-inflammatory actions and downregulation of angiotensin type 1 receptor expression that contribute to improvements in enodthelial function and arterial compliance. Since enodthelial dysfunction and reduced arterial compliance are important pathophysiological determinants of essential hypertension, these actions of statins raise the possibility that statin therapy may be useful for simultaneously treating dyslipidemias and hypertension. However, it has been unclear whether statins are effective in lowering blood pressure. This controversy stems from a variety of methodological limitations including inadequate sample size, confounding effects of antihypertensive drugs, differences in blood pressure measurement techniques, and differences in patient populations. However, based on published results from both small clinical studies and large randomized clinical trials, statins modestly lower blood pressure in patients with high, but not normal, blood pressure, regardless of cholesterol level.

Dyslipidemia and the risk of incident hypertension in a population of community-dwelling Brazilian elderly: the Bambuí cohort study of aging

“…Renal microvascular injuries due to dyslipidemias are also postulated to contribute to arterial hypertension 12 . Finally, coincident genetic factors, such as having chromosomal regions related to blood pressure and dyslipidemias in common 13,14 , which predispose for the concomitant occurrence of hypertension and dyslipidemia 15 , and the fact that reductions in blood pressure in hypertensive individuals have been attributed to use of statins 16 , suggest shared pathophysiologic mechanisms that need to be better elucidated.…”

Statin prescribing among hypertensive patients in southwest Nigeria: findings and implications for the future

“…Statins (3-hydroxy 3-methyl glutaryl co-enzyme A (HMG-COA) reductase inhibitors) are first-line treatment for patients with cardiovascular risk and elevated serum cholesterol [6][7][8] . Statins are particularly useful for treating hypercholesterolemia in hypertensive patient because of their concomitant blood pressure reducing effects [9][10][11]. These effects have been largely attributed to their reported ability to improve arterial compliance, increase bioavailability of nitric oxide, improve endothelial-dependent vasodilation and reduce levels of endothelin-1, which is a potent vasoconstrictor [12][13][14][15].…”

Prevention of Atherosclerosis in Overweight/Obese Patients - In Need of Novel Multi-Targeted Approaches -

“…These studies strongly support our view that statins modestly lower blood pressure in patients with high, but not normal, blood pressure, regardless of cholesterol level. 57 However, although statins may not improve blood pressure control in subjects with both hypercholesterolemia and controlled hypertension, statins markedly reduced the burden of cardiovascular disease. 59, 60 In clinical studies, combined therapy significantly reduced cholesterol levels and blood pressure, and increased adiponectin levels and thus improved endothelial dysfunction and insulin resistance.…”

“…55 Statins Statins may significantly improve blood pressure control in subjects with both hypercholesterolemia and uncontrolled hypertension. 56, 57 On the other hand, statins may not improve blood pressure control in subjects with both hypercholesterolemia and controlled hypertension. 57, 58 For instance, in the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese study, 89% and 88% of the diet and diet plus pravastatin groups, respectively, were taking antihypertensive drugs.…”