Does Fenofibrate Lower Blood Pressure?

Abstract

Walker et al 1 demonstrated that short-term treatment with fenofibrate improves vascular endothelial function in healthy normolipidemic middle-aged and older adults by reducing oxidative stress and induces an increase in endothelial NO synthase without lowering systolic and diastolic blood pressure (SBP and DBP) significantly, providing potential support for the non-lipid-lowering effects of fenofibrate in mediating its vascular health-promoting influence in humans.With regard to arterial blood pressure (BP), the effect of fenofibrate is inconsistent because baseline BP may affect the effect of fenofibrate. Indeed, we first reported that fenofibrate significantly reduced SBP by 3 mm Hg (P=0.007) and DBP by 3 mm Hg (P=0.033) after 2 months' administration in hypertriglyceridemic, hypertensive patients when compared with baseline SBP 142 and DBP 90 mm Hg.2 In a different study of ours in patients with primary hypertriglyceridemia, 3 fenofibrate did not significantly reduce SBP and DBP. Ten among 46 patients were mildly hypertensive. The baseline SBP and DBP were 134 and 80 mm Hg, respectively. In the study by Walker et al, 1 the baseline SBP and DBP were 117 and 72 mm Hg, respectively, in the fenofibrate group.The effects of fenofibrate are quite similar to statins regarding pleiotropic effects beyond lipid lowering, such as improving vascular endothelial function, reducing oxidative stress, and inducing an increase in endothelial NO synthase. 4 Because endothelial 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 BP. This controversy stems from a variety of methodological limitations, including inadequate sample size, confounding effects of antihypertensive drugs, differences in BP measurement techniques, and differences in patient populations. However, on the basis of published results from both small clinical studies and large randomized clinical trials, statins modestly lower BP in patients with high, but not normal, BP, regardless of cholesterol level.5 Similarly, fenofibrate therapy may modestly lower BP in patients with high, but not normal, BP, regardless of lipid level. DisclosuresNone.