Effect of Statin use on Patients with Hypertension: A Systematic Review and Meta-analysis

Abstract

Introduction This meta-analysis focused on the effects of statin use (either alone or in combination with antihypertensive drugs) on hypertension-related outcome measures, including systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein-cholesterol (LDL-C), low-density lipoprotein- cholesterol (HDL-C), triglyceride (TG), total cholesterol, TG and total cholesterol. Methods We searched the PubMed, EMBASE, and Cochrane databases before October1 2023.Studies designed as cohort study or randomized controlled trials and investigating the effects of statin use or combined with antihypertensive therapy versus no statin use or antihypertensive therapy alone were included. Authors extracted the data independently; differences were decided to discussion. we use random-effects models to evaluate the merged outcomes. Due to the high heterogeneity of HDL-C group, we performed subgroup analysis according to the type of statin. We use sensitivity analysis, Egger’s test and Funnel plots to evaluate the stability and publication bias of our study. Results 23 trials were included in this meta-analysis. The primary outcomes revealed that (1) administering statins did not significantly impact the SBP of hypertensive patients (MD,-1.77; 95% CI, -4.82 to 1.27). Subgroup analyses revealed a decrease in SBP in patients who received rosuvastatin (MD,-1.70; 95% CI,-2.75 to -0.65) and pravastatin (MD,-8.00; 95% CI,-10.79 to -5.21); (2) no significant effect of statin treatment on DBP in hypertensive patients (MD,-2.04; 95% CI,-4.11 to 0.02). However, subgroup analyses suggest that simvastatin (MD,-2.49; 95% CI, -4.91 to -0.07) and pravastatin (MD,-5.00; 95% CI, -6.60 to -3.40) significantly reduced DBP in hypertensive patients. The secondary outcomes revealed that (1) the use of statins resulted in a significant reduction in LDL-C in hypertensive patients (MD, -0.95; 95% CI, -1.32 to -0.65), while significantly increasing HDL-C (MD, 0.39; 95% CI, 0.15 to 0.64); (2) statins were shown to significantly reduce TG levels in hypertensive patients (MD -0.14, 95% CI -0.23 to -0.05); (3) statins significantly reduced total cholesterol in those hypertensive patients (MD, -1.75; 95% CI, -2.66 to -0.83); (4) statins significantly reduced the incidence of cardiovascular events (HR, 0.73; 95% CI, 0.62 to 0.85) and mortality (HR, 0.47; 95% CI, 0.33 to 0.60). Conclusion Statin use did not modulate SBP and DBP of patients with hypertension, but SBP was decreased in rosuvastatin or pravastatin subgroup and DBP was decreased in simvastatin or pravastatin subgroup. Statin treatment reduced LDL-C, increased HDL-C, reduced TG and total cholesterol, reduced the incidence of cardiovascular events and mortality compared to control groups.

Statins As Anti-Hypertensive Therapy: A Systematic Review and Meta-Analysis

“…Two independent reviewers performed a literature search using the above search engines and agreed on the inclusion and exclusion of articles. In case of disagreement between the two reviewers, a third independent reviewer’s opinion was sought, and a decision about the inclusion or exclusion of the articles was made through a majority consensus [ 1 - 48 ].…”

“…The details of the studies included in this meta-analysis are presented in Tables 2 , 3 . Numerous articles have been published on the role of statins in hypertension and dyslipidaemia [ 1 - 48 ]. Table 2 provides demographic and outcome data for the 25 RCTs included in the current meta-analysis and Table 3 provides the data for the seven meta-analyses included in the current meta-analysis.…”

“…Several studies, including RCTs and meta-analyses, have demonstrated the blood pressure-lowering effects of statins when used alone or in combination with antihypertensive therapy in patients with hypertension [ 1 - 48 ]. Statins also offer additional benefits, such as cholesterol-lowering effects, improved endothelial function, and reduced inflammatory response.…”