Low-dose atorvastatin reduces ambulatory blood pressure in patients with mild hypertension and hypercholesterolaemia: a double-blind, randomized, placebo-controlled study

Abstract

Among several beneficial cardiovascular actions of statins, experimental studies have suggested that statins may also induce a mild blood pressure (BP) reduction. However, clinical data were controversial and the potential hypotensive statin effect remains uncertain. This study aimed to investigate the effect of atorvastatin on ambulatory BP in patients with mild hypertension and hypercholesterolaemia. A total of 50 patients with mild hypertension and hypercholesterolaemia participated in this double-blind, randomized, placebo-controlled study. Patients were randomized to either 10 mg atorvastatin or placebo for 26 weeks. Background antihypertensive treatment, if any, remained unchanged during follow-up. At baseline and study-end (26 weeks), ambulatory BP monitoring and blood sampling for determination of standard biochemical and safety parameters were performed in all participants. BP loads were defined as the percentage of BP measurements exceeding the hypertension threshold of 140/90 mm Hg for daytime and 125/75 mm Hg nighttime period. Atorvastatin significantly reduced 24-h systolic and diastolic BP (DBP; median (range)) as compared with placebo (-5.0 (-21.0, 4.0) vs +1.0 (-6.0, 7.0) mm Hg, P<0.001 and -3.0 (-16.0, 2.0) vs +0.1 (-7, 4) mm Hg, P<0.01, respectively). Reductions in systolic and DBP loads during follow-up were also evident in the atorvastatin, but not in the placebo group. BP-lowering effects of atorvastatin were consistent in both daytime and nighttime periods. This study shows a mild, but consistent throughout the 24-h period BP-lowering effect of atorvastatin in patients with mild hypertension and hypercholesterolaemia. This beneficial effect of atorvastatin on BP may represent another pathway through which this drug class provides cardiovascular risk reduction.

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

“…One study compared fluvastatin plus orlistat (an inhibitor of intestinal lipid digestion) with orlistat alone. Some studies included only hypertensive patients, and other studies up‐titrated the antihypertensive agents . Four studies included only type 1 or only type 2 diabetic patients …”

“…The mean age of patients taking statins was 57.9AE5.8 years, which was not significantly different from the mean age of the control group (57.7AE6.5 years). Atorvastatin was the statin used in 15 studies, 7,[9][10][11][12]14,16,20,24,31,34,36,37,41,43 pravastatin in 8 studies, 8,13,19,26,28,39,40,42,46 simvastatin in 10 studies, 13,23,29,30,35,39,44,45,47,49 fluvastatin in 4 studies, 21,27,38,39 cerivastatin in 2 studies, 15,25 and lovastatin in 1 study. 48 One study 27 compared fluvastatin plus orlistat (an inhibitor of intestinal lipid digestion) with orlistat alone.…”

“…48 One study 27 compared fluvastatin plus orlistat (an inhibitor of intestinal lipid digestion) with orlistat alone. Some studies included only hypertensive patients, 7,9,10,12,[15][16][17][18][19][20][21][22][23][24]28,30,31,[35][36][37][38][39][40][41][42]44,45 and other studies up-titrated the antihypertensive agents. 7,9,10,12,15,17-19, 21,36,38-40,49 Four studies included only type 1 or only type 2 diabetic patients.…”

Effect of Monacolin K and COQ10 supplementation in hypertensive and hypercholesterolemic subjects with metabolic syndrome

“…Structural and functional effects of statins include reductions in vascular smooth muscle hypertrophy and proliferation, fibrin and collagen deposition [29], improving endothelial function, reducing inflammatory cytokines and reactive oxygen species, and the down-regulation of the angiotensin II and endothelin receptors [30]. We speculate a possible vasoactive action of Monacolin K leading to a mild BP lowering effect as well as observed with low doses of statins [31]. In addition, Monacolin K seems works better when paired with Mediterranean diet, thus opening the question if it shows the same benefit when added with other diets.…”

Future Treatment of Hypertension: Shifting the Focus from Blood Pressure Lowering to Arterial Stiffness Modulation?

“…Direct Treatment of PWV A number of short-term randomised controlled trials investigating the blockade/ inhibition of renin [71], angiotensin converting enzyme/ angiotensin AT1 receptor blockers [72][73][74][75][76][77][78][79][80], endothelin [81], aldosterone [82,83], phosphodiesterase V [84,85], HMGcoA reductase [86][87][88][89][90][91][92] and xanthine oxidase [93] have been shown to reduce aortic PWV. An important randomised trial in patients with early renal impairment showed both PWV and left ventricular mass reduction over 1 year on just 25 mg spironolactone versus placebo, which the authors claimed was independent of BP [94].…”