Statins: another class of antihypertensive agents?

Abstract

The assessment of global cardiovascular risk is an essential step in the management of atherosclerotic disease prevention. Among the risk factors to be addressed are hypertension and hyperlipidaemia; these commonly coexist. A neutral or lipid-friendly antihypertensive agent is probably useful in the presence of lipid abnormalities. Similarly, statins have been shown to decrease cardiovascular risk in hypertensive patients. There is also experimental and clinical evidence that statins have blood pressure (BP)-lowering effects. In this review, we discuss the beneficial effects of statins on BP, and provide an overview of the underlying pathophysiology. We also consider the evidence justifying the use of statins in the management of hypertensive patients.

Prevention of cardiovascular disease in clinical practice: The Joint British Societies' (JBS 2) guidelines

“…33 Whether statins per se have a blood pressure lowering effect per se has been subject of recent debate. 34,35 Whereas the frequency of lipid lowering therapy in CHD patients is relatively high, there still remains a treatment gap, 36 and the new JBS-2 guidelines provides clear guidelines that will hopefully help bridge these gaps in management and facilitate measures geared towards achieving targets. The recommended targets in JBS-2 are a serum total cholesterol o4.0 mmol/l and LDL cholesterol o2.0 mmol/l, or a 25% reduction in total cholesterol and a 30% reduction in LDL cholesterol, whichever gets the person to the lowest absolute level.…”

Towards improving the clinical assessment and management of human hypertension: an overview from this Journal

“…Statins have a track record of cardiovascular protection, and interest has been directed to its possible effect on BP. 25,26 Indeed, contrasting effects have been shown with the (controversial) suggestion by Wierzbicki 25 that statins may reduce BP only provided that low-density lipoprotein cholesterol is reduced by 50% or o2 mmol/l, and that these effects may be better demonstrated in lower risk primary prevention populations where endothelial function is easier to normalize. In one study, for example, statin use by hyperlipidaemic hypertensive patients was associated with a significant reduction in aortic stiffness without any marked effect on BP.…”

Effects of Atorvastatin on Red-blood Cell Na+/Li+ Countertransport in Hyperlipidemic Patients With and Without Hypertension

“…Owing to the high prevalence of these conditions in the general population this association should not be regarded as merely coincidental and may result from shared environmental and genetic risk factors. 1 Large landmark studies confirm that 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) can reduce cardiovascular disease (CVD) risk in hyperlipidemic hypertensive patients. 1 Current therapeutic strategies include initiation of a statin in hypertensive patients with dyslipidemia depending on the level of CVD risk.…”

“…1 Large landmark studies confirm that 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) can reduce cardiovascular disease (CVD) risk in hyperlipidemic hypertensive patients. 1 Current therapeutic strategies include initiation of a statin in hypertensive patients with dyslipidemia depending on the level of CVD risk. 2 In addition to their lipid-lowering capacity, these agents exhibit ancillary actions, collectively known as "pleiotropic," including favorable effects on blood pressure (BP) as well as on target-organ damage associated with hypertension.…”

“…2 In addition to their lipid-lowering capacity, these agents exhibit ancillary actions, collectively known as "pleiotropic," including favorable effects on blood pressure (BP) as well as on target-organ damage associated with hypertension. 1 Abnormalities in the transmembrane transport system of sodium have been proposed as a factor that might be the phenotypic expression of coaggregation of hypertension and lipid abnormalities. 3 Elevated red cell sodium-lithium countertransport (Na + /Li + CT) activity has been demonstrated in patients with essential hypertension, [4][5][6] insulin resistance and diabetes mellitus, 7,8 as well as with hyperlipidemia.…”