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Statins shown to reduce blood pressure

A randomised, controlled trial has demonstrated a small but significant reduction in systolic and diastolic blood pressure with both a lipophilic and a hydrophilic statin.

Nearly 1,000 men and women without known cardiovascular disease or diabetes and with LDL cholesterol levels of 115-190mg/dl (3-5mmol/l) were enrolled. Baseline blood pressure was measured and participants were randomised to simvastatin 20mg, pravastatin 40mg or placebo for six months. Additional blood pressure recordings were made at one and six months, and two months after treatment ended.

Mean systolic and diastolic blood pressure at baseline was 126mmHg and 75mmHg respectively across the three treatment groups. High baseline blood pressure was defined as systolic >140mmHg or diastolic >90mmHg.

The results showed a significant blood pressure reduction with statins compared with placebo: 2.2mmHg for systolic (P=0.02) and 2.4mmHg for diastolic (P=<0.001). Patients taking simvastatin achieved a greater mean reduction than those taking pravastatin (2.9/3.0mmHg compared with 1.5/2.3mmHg).

When patients with hypertension or taking antihypertensives at baseline were excluded from the analysis, mean blood pressure reduction was 2.6/2.5mmHg in the statins group, with a mean reduction of 3.0/2.7mmHg and 2.2/2.3mmHg for simvastatin and pravastatin respectively.

After drug therapy was stopped, the effect on blood pressure was lost.

The effects of statins on lipids are well described and there is a robust body of evidence supporting their use across the spectrum of cardiovascular disease. Some of these studies have pointed towards a beneficial effect of statins on blood pressure. This North American study is the first randomised, controlled trial to address this question specifically with both a lipophilic and a hydrophilic statin.

This trial has demonstrated a small but significant reduction in both systolic and diastolic blood pressure with both types of statin. This may help explain the early reduction in cardiovascular events with statins and such effects could be mediated through improvements in endothelial function and, in particular, nitric oxide-mediated vasodilatation.

However, I think it is a little early to start prescribing statins as antihypertensives.

Golomb BA, Dimsdale JE, White HL et al. Reduction in Blood Pressure With Statins: Results From the UCSD Statin Study, a Randomized Trial. Arch Intern Med 2008;168:721-7

Reviewer

Dr Peter Savill
GPwSI Cardiology, Southampton

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