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Wan J, Chen M. Effects of statin on hypertension patients: A systematic review and meta-analysis. EUR J INFLAMM 2023. [DOI: 10.1177/1721727x221144454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective To conduct a systematic review and meta-analysis to compare the effects of statins and placebo on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension. Methods We used different databases such as MEDLINE and the Cochrane Library Central Register of Controlled Trials (CENTRAL) to search for randomized controlled trials published from 1 January 2000 to 1 January 2022 to retrieve relevant studies and full-text articles evaluating statins versus placebo in patients with hypertension. Data were taken from eligible studies. The included articles also performed Cochran’s Q statistics, forest plots, funnel plots, Egger’s test, and sensitivity analyses. Results This study included 8 studies with a total of 3086 patients. We sought to assess patients' SBP and DBP. The results were expressed as mean differences (MD) with 95% confidence intervals. There was no difference in DBP between the statin and placebo groups (MD = 2.48, 95% CI [−2.00, 6.96], p = .28, random effects model). In terms of SBP, the statin group was superior to the placebo group (MD = 4.37, 95% CI [0.72, 8.02], p = .02, random-effects model). Sensitivity analyses and funnel plots showed that our study was robust, with low publication bias. Conclusion The results show that statins could be clinically more effective than placebo in patients with hypertension.
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Affiliation(s)
- Jianwei Wan
- Department of Pharmacy, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, China
| | - Min Chen
- Department of Pharmacy, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, China
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Ali N, Faheem M, Ullah H, Shabana H, Kassem A, Ahmed MO, Elmahdi E. Atorvastatin as an Antihypertensive Agent: A Pilot Study. Cureus 2023; 15:e49532. [PMID: 38156151 PMCID: PMC10753094 DOI: 10.7759/cureus.49532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Hypertension (HTN) is among the most common causes of chronic disease burden, along with dyslipidemia. It is a prominent risk factor for cardiovascular and cerebrovascular morbidity and mortality. More often than not, HTN coexists with dyslipidemia. This study aimed to see the antihypertensive effect of statins (atorvastatin), as certain animal models have shown that statins have a voltage-gated calcium channel-blocking effect. Material and methods This was a randomized controlled trial done at the Ayub Hospital Complex in Abbottabad, Pakistan. After ethical approval, 120 patients with newly diagnosed hypertension belonging to either gender and aged 35 and above were enrolled in the trial. They were randomly divided into two groups, with each group comprising 60 patients. One group was administered amlodipine 5 mg per oral (PO) once a day, while the other group was given 5 mg of amlodipine PO plus 10 mg of atorvastatin PO. The patients were examined on a follow-up visit 14 days later, and blood pressure was recorded as per protocols. Results A total of 120 newly diagnosed patients were studied in this trial. The mean age was 51.07 years, with a standard deviation of ±6.15 years and a range of 41-60 years. There were 64 (53.3%) males and 56 (46.7%) females in the study. The mean systolic blood pressures (SBPs) and diastolic blood pressures (DBPs) in Group 2 (amlodipine 5 mg + atorvastatin 10 mg) were significantly lower than the patients in Group 1 (only amlodipine 5 mg) in the follow-up visit, which was 14 days after starting the medication (p≤0.05). Conclusion The addition of a lipid-lowering drug to an antihypertensive regimen results in a better lowering of blood pressure in hypertensive individuals.
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Affiliation(s)
- Niaz Ali
- Pharmacology, College of Medicine, Shaqra University, Shaqra, SAU
| | | | - Himayat Ullah
- Medicine, College of Medicine, Shaqra University, Shaqra, SAU
| | - Hosam Shabana
- Medicine, College of Medicine, Shaqra University, Shaqra, SAU
| | - Arafat Kassem
- Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Mahmoud O Ahmed
- Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Essam Elmahdi
- Internal Medicine, Faculty of Medicine, Mansoura University, Al Mansoura, EGY
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Lee S, Yang S, Chang MJ. Antihypertensive effects of rosuvastatin in patients with hypertension and dyslipidemia: A systemic review and meta-analysis of randomized studies. PLoS One 2021; 16:e0260391. [PMID: 34818350 PMCID: PMC8612562 DOI: 10.1371/journal.pone.0260391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Some studies have suggested the antihypertensive effects of statins, a class of lipid-lowering agents, particularly in patients with hypertension. However, the evidence for the role of statins in blood pressure (BP) lowering is controversial, and no meta-analysis of rosuvastatin therapy has been conducted to assess its BP-lowering effects. Therefore, the aim of this meta-analysis of randomized controlled trials (RCTs) was to investigate the effects of rosuvastatin on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension. We systematically searched the electronic databases MEDLINE, EMBASE, and Cochrane Library to identify RCTs in which patients were assigned to groups of rosuvastatin plus antihypertensive agents vs. antihypertensive agents. The three authors independently selected the studies, extracted data, and assessed methodological quality. We included five RCTs in this meta-analysis with 288 patients treated with rosuvastatin and 219 patients without rosuvastatin. The mean DBP in the rosuvastatin group was significantly lower than that in the non-rosuvastatin group by -2.12 mmHg (95% confidence interval (CI) -3.72 to -0.52; Pfixed-effects model = 0.009; I2 = 0%, Pheterogeneity = 0.97). Rosuvastatin treatment also lowered the mean SBP compared with the non-rosuvastatin treatment by -2.27 mmHg, but not significantly (95% CI - 4.75 to 0.25; Pfixed-effects model = 0.08; I2 = 0%, Pheterogeneity = 0.82). In this study, we reviewed the antihypertensive effects of rosuvastatin in patients with hypertension and dyslipidemia. We demonstrated a modest significant reduction of DBP and a trend toward a lowered SBP in patients with hypertension with rosuvastatin therapy. Rosuvastatin could be beneficial to control hypertension and, consequently, contribute toward reducing the risk of cardiovascular events in patients with hypertension and dyslipidemia.
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Affiliation(s)
- Sungjae Lee
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Seungwon Yang
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Science, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Min Jung Chang
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Science, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Industrial Pharmaceutical Science, Yonsei University, Incheon, Republic of Korea
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Akunne OO, Godman B, Adedapo AD, Truter I, Fadare J. Statin prescribing among hypertensive patients in southwest Nigeria: findings and implications for the future. J Comp Eff Res 2016; 5:281-8. [DOI: 10.2217/cer.15.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Statins reduce cardiovascular risk, especially in patients with hypertension due to their concomitant blood pressure reducing effects. Prescribing generic statins minimizes cost and improves access. Aims: Ascertain current prescribing of statins in Nigeria and potential savings from the increased use of generic statins. Methods: Prospective study involving hypertensive patients attending University College Hospital (Ibadan, Nigeria). Results: In total, 228 hypertensive patients received statins. Atorvastatin was the most prescribed statin, followed by simvastatin, rosuvastatin and finally fluvastatin. Prescribed doses were less than one defined daily dose in the majority, with high use of originators. Average monthly potential savings from increased prescribing of generic statins was US$2635 for atorvastatin and US$10,578 for rosuvastatin. Conclusion: A shift toward increased prescribing generic statins is recommended to minimize costs.
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Affiliation(s)
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela Metropolitan University, Port Elizabeth 6031, South Africa
| | - Joseph Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Nigeria
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Koh KK, Oh PC, Sakuma I, Kim EY, Lee Y, Hayashi T, Han SH, Park YM, Shin EK. Vascular and metabolic effects of ezetimibe combined with simvastatin in patients with hypercholesterolemia. Int J Cardiol 2015; 199:126-31. [DOI: 10.1016/j.ijcard.2015.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022]
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Lee CK, Choi JS, Choi DH. Effects of HMG-CoA reductase inhibitors on the pharmacokinetics of nifedipine in rats: Possible role of P-gp and CYP3A4 inhibition by HMG-CoA reductase inhibitors. Pharmacol Rep 2015; 67:44-51. [DOI: 10.1016/j.pharep.2014.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 01/12/2023]
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Effects of Atorvastatin on Resting and Peak Exercise Blood Pressure among Normotensive Men and Women. CHOLESTEROL 2014; 2014:720507. [PMID: 25478215 PMCID: PMC4251356 DOI: 10.1155/2014/720507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
Statins are the most widely prescribed and effective medication for reducing low density lipoprotein cholesterol. Statins may also lower resting blood pressure (BP); however, results are inconsistent. We sought to determine if the maximum dose of atorvastatin reduces resting BP and the peak systolic BP (SBP) achieved on a graded exercise stress test (GEST) among a large sample of 419 healthy men (48%) and women (52%). Subjects (419, 44.1 ± 0.8 yr) were double-blinded and randomized to 80 mg·d−1 of atorvastatin (n = 202) or placebo (n = 217) for 6 mo. Among the total sample, there were no differences in resting BP (SBP, P = 0.30; diastolic BP [DBP], P = 0.69; mean arterial pressure (P = 0.76); or peak SBP on a GEST (P = 0.99)) over 6 mo, regardless of drug treatment group. However, among women on atorvastatin, resting SBP/DBP (3.7±1.5 mmHg, P = 0.01/3.2±0.9 mmHg, P = 0.02) and peak SBP on a GEST (6.5±1.5 mmHg, P = 0.04) were lower versus men. Atorvastatin lowered resting BP 3-4 mmHg and peak SBP on a GEST ~7 mmHg more among women than men over 6 mo of treatment. The inconsistent findings regarding the antihypertensive effects of statins may be partially explained by not accounting for sex effects.
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Cheng WH, Ho WY, Chang CF, Lu PJ, Cheng PW, Yeh TC, Hong LZ, Sun GC, Hsiao M, Tseng CJ. Simvastatin induces a central hypotensive effect via Ras-mediated signalling to cause eNOS up-regulation. Br J Pharmacol 2014; 170:847-58. [PMID: 23889671 DOI: 10.1111/bph.12317] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/08/2013] [Accepted: 07/21/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Clinical studies indicate that statins have a BP-lowering effect in hypercholesterolemic individuals with hypertension. Specifically, statins modulate BP through the up-regulation of endothelial NOS (eNOS) activation in the brain. However, the signalling mechanisms through which statins enhance eNOS activation remain unclear. Therefore, we examined the possible signalling pathways involved in statin-mediated BP regulation in the nucleus tractus solitarii (NTS). EXPERIMENTAL APPROACH To investigate the involvement of Ras and other signalling pathways in simvastatin-induced effects on BP, BP and renal sympathetic nerve activity (RSNA) were determined in spontaneously hypertensive rats (SHRs) before and after i.c.v. administration of simvastatin in the absence and presence of a Ras-specific inhibitor (farnesyl thiosalicylic acid, FTS), a geranylgeranyltransferase inhibitor (GGTI-2133), a PI3K inhibitor (LY294002) or a MAPK-ERK kinase (MEK) inhibitor (PD98059). KEY RESULTS FTS significantly attenuated the decrease in BP and increased NO evoked by simvastatin and reversed the decrease in basal RSNA induced by simvastatin. Immunoblotting and pharmacological studies showed that inhibition of Ras activity by FTS significantly abolished simvastatin-induced phosphorylation of ERK1/2, ribosomal protein S6 kinase (RSK), Akt and decreased eNOS phosphorylation. Likewise, administration of Akt and ERK1/2 signalling inhibitors, LY294002 and PD98059, attenuated the reduction in BP evoked by simvastatin. Furthermore, i.c.v. simvastatin decreased Rac1 activation and the number of ROS-positive cells in the NTS. CONCLUSIONS AND IMPLICATIONS Simvastatin modulates central BP control in the NTS of SHRs by increasing Ras-mediated activation of the PI3K-Akt and ERK1/2-RSK signalling pathways, which then up-regulates eNOS activation.
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Affiliation(s)
- Wen-Han Cheng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Ballard KD, Quann EE, Kupchak BR, Volk BM, Kawiecki DM, Fernandez ML, Seip RL, Maresh CM, Kraemer WJ, Volek JS. Dietary carbohydrate restriction improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers in individuals taking statins. Nutr Res 2013; 33:905-12. [PMID: 24176230 DOI: 10.1016/j.nutres.2013.07.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/25/2022]
Abstract
Statins positively impact plasma low-density lipoprotein cholesterol, inflammation and vascular endothelial function (VEF). Carbohydrate restricted diets (CRD) improve atherogenic dyslipidemia, and similar to statins, have been shown to favorably affect markers of inflammation and VEF. No studies have examined whether a CRD provides additional benefit beyond that achieved by habitual statin use. We hypothesized that a CRD (<50 g carbohydrate/d) for 6 weeks would improve lipid profiles and insulin sensitivity, reduce blood pressure, decrease cellular adhesion and inflammatory biomarkers, and augment VEF (flow-mediated dilation and forearm blood flow) in statin users. Participants (n = 21; 59.3 ± 9.3 y, 29.5 ± 3.0 kg/m(2)) decreased total caloric intake by approximately 415 kcal at 6 weeks (P < .001). Daily nutrient intakes at baseline (46/36/17% carb/fat/pro) and averaged across the intervention (11/58/28% carb/fat/pro) demonstrated dietary compliance, with carbohydrate intake at baseline nearly 5-fold greater than during the intervention (P < .001). Compared to baseline, both systolic and diastolic blood pressure decreased after 3 and 6 weeks (P < .01). Peak forearm blood flow, but not flow-mediated dilation, increased at week 6 compared to baseline and week 3 (P ≤ .03). Serum triglyceride, insulin, soluble E-Selectin and intracellular adhesion molecule-1 decreased (P < .01) from baseline at week 3, and this effect was maintained at week 6. In conclusion, these findings demonstrate that individuals undergoing statin therapy experience additional improvements in metabolic and vascular health from a 6 weeks CRD as evidenced by increased insulin sensitivity and resistance vessel endothelial function, and decreased blood pressure, triglycerides, and adhesion molecules.
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Affiliation(s)
- Kevin D Ballard
- Departments of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
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Blood pressure-lowering effect of simvastatin: a placebo-controlled randomized clinical trial with 24-h ambulatory blood pressure monitoring. J Hum Hypertens 2013; 28:62-7. [PMID: 23677131 DOI: 10.1038/jhh.2013.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 03/02/2013] [Accepted: 03/14/2013] [Indexed: 01/29/2023]
Abstract
Part of the efficacy of statins in the prevention of cardiovascular events can be attributed to their blood pressure-lowering effect, but clinical trials primarily designed to investigate this effect are scarce. In a double-blind parallel placebo-controlled clinical trial with ambulatory blood pressure (ABP) monitoring, 79 hypertensive patients were randomly assigned to 40 mg of simvastatin (n=40) or placebo (n=39) taken in the morning for 2 months. Between-group deltas of ABP change, adjusted for the corresponding baseline BP, were 2.8 mm Hg (95% CI: 0.4-5.1; P=0.02) for 24-h diastolic blood pressure (DBP), 4.2 mm Hg (95% CI: 0.1-8.4; P=0.04) for daytime systolic BP and 3.1 mm Hg (95% CI: 0.4-5.9; P=0.02) for daytime DBP. There was no effect on nighttime BP. There was an interaction between baseline cholesterol levels and treatment effect, which was restricted to patients with cholesterol above the median of the whole sample. There was no significant change in office BP. In conclusion, simvastatin lowers ABP in patients with hypertension, particularly in the presence of higher levels of cholesterol. This effect may contribute to the beneficial effects of statins in the prevention of cardiovascular disease.
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Abdel-Zaher AO, Elkoussi AEA, Abudahab LH, Elbakry MH, Elsayed EAE. Effect of simvastatin on the antihypertensive activity of losartan in hypertensive hypercholesterolemic animals and patients: Role of nitric oxide, oxidative stress, and high-sensitivity C-reactive protein. Fundam Clin Pharmacol 2013; 28:237-48. [DOI: 10.1111/fcp.12020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/03/2013] [Accepted: 01/21/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Ahmed O. Abdel-Zaher
- Department of Pharmacology; Faculty of Medicine; Assiut University; Assiut Egypt
| | | | - Lotfy H. Abudahab
- Department of Internal Medicine; Faculty of Medicine; Sohag University; Sohag Egypt
| | - Mohammed H. Elbakry
- Department of Pharmacology; Faculty of Medicine; Al-Azhar University; Assiut Egypt
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Affiliation(s)
- Kwang Kon Koh
- Division of Cardiology, Gachon University, Gil Medical Center, Incheon, Korea
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Bratseth V, Pettersen AÅ, Opstad TB, Arnesen H, Seljeflot I. Markers of hypercoagulability in CAD patients. Effects of single aspirin and clopidogrel treatment. Thromb J 2012; 10:12. [PMID: 22883224 PMCID: PMC3552672 DOI: 10.1186/1477-9560-10-12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/08/2012] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED BACKGROUND Cardiovascular disease with disturbances in the haemostatic system, might lead to thrombotic complications with clinical manifestations like acute myocardial infarction (AMI) and stroke. Activation of the coagulation cascade with subsequent increased thrombin generation, characterizes a prothrombotic phenotype. In the present study we investigated whether prothrombotic markers were associated with risk factors and clinical subgroups in a cohort of patients with angiographically verified coronary artery disease (CAD). The patients were randomized to long-term treatment with the antiplatelet drugs aspirin or clopidogrel, and we further investigated the effect on hypercoagulability of such treatment for 1 year, of which limited data exists. METHODS Venous blood samples were collected in fasting condition between 08:00 and 10:30 am, at baseline when all patients were on aspirin therapy (n = 1001) and in 276 patients after 1 year follow-up on aspirin or clopidogrel. In vivo thrombin generation was assessed by prothrombin fragment 1 + 2 (F1+2) and D-dimer, and the endogenous thrombin potentiale (ETP) in the calibrated automated thrombogram (CAT) assay, representing ex vivo thrombin generation. In addition soluble tissue factor (sTF) and free- and total tissue factor pathway inhibitor (TFPI) were measured. RESULTS We found age to be significantly associated with F1+2 and D-dimer (β = 0.229 and β =0.417 respectively, p <0.001, both). Otherwise, only weak associations were found. F1+2 and D-dimer were higher in women compared to men (p <0.001 and p = 0.033, respectively). Smokers had elevated levels of ETP compared to non-smokers (p = 0.014). Additionally, patients on renin-angiotensin system (RAS) inhibition showed significantly higher levels of F1+2, compared to non-users (p = 0.013). Both aspirin and clopidogrel reduced levels of ETP after 12 months intervention (p = 0.003 and p <0.001, respectively) and the levels of F1+2 were significantly more reduced on aspirin compared to clopidogrel (p = 0.023). CONCLUSIONS In the present population of stable CAD, we could demonstrate a more hypercoagulable profile among women, smokers and patients on RAS medication, assessed by the prothrombotic markers F1+2, D-dimer and ETP. Long-term antiplatelet treatment with aspirin alone seems to attenuate thrombin generation to a greater extent than with clopidogrel alone. The study is registered at http://www.clinicaltrials.gov: NCT00222261.
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Affiliation(s)
- Vibeke Bratseth
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, Pb 4956 Nydalen, Oslo, N-0424, Norway
| | - Alf-Åge Pettersen
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, Pb 4956 Nydalen, Oslo, N-0424, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Trine B Opstad
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, Pb 4956 Nydalen, Oslo, N-0424, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Harald Arnesen
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, Pb 4956 Nydalen, Oslo, N-0424, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingebjørg Seljeflot
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, Pb 4956 Nydalen, Oslo, N-0424, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Han KH, Kim HJ, Kim JJ. Cost-effectiveness of the Use of Statins in the Korean Population. J Lipid Atheroscler 2012. [DOI: 10.12997/jla.2012.1.2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ki-Hoon Han
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Joong Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Tycinska AM, Janica J, Mroczko B, Musial WJ, Sawicki R, Sobkowicz B, Kaminski K, Lebkowska U, Szmitkowski M. Hypotensive effect of atorvastatin in hypertensive patients: the association among flow-mediated dilation, oxidative stress and endothelial dysfunction. Arch Med Sci 2011; 7:955-62. [PMID: 22328877 PMCID: PMC3264986 DOI: 10.5114/aoms.2011.26606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/20/2011] [Accepted: 08/19/2011] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION To investigate the hypothesis that atorvastatin decreases blood pressure (BP) values and improves endothelial function assessed by flow-mediated dilation (FMD) in normolipidaemic hypertensive patients. MATERIAL AND METHODS Fifty-six hypertensive patients were randomized in a 2 : 1 proportion to atorvastatin (80 mg/day/3 months; group A; n = 39) or previous standard anti-hypertensive therapy (group B), which means the patients were treated with angiotensin-converting enzyme inhibitors, diuretics, β-blockers, calcium antagonists and angiotensin receptor blockers. The study had a crossover design: after 3 months, both groups were changed (group A* stopped and group B* started atorvastatin treatment). Nitric oxide (NO), total antioxidant status (TAS), endothelin-1 (ET-1), and peroxide concentrations as well as FMD were measured before, after 3 and after 6 months of treatment. Atorvastatin added to existing treatment decreased BP in both groups. RESULTS Flow-mediated dilation improved in both statin-treated groups, but only significantly in group B* (from 11.9 ±8.3% to 22.1 ±9.0%; p < 0.05). In patients with FMD improvement, there was a greater BP reduction. After treatment discontinuation, FMD significantly decreased (from 19.6 ±12.6% to 13.0 ±10.5%; p < 0.05), which was consistent with BP increase. Changes in FMD were not significantly related to the increase in NO and TAS concentrations and decrease in ET-1 and peroxides measurements. CONCLUSIONS The hypotensive effect of atorvastatin is associated with FMD improvement in normolipidaemic, hypertensive patients. Although this could be related to changes in oxidative stress and endothelial function, this was not demonstrated in this study and warrants further investigation.
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Affiliation(s)
| | - Jacek Janica
- Department of Radiology, Medical University of Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Poland
| | | | - Robert Sawicki
- Department of Cardiology, Medical University of Bialystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Poland
| | - Karol Kaminski
- Department of Cardiology, Medical University of Bialystok, Poland
| | | | - Maciej Szmitkowski
- Department of Biochemical Diagnostics, Medical University of Bialystok, Poland
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Abdel-Zaher AO, Elkoussi AEA, Abudahab LH, Elbakry MH, Elsayed EAE. Simvastatin enhances the antihypertensive effect of ramipril in hypertensive hypercholesterolemic animals and patients. Possible role of nitric oxide, oxidative stress, and high sensitivity C-reactive protein. Fundam Clin Pharmacol 2011; 26:701-11. [DOI: 10.1111/j.1472-8206.2011.00975.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang SH, Choi JS, Choi DH. Effects of HMG-CoA reductase inhibitors on the pharmacokinetics of losartan and its main metabolite EXP-3174 in rats: possible role of CYP3A4 and P-gp inhibition by HMG-CoA reductase inhibitors. Pharmacology 2011; 88:1-9. [PMID: 21709429 DOI: 10.1159/000328773] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 04/26/2011] [Indexed: 11/19/2022]
Abstract
The present study was designed to investigate the effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (atorvastatin, pravastatin, simvastatin) on the pharmacokinetics of losartan and its active metabolite EXP-3174 in rats. Pharmacokinetic parameters of losartan and EXP-3174 in rats were determined after oral and intravenous administration of losartan (9 mg/kg) without and with HMG-CoA reductase inhibitors (1 mg/kg). The effect of HMG-CoA reductase inhibitors on P-gp and cytochrome (CYP) 3A4 activity were also evaluated. Atorvastatin, pravastatin and simvastatin inhibited CYP3A4 activities with IC₅₀ values of 48.0, 14.1 and 3.10 μmol/l, respectively. Simvastatin (1-10 μmol/l) enhanced the cellular uptake of rhodamine-123 in a concentration-dependent manner. The area under the plasma concentration-time curve (AUC₀₋∞) and the peak plasma concentration of losartan were significantly (p < 0.05) increased by 59.6 and 45.8%, respectively, by simvastatin compared to those of control. The total body clearance (CL/F) of losartan after oral administration with simvastatin was significantly decreased (by 34.8%) compared to that of controls. Consequently, the absolute bioavailability (F) of losartan after oral administration with simvastatin was significantly increased by 59.4% compared to that of control. The metabolite-parent AUC ratio was significantly decreased by 25.7%, suggesting that metabolism of losartan was inhibited by simvastatin. In conclusion, the enhanced bioavailability of losartan might be mainly due to inhibition of P-gp in the small intestine and CYP3A subfamily-mediated metabolism of losartan in the small intestine and/or liver and to reduction of the CL/F of losartan by simvastatin.
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Affiliation(s)
- Si-Hyung Yang
- College of Medicine, Dankuk University, Cheonan, South Korea
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Additive beneficial effects of atorvastatin combined with amlodipine in patients with mild-to-moderate hypertension. Int J Cardiol 2011; 146:319-25. [DOI: 10.1016/j.ijcard.2009.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 11/21/2022]
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Freitas MPD, Loyola Filho AID, Lima-Costa MF. Dyslipidemia and the risk of incident hypertension in a population of community-dwelling Brazilian elderly: the Bambuí cohort study of aging. CAD SAUDE PUBLICA 2011; 27 Suppl 3:S351-9. [DOI: 10.1590/s0102-311x2011001500005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 02/28/2011] [Indexed: 01/11/2023] Open
Abstract
This study aimed to examine the prognostic value of lipid parameters for incident hypertension in elderly living in a community. The study included 306 (81% from total) persons aged > 60 years who were free of hypertension and of cardiovascular diseases at the baseline survey of the Bambuí Cohort Study of Aging. The cumulative incidence of hypertension over three years was 37.3%. The relative risk (RR) of incident hypertension decreased 0.92 for each unit of HDL-cholesterol (95%CI: 0.86-0.99) independent of several potential confounding factors. Individuals with HDL-cholesterol in the top tercile (> 55mg/dL) had a risk of hypertension halve that those in the bottom tercile (RR = 0.54; 95%CI: 0.33-0.90). Other lipid parameters had no significant effect on the outcome. High HDL-cholesterol showed an independent protective effect on subsequent development of hypertension in the elderly.
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Affiliation(s)
- Marco Polo Dias Freitas
- Universidade de Brasília, Brasil; Fundação Oswaldo Cruz; Universidade Federal de Minas Gerais
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Herring N, Lee CW, Sunderland N, Wright K, Paterson DJ. Pravastatin normalises peripheral cardiac sympathetic hyperactivity in the spontaneously hypertensive rat. J Mol Cell Cardiol 2010; 50:99-106. [PMID: 20933519 PMCID: PMC3020274 DOI: 10.1016/j.yjmcc.2010.09.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 08/25/2010] [Accepted: 09/29/2010] [Indexed: 12/20/2022]
Abstract
Hypertension is associated with heightened cardiac sympathetic drive whilst statins reduce angiotensin II (ATII) signalling, superoxide anion production and increase nitric oxide bioavailability, events that can potentially reduce peripheral cardiac sympathetic neurotransmission. We therefore investigated whether pravastatin alters peripheral cardiac sympathetic control in the spontaneously hypertensive rat (SHR). SHRs (16–18 weeks) had significantly (p < 0.05) enhanced atrial 3H-norepinephrine (3H-NE) release to field stimulation compared to normotensive WKYs. 2-week pravastatin supplementation significantly reduced 3H-NE release to levels observed in the WKY. In-vivo, pravastatin lowered resting heart rate (HR) in the SHR despite not affecting arterial blood pressure or serum cholesterol. In SHR atria/right stellate ganglion preparations, the HR response to stellate stimulation (1, 3, and 5 Hz) was also significantly reduced by pravastatin whilst the HR response to exogenous NE (0.025–5 μmol) remained similar. The nitric oxide synthase (NOS) inhibitor l-NAME (1 mmol/l) increased 3H-NE release by similar amounts in atria from supplemented and non-supplemented SHRs, whilst Western blotting showed no difference in protein levels of nNOS, eNOS, guanylyl cyclase, or the NADPH oxidase subunits Gp91 and P40phox. Pravastatin significantly reduced cardiac ATII levels and angiotensin converting enzyme 1 and 2 expressions whilst protein levels of the ATII receptor (ATR1) remained unchanged in the SHR. Immunohistochemistry co-localised ATR1 with tyrosine hydroxylase positive neurons in the stellate ganglion. The ATR1 antagonist Losartan (5 μmol) equalised release of 3H-NE to comparable levels in supplemented and non-supplemented SHRs. These results suggest 2-week pravastatin treatment reduces cardiac ATII, and prevents its facilitatory effect on NE release thus normalising cardiac sympathetic hyper-responsiveness in SHRs.
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Bigalke B, Stellos K, Geisler T, Seizer P, Mozes V, Gawaz M. High plasma levels of adipocytokines are associated with platelet activation in patients with coronary artery disease. Platelets 2009; 21:11-9. [DOI: 10.3109/09537100903377584] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Boris Bigalke
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
| | - Konstantinos Stellos
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
| | - Tobias Geisler
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
| | - Viktoria Mozes
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
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Combination therapy for treatment or prevention of atherosclerosis: focus on the lipid-RAAS interaction. Atherosclerosis 2009; 209:307-13. [PMID: 19800624 DOI: 10.1016/j.atherosclerosis.2009.09.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 08/27/2009] [Accepted: 09/04/2009] [Indexed: 12/20/2022]
Abstract
Large clinical trials demonstrate that control of blood pressure or hyperlipidemia reduces risk for cardiovascular events by approximately 30%. Factors that may further reduce remaining risk are not definitively established. One potential target is atherosclerosis, a crucial feature in the pathogenesis of cardiovascular diseases whose development is determined by multiple mechanism including complex interactions between endothelial dysfunction and insulin resistance. Reciprocal relationships between endothelial dysfunction and insulin resistance as well as cross-talk between hyperlipidemia and the rennin-angiotensin-aldosterone system may contribute to development of atherosclerosis. Therefore, one appealing strategy for prevention or treatment of atherosclerosis may be to simultaneously address several risk factors with combination therapies that target multiple pathogenic mechanisms. Combination therapy with statins, peroxisome proliferators-activated receptor agonists, and rennin-angiotensin-aldosterone system blockers demonstrate additive beneficial effects on endothelial dysfunction and insulin resistance when compared with monotherapies in patients with cardiovascular risk factors. Additive beneficial effects of combined therapy are mediated by both distinct and interrelated mechanisms, consistent with both pre-clinical and clinical investigations. Thus, combination therapy may be an important concept in developing more effective strategies to treat and prevent atherosclerosis, coronary heart disease, and co-morbid metabolic disorders characterized by endothelial dysfunction and insulin resistance.
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Stepien M, Banach M, Mikhailidis DP, Gluba A, Kjeldsen SE, Rysz J. Role and significance of statins in the treatment of hypertensive patients. Curr Med Res Opin 2009; 25:1995-2005. [PMID: 19555312 DOI: 10.1185/03007990903098081] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Statins are the first-line drug therapy in the treatment of hypercholesterolemia. The beneficial clinical impact of statins on the cardiovascular system results not only from their lipid-lowering action but also from other effects. Recently, it has been suggested that statins can reduce blood pressure, especially in hypertensive patients. AIM The role of the hypotensive action of statins and other mechanisms which reduce cardiovascular risk in hypertensive patients are discussed in this review. METHODS Electronic databases searched were [MEDLINE (1966 - February 2009), EMBASE and SCOPUS (1965 - February 2009), DARE (1966 -- February 2009)]. Additionally, abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. The main data search terms were: blood pressure, hypertension, hypercholesterolemia and statins. FINDINGS At present, it is difficult to unequivocally assess the impact of statins on blood pressure. However, according to most authors, the impact of statins on the decrease in BP is slight, but significant, especially among patients with hypertension.
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Affiliation(s)
- Mariusz Stepien
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland
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Zhou MS, Schuman IH, Jaimes EA, Raij L. Renoprotection by statins is linked to a decrease in renal oxidative stress, TGF-beta, and fibronectin with concomitant increase in nitric oxide bioavailability. Am J Physiol Renal Physiol 2008; 295:F53-9. [PMID: 18463318 DOI: 10.1152/ajprenal.00041.2008] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Clinical and experimental studies have provided evidence suggesting that statins exert renoprotective effects. To investigate the mechanisms by which statins may exert renoprotection, we utilized the hypertensive Dahl salt-sensitive (DS) rat model, which manifests cardiovascular and renal injury linked to increased angiotensin II-dependent activation of NADPH oxidase and decreased nitric oxide (NO) bioavailability. DS rats given high salt diet (4% NaCl) for 10 wk exhibited hypertension [systolic blood pressure (SBP) 200 +/- 8 vs. 150 +/- 2 mmHg in normal salt diet (0.5% NaCl), P < 0.05], glomerulosclerosis, and proteinuria (158%). This was associated with increased renal oxidative stress demonstrated by urinary 8-F(2alpha)-isoprostane excretion and NADPH oxidase activity, increased protein expression of transforming growth factor (TGF)-beta (63%) and fibronectin (181%), increased mRNA expression of the proinflammatory molecules monocyte chemoattractant protein-1 (MCP-1) and lectin-like oxidized LDL receptor-1 (LOX-1), as well as downregulation of endothelial NO synthase (eNOS) activity (-44%) and protein expression. Return to normal salt had no effect on SBP or any of the measured parameters. Atorvastatin (30 mg.kg(-1).day(-1)) significantly attenuated proteinuria and glomerulosclerosis and normalized renal oxidative stress, TGF-beta1, fibronectin, MCP-1 and LOX-1 expression, and eNOS activity and expression. Atorvastatin-treated rats showed a modest reduction in SBP that remained in the hypertensive range (174 +/- 8 mmHg). Atorvastatin combined with removal of high salt normalized SBP and proteinuria. These findings suggest that statins mitigate hypertensive renal injury by restoring the balance among NO, TGF-beta1, and oxidative stress and explain the added renoprotective effects observed in clinical studies using statins in addition to inhibitors of the renin-angiotensin system.
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Affiliation(s)
- Ming-Sheng Zhou
- Nephrology-Hypertension Section, Veterans Affairs Medical Center, Vascular Biology Institute, University of Miami Miller School of Medicine, Miami, FL 33125, USA.
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Panoulas VF, John H, Kitas GD. Six-step management of hypertension in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17460816.3.1.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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