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Liu HT, Deng NH, Wu ZF, Zhou ZY, Tian Z, Liu XY, Wang YX, Zheng HY, Ou YS, Jiang ZS. Statin's role on blood pressure levels: Meta-analysis based on randomized controlled trials. J Clin Hypertens (Greenwich) 2023; 25:238-250. [PMID: 36799888 PMCID: PMC9994171 DOI: 10.1111/jch.14645] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
Statins have been proven to be effective in minimizing the risk of cardiovascular adverse events, however, their effect on BP variability is debatable with respect to their significance and their use as a potential anti-hypertensive. Using a meta-analysis approach, the aim of this study was to explore whether certain statins have the potential to lower blood pressure (BP). For the period 2002-2022, Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched for the studies that examined the effect of statins on blood pressure in normotensive or hypertensive individuals. Randomized controlled clinical trials that investigated this effect were included based on our inclusion criteria. Our primary outcomes were changes in systolic and diastolic blood pressure (DBP). The final analysis of the study included 49 RCTs involving 45 173 participants randomized to receive either statins or placebo. Among the two groups, the total weighted mean difference (WMD) for systolic blood pressure (ΔSBP) was -1.42 (95% CI: -2.38, -0.46; p = .004) and diastolic blood pressure (ΔDBP) was 0.82 (95% CI: -1.28, -0.36; p = .0005). Despite various studies suggesting the efficacy of statins in blood pressure lowering to be significant and non-significant both, we observed a decrease in SBP and DBP both, although the change was not as large and could be considered significant. A large multicenter, multi-ethnic, large sample pool size, and a long period follow-up study is still required to assert these claims.
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Affiliation(s)
- Hui Ting Liu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Nian Hua Deng
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Ze Fan Wu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Zhan Yang Zhou
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, PR China
| | - Zhen Tian
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Xi Yan Liu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Yan Xia Wang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Hong Yu Zheng
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Yang Shao Ou
- The Second Hospital, University of South China, Hengyang, Hunan, PR China
| | - Zhi Sheng Jiang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
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2
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Abebe RB, Kebede SA, Birarra MK. The association of lipid-lowering therapy and blood pressure control among outpatients with hypertension at the Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Front Cardiovasc Med 2023; 10:1071338. [PMID: 36937906 PMCID: PMC10014929 DOI: 10.3389/fcvm.2023.1071338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/02/2023] [Indexed: 03/05/2023] Open
Abstract
Background The lipid-lowering medications known as statins have been shown in controlled clinical trials to have pleiotropic properties, such as lowering blood pressure, in addition to lowering cholesterol levels. The purpose of this study was to see if there was a possible link between blood pressure control and statin therapy in outpatients with hypertension in a real clinical setting. Patients and methods A retrospective comparative cohort study of 404 patients with hypertension was carried out. A systematic random sampling technique was used. For data entry, Epi-Data version 4.6 was used, and SPSS version 25 was used for further analysis. For group comparisons, chi-square and independent t-tests were computed. To determine the relationship between statin use and blood pressure control, a binary logistic regression model was employed. To declare statistical significance, a 95% confidence interval and a P-value of <0.05 were used. Results Half of the study participants who were using a prescribed statin were assigned to the statin group, whereas the remaining participants who do not take statins were assigned to the control group. After 3 months of statin treatment, BP control to <130/80 mmHg was significantly greater (P = 0.022) in the statin group (52.5%) than in the control group (41.0%). The use of statins raises the likelihood of having blood pressure under control by 1.58 times when compared to statin non-users. After controlling for possible confounders, statin therapy still increased the odds of having controlled BP by a factor of 5.98 [OR = 5.98; 95% CI: 2.77-12.92]. Conclusion This study revealed that blood pressure control was higher among statin user hypertensive patients. Favorable effects of statin use were independently observed, even after correction for age, presence of dyslipidemia, and duration of antihypertensive therapy. Therefore, the importance of concomitantly added lipid-lowering drugs such as statins and their role in managing poor blood pressure control should be given due emphasis.
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Affiliation(s)
- Rahel Belete Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Rahel Belete Abebe
| | - Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mequanent Kassa Birarra
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wu P, Feng Q, Kerchberger VE, Nelson SD, Chen Q, Li B, Edwards TL, Cox NJ, Phillips EJ, Stein CM, Roden DM, Denny JC, Wei WQ. Integrating gene expression and clinical data to identify drug repurposing candidates for hyperlipidemia and hypertension. Nat Commun 2022; 13:46. [PMID: 35013250 PMCID: PMC8748496 DOI: 10.1038/s41467-021-27751-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Discovering novel uses for existing drugs, through drug repurposing, can reduce the time, costs, and risk of failure associated with new drug development. However, prioritizing drug repurposing candidates for downstream studies remains challenging. Here, we present a high-throughput approach to identify and validate drug repurposing candidates. This approach integrates human gene expression, drug perturbation, and clinical data from publicly available resources. We apply this approach to find drug repurposing candidates for two diseases, hyperlipidemia and hypertension. We screen >21,000 compounds and replicate ten approved drugs. We also identify 25 (seven for hyperlipidemia, eighteen for hypertension) drugs approved for other indications with therapeutic effects on clinically relevant biomarkers. For five of these drugs, the therapeutic effects are replicated in the All of Us Research Program database. We anticipate our approach will enable researchers to integrate multiple publicly available datasets to identify high priority drug repurposing opportunities for human diseases.
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Affiliation(s)
- Patrick Wu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - QiPing Feng
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vern Eric Kerchberger
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qingxia Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd L Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Biomedical Laboratory Research and Development, Tennessee Valley Healthcare System (626)/Vanderbilt University, Nashville, TN, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Phillips
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Infectious Diseases and Immunology, Murdoch University, Murdoch, Western Australia, Australia
| | - C Michael Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua C Denny
- All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Statin therapy is associated with better ambulatory blood pressure control: a propensity score analysis. J Hypertens 2021; 38:546-552. [PMID: 31584522 DOI: 10.1097/hjh.0000000000002276] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Statin therapy was associated with lower blood pressure (BP) in some but not all studies. We evaluated the association between statin therapy and ambulatory BP in a large hypertensive population using 'propensity score matching'. METHODS Retrospective observational study on 1827 consecutive essential hypertensive patients evaluated with 24-h ambulatory BP monitoring. Antihypertensive treatment intensity (ATI) was calculated to compare different drug associations. We used a propensity score matching to compare two equally-sized cohorts of patients with similar characteristics according to statin therapy. Matching was performed on log-transformed propensity score in a 1 : 1 fashion with a caliper of 0.1, in order to account for the different baseline characteristics between statin and no-statin group. RESULTS Mean age: 58.1 ± 13.8 years; male sex: 55%. Patients on statin therapy: 402 (22%). These patients showed lower 24-h BP (-2.8/-7.1 mmHg), daytime (-3.3/-7.6 mmHg) and night-time BP (-2.5/-6.0 mmHg, all P < 0.001). They also showed better ambulatory BP control, even after adjustment for confounding factors. The analyses on the groups derived from the 'propensity score matching' (369 patients in each group) confirmed these results (OR 1.8 for 24-h BP control; OR = 1.6 for daytime BP control; OR = 1.7 for night-time BP control, all P < 0.001). CONCLUSION Statin therapy is associated with better ambulatory BP control in essential hypertensive patients. This result is not affected by the intensity of the antihypertensive treatment or by the several cofactors analyzed.
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Zhang X, Xing L, Jia X, Pang X, Xiang Q, Zhao X, Ma L, Liu Z, Hu K, Wang Z, Cui Y. Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials. Cardiovasc Ther 2020; 2020:3987065. [PMID: 32411300 PMCID: PMC7201823 DOI: 10.1155/2020/3987065] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/30/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The drug efficacy may differ among different statins, and evidence from head-to-head comparisons is sparse and inconsistent. The study is aimed at comparing the lipid-lowering/increasing effects of 7 different statins in patients with dyslipidemia, cardiovascular diseases, or diabetes mellitus by conducting systematic review and network meta-analyses (NMA) of the lipid changes after certain statins' use. METHODS In this study, we searched four electronic databases for randomized controlled trials (RCTs) published through February 25, 2020, comparing the lipid-lowering efficacy of no less than two of the included statins (or statin vs. placebo). Three reviewers independently extracted data in duplicate. Firstly, mixed treatment overall comparison analyses, in the form of frequentist NMAs, were conducted using STATA 15.0 software. Then, subgroup analyses were conducted according to different baseline diseases. At last, sensitivity analyses were conducted according to age and follow-up duration. The trial was registered with PROSPERO (number CRD42018108799). RESULTS As a result, seven statin monotherapy treatments in 50 studies (51956 participants) were used for the analyses. The statins included simvastatin (SIM), fluvastatin (FLU), atorvastatin (ATO), rosuvastatin (ROS), lovastatin (LOV), pravastatin (PRA), and pitavastatin (PIT). In terms of LDL-C lowering, rosuvastatin ranked 1st with a surface under cumulated ranking (SUCRA) value of 93.1%. The comparative treatment efficacy for LDL-C lowering was ROS>ATO>PIT>SIM>PRA>FLU>LOV>PLA. All of the other ranking and NMA results were reported in SUCRA plots and league tables. CONCLUSIONS According to the NMAs, it can be concluded that rosuvastatin ranked 1st in LDL-C, ApoB-lowering efficacy and ApoA1-increasing efficacy. Lovastatin ranked 1st in TC- and TG-lowering efficacy, and fluvastatin ranked 1st in HDL-C-increasing efficacy. The results should be interpreted with caution due to some limitations in our review. However, they can provide references and evidence-based foundation for drug selection in both statin monotherapies and statin combination therapies.
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Affiliation(s)
- Xiaodan Zhang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Lu Xing
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy, China Pharmaceutical University, Nanjing 210000, China
| | - Xiaona Jia
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Xiaocong Pang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Qian Xiang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Xia Zhao
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Lingyue Ma
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Zhiyan Liu
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Kun Hu
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Zhe Wang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Yimin Cui
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
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6
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Silveira LCJ, Aliti GB, Da Silva EM, Pimentel RP, Gus M, Rabelo-Silva ER. Effect of motivational interviewing in hypertensive patients (MIdNIgHT): study protocol for a randomized controlled trial. Trials 2019; 20:414. [PMID: 31288854 PMCID: PMC6617897 DOI: 10.1186/s13063-019-3486-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Only one-third of hypertensive patients achieve and maintain blood-pressure control. This is attributed to low treatment adherence and has a negative impact on clinical outcomes. Adherence is multidimensional and involves aspects both related to patient characteristics and to the chronic nature of the disease. In this context, motivational interviewing has been proposed as an approach to foster patients' motivations to change their behavior for the benefit of their own health, thus providing more lasting behavioral changes. DESIGN AND METHODS Single-center, parallel, randomized controlled trial with outcome-assessor blinding. This study will select adult patients (n = 120) diagnosed with hypertension who receive regular follow-up in a specialized outpatient clinic. Patients will be randomly allocated across two groups: the intervention group will have appointments focused on motivational interviewing, while the control group will have traditional appointments. Patients will be monitored face-to-face, once monthly for six months. The primary outcomes will be a reduction of at least 8 mmHg in systolic blood pressure and changes in mean blood pressure measured by 24-h ambulatory blood pressure monitoring. Secondary outcomes include improvement of adherence to a low-sodium diet, adherence to self-care behaviors, regular use of antihypertensive medications, increase or maintenance of physical activity, weight reduction, evaluation of changes in daytime sleepiness, and cessation of smoking. DISCUSSION This study shows an intervention strategy that will be tested and, if effective, warrant replication in monitoring of other chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov, NCT02892929 . Registered on 24 August 2016.
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Affiliation(s)
- Luana Claudia Jacoby Silveira
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Graziella Badin Aliti
- Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Elisabeth Meyer Da Silva
- Graduate Program, Instituto de Cardiologia - Fundação Universitária de Cardiologia, Rua Princesa Isabel, 395, Porto Alegre, RS, 90620-001, Brazil
| | - Ravi Pereira Pimentel
- Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil
| | - Miguel Gus
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil. .,Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil. .,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil.
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Efficacy and Tolerability of Telmisartan/Amlodipine and Rosuvastatin Coadministration in Hypertensive Patients with Hyperlipidemia: A Phase III, Multicenter, Randomized, Double-blind Study. Clin Ther 2019; 41:728-741. [DOI: 10.1016/j.clinthera.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/10/2019] [Accepted: 02/19/2019] [Indexed: 12/15/2022]
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8
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Presta V, Figliuzzi I, Citoni B, Miceli F, Battistoni A, Musumeci MB, Coluccia R, De Biase L, Ferrucci A, Volpe M, Tocci G. Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24-hour ambulatory blood pressure database. J Clin Hypertens (Greenwich) 2018; 20:967-975. [DOI: 10.1111/jch.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Vivianne Presta
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Ilaria Figliuzzi
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Barbara Citoni
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Francesca Miceli
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Allegra Battistoni
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Maria Beatrice Musumeci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | | | - Luciano De Biase
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Andrea Ferrucci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Massimo Volpe
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | - Giuliano Tocci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
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9
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Parvanova A, Trillini M, Podestà MA, Iliev IP, Aparicio C, Perna A, Peraro F, Rubis N, Gaspari F, Cannata A, Ferrari S, Bossi AC, Trevisan R, Parameswaran S, Chávez-Iñiguez JS, Masnic F, Seck SM, Jiamjariyaporn T, Cortinovis M, Perico L, Sharma K, Remuzzi G, Ruggenenti P, Warnock DG. Blood Pressure and Metabolic Effects of Acetyl-l-Carnitine in Type 2 Diabetes: DIABASI Randomized Controlled Trial. J Endocr Soc 2018; 2:420-436. [PMID: 29696241 PMCID: PMC5912091 DOI: 10.1210/js.2017-00426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/19/2018] [Indexed: 12/21/2022] Open
Abstract
Context Acetyl-l-carnitine (ALC), a mitochondrial carrier involved in lipid oxidation and glucose metabolism, decreased systolic blood pressure (SBP), and ameliorated insulin sensitivity in hypertensive nondiabetic subjects at high cardiovascular risk. Objective To assess the effects of ALC on SBP and glycemic and lipid control in patients with hypertension, type 2 diabetes mellitus (T2D), and dyslipidemia on background statin therapy. Design After 4-week run-in period and stratification according to previous statin therapy, patients were randomized to 6-month, double-blind treatment with ALC or placebo added-on simvastatin. Setting Five diabetology units and one clinical research center in Italy. Patients Two hundred twenty-nine patients with hypertension and dyslipidemic T2D >40 years with stable background antihypertensive, hypoglycemic, and statin therapy and serum creatinine <1.5 mg/dL. Interventions Oral ALC 1000 mg or placebo twice daily on top of stable simvastatin therapy. Outcome and Measures Primary outcome was SBP. Secondary outcomes included lipid and glycemic profiles. Total-body glucose disposal rate and glomerular filtration rate were measured in subgroups by hyperinsulinemic–euglycemic clamp and iohexol plasma clearance, respectively. Results SBP did not significantly change after 6-month treatment with ALC compared with placebo (−2.09 mm Hg vs −3.57 mm Hg, P = 0.9539). Serum cholesterol, triglycerides, and lipoprotein(a), as well as blood glucose, glycated hemoglobin, fasting insulin levels, homeostatic model assessment of insulin resistance index, glucose disposal rate, and glomerular filtration rate did not significantly differ between treatments. Adverse events were comparable between groups. Conclusions Six-month oral ALC supplementation did not affect blood pressure, lipid and glycemic control, insulin sensitivity and kidney function in hypertensive normoalbuminuric and microalbuminuric T2D patients on background statin therapy.
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Affiliation(s)
- Aneliya Parvanova
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Matias Trillini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Manuel A Podestà
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.,Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Ilian P Iliev
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Carolina Aparicio
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Annalisa Perna
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Francesco Peraro
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Nadia Rubis
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Flavio Gaspari
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Antonio Cannata
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Silvia Ferrari
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Antonio C Bossi
- Unit of Diabetology, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio-Caravaggio-Romano, Italy
| | - Roberto Trevisan
- Unit of Diabetology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Sreejith Parameswaran
- Jawaharlal Institute of Postgraduate Medical Education and Research, Tamil Nadu, India
| | | | - Fahrudin Masnic
- Clinic for Hemodialysis, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sidy Mohamed Seck
- Department of Nephrology, Faculty of Health Sciences, University Gaston Berger, Saint-Louis, Senegal
| | | | - Monica Cortinovis
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Luca Perico
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Kanishka Sharma
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Giuseppe Remuzzi
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.,Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Biomedical and Clinical Science, L. Sacco, University of Milan, Milan, Italy
| | - Piero Ruggenenti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.,Department of Medicine, Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - David G Warnock
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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You T, Liu XG, Hou XD, Wang XK, Xie HH, Ding F, Yi K, Zhang P, Xie XD. Effect of statins on blood pressure: Analysis on adverse events released by FDA. Clin Exp Hypertens 2017; 39:325-329. [PMID: 28513233 DOI: 10.1080/10641963.2016.1254224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE As a class of cholesterol-lowering drugs, statins have been reported to cause unexpected decrease in blood pressure (BP). However, most studies in this issue were subject to inadequate study design or very small sample size. The present study was designed to examine the BP-lowering effect of various statins. METHODS Here we retrieved 5.9 million clinical reports submitted to FDA Adverse Event Reporting System (FAERS) from 2004 to 2015. Meta-analysis was performed to estimate the overall reporting odds ratio (ROR) of hypotension adverse events concurrent with various statins (i.e., atorvastatin, simvastatin, and rosuvastatin). RESULTS Comparing the reporting rate of hypotension event between statins and other drugs found that atorvastatin (pooled ROR = 1.26, adjusted p-value = 8.60 × 10-4) and simvastatin (pooled ROR = 1.94, adjusted p-value = 4.16 × 10-45) were significantly associated with reduction in BP. On the other hand, the association between rosuvastatin and hypotension was observed to be nonsignificant (adjusted p-value = 0.65). CONCLUSION To our knowledge, this is the first pooled analysis on large-scale data of adverse events to identify the BP-lowering effect of statins. The results will contribute to the development of novel statin-based antihypertensive therapies. In addition, the differential effects of individual statins can warrant subsequent research on the underlying mechanisms of BP control.
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Affiliation(s)
- Tao You
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Xing-Guang Liu
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Xiao-Dong Hou
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Xin-Kuan Wang
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Han-Hui Xie
- b School of Basic Medical Science , Lanzhou University , Lanzhou City , Gansu Province , China
| | - Fan Ding
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Kang Yi
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Peng Zhang
- a Department of Cardiovascular , Surgery of Gansu Provincial Hospital , Lanzhou City , Gansu Province , China
| | - Xiao-Dong Xie
- b School of Basic Medical Science , Lanzhou University , Lanzhou City , Gansu Province , China
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Sirenko Y, Radchenko G. Impact of Statin Therapy on the Blood Pressure-Lowering Efficacy of a Single-Pill Perindopril/Amlodipine Combination in Hypertensive Patients with Hypercholesterolemia. High Blood Press Cardiovasc Prev 2017; 24:85-93. [PMID: 28150140 DOI: 10.1007/s40292-017-0184-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Several lines of research indicate that statins can lower blood pressure (BP) independently of their lipid-lowering effects when used as monotherapy and in combination with antihypertensive agents. AIM This short-term, open-label study examined whether statin therapy had a synergistic effect on the BP-lowering efficacy of perindopril/amlodipine in a subgroup of patients in the PERSPECTIVA study with concomitant hypertension and hypercholesterolemia, with or without statin at baseline. METHODS The PERSPECTIVA study recruited 732 adults with untreated or uncontrolled hypertension. This subgroup analysis of PERSPECTIVA included 587 patients with concomitant hypertension and hypercholesterolemia (mean age 56.7 years) of whom 226 were receiving a statin at baseline (statin [+] group) and 361 were not (statin [-] group). All patients received treatment with single-pill combination perindopril/amlodipine at a dose of 5/5, 10/5 or 10/10 mg/day. The study duration was 60 days with follow-up visits for BP monitoring at 7, 15, 30 and 60 days. RESULTS At day 60, BP control (<140/90 mmHg) was significantly greater in the statin [+] vs statin [-] group: 73 vs 64% respectively (+14%, P < 0.05). In the statin [+] group, the single-pill perindopril/amlodipine combination significantly reduced BP in patients previously untreated (n = 18), or treated with monotherapy (n = 97), dual therapy (n = 93), or triple therapy (n = 18): -38.8/-20.0, -39.1/-20.1, -38.0/-19.4, -39.9/-18.3 mmHg respectively (P < 0.001 vs baseline BP). The greatest BP reductions were observed in the first 7 days. Treatment was well tolerated with a similar rate of adverse events in the statin [+] group (0.9%) vs the statin [-] group (2.5%). CONCLUSION BP control rates in patients with uncontrolled hypertension and concomitant hypercholesterolemia are significantly improved with a treatment regimen that combines perindopril/amlodipine with statin therapy, regardless of previous antihypertensive therapy. This subanalysis of the PERSPECTIVA study supports the synergistic BP-lowering effect of statins and perindopril/amlodipine.
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Affiliation(s)
- Yuriy Sirenko
- National Scientific Center, Strazhesko Institute of Cardiology, 5, Narodnogo Opolcheniya Street, Kiev, 03680, Ukraine.
| | - Ganna Radchenko
- National Scientific Center, Strazhesko Institute of Cardiology, 5, Narodnogo Opolcheniya Street, Kiev, 03680, Ukraine
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Affiliation(s)
- Charlotte Andersson
- From the Department of Internal Medicine, Section of Cardiology, Glostrup Hospital, Glostrup, Denmark (C.A.); and The Framingham Heart Study, and the Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.).
| | - Ramachandran S Vasan
- From the Department of Internal Medicine, Section of Cardiology, Glostrup Hospital, Glostrup, Denmark (C.A.); and The Framingham Heart Study, and the Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.)
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