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Khan Z, Gul A, Mlawa G, Bhattacharjee P, Muhammad SA, Carpio J, Yera H, Wahinya M, Kazeza AP, Amin MS, Gupta A. Statins As Anti-Hypertensive Therapy: A Systematic Review and Meta-Analysis. Cureus 2024. [DOI: 10.7759/cureus.57825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
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Lee CJ, Kang WC, Ihm SH, Sohn IS, Woo JS, Kim JW, Hong SJ, Choi JH, Suh J, Seo J, Doh J, Son J, Park J, Lee J, Hong YJ, Heo JH, Shin J, Kang S. Efficacy and safety of combination therapy with telmisartan, rosuvastatin, and ezetimibe in patients with dyslipidemia and hypertension: A randomized, double-blind, multicenter, therapeutic confirmatory, phase III clinical trial. J Clin Hypertens (Greenwich) 2024; 26:262-273. [PMID: 38319595 PMCID: PMC10918710 DOI: 10.1111/jch.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/14/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
This study aimed to compare and evaluate the efficacy of the blood pressure (BP) control and cholesterol-lowering effects and safety of combination therapy with telmisartan, rosuvastatin, and ezetimibe versus rosuvastatin and ezetimibe double therapy or telmisartan single therapy in dyslipidemia patients with hypertension. After a wash-out/therapeutic lifestyle change period of ≥4 weeks, a total of 100 eligible patients were randomized and received one of three treatments for 8 weeks: (1) telmisartan 80 mg/rosuvastatin 20 mg/ezetimibe 10 mg (TRE), (2) rosuvastatin 20 mg/ezetimibe 10 mg (RE), or (3) telmisartan 80 mg (T). The primary endpoint was the efficacy evaluation of TRE by comparing changes in mean sitting systolic blood pressure (msSBP) and mean percentage change in low-density lipoprotein-C (LDL-C) from baseline after 8 weeks of treatment. The least square (LS) mean (SE) changes in msSBP at 8 weeks compared with baseline were -23.02 (3.04) versus -7.18 (3.09) mmHg in the TRE and RE groups, respectively (p < .0001), and -25.80 (2.74) versus -14.92 (2.65) mmHg in the TRE and T groups, respectively (p = .0005). The percentage changes in the mean (SD) LDL-C at 8 weeks compared with baseline were -54.97% (3.49%) versus -0.17% (3.23%) in the TRE and T groups, respectively (p < .0001). No serious adverse events occurred, and no statistically significant differences in the incidence of overall AEs and adverse drug reactions occurred among the three groups. TRE therapy significantly decreased msSBP and LDL-C compared to RE or T therapy with comparable safety and tolerability profiles.
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Affiliation(s)
- Chan Joo Lee
- Division of CardiologyDepartment of Internal MedicineSeverance HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Woong Chol Kang
- Department of CardiologyGil HospitalGachon UniversityIncheonSouth Korea
| | - Sang Hyun Ihm
- Division of CardiologyDepartment of Internal MedicineBucheon St. Mary's HospitalThe Catholic University of KoreaSeoulSouth Korea
| | - Il Suk Sohn
- Department of CardiologyKyung Hee University Hospital at GangdongSeoulSouth Korea
| | - Jong Shin Woo
- Department of Internal MedicineKyung Hee University College of MedicineKyung Hee University Medical CenterSeoulSouth Korea
| | - Jin Won Kim
- Division of Interventional CardiologyCardiovascular CenterKorea University Guro HospitalSeoulSouth Korea
| | - Soon Jun Hong
- Division of CardiologyDepartment of Internal MedicineKorea University Anam HospitalSeoulSouth Korea
| | - Jung Hyun Choi
- Division of CardiologyDepartment of Internal MedicinePusan National University School of MedicineBusanSouth Korea
| | - Jung‐Won Suh
- Division of CardiologyDepartment of Internal MedicineSeoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jae‐Bin Seo
- Division of CardiologyDepartment of Internal MedicineBoramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea
| | - Joon‐Hyung Doh
- Division of CardiologyDepartment of MedicineInje University Ilsan Paik HospitalGoyangSouth Korea
| | - Jung‐Woo Son
- Division of CardiologyDepartment of Internal MedicineWonju Severance Christian HospitalYonsei University Wonju College of MedicineWonjuSouth Korea
| | - Jae‐Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University HospitalSchool of Medicine, Chungnam National UniversityDaejeonSouth Korea
| | - Ju‐Hee Lee
- Division of CardiologyDepartment of Internal MedicineChungbuk National University HospitalChungbuk National University College of MedicineCheongjuSouth Korea
| | - Young Joon Hong
- Division of CardiologyChonnam National University Medical SchoolChonnam National University HopitalGwangjuSouth Korea
| | - Jung Ho Heo
- Division of CardiologyDepartment of Internal MedicineKosin University Gospel HospitalBusanSouth Korea
| | - Jinho Shin
- Division of CardiologyDepartment of Internal MedicineHanyang University Seoul HospitalHanyang University College of MedicineSeoulSouth Korea
| | - Seok‐Min Kang
- Division of CardiologyDepartment of Internal MedicineSeverance HospitalYonsei University College of MedicineSeoulSouth Korea
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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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Ali W, Ali N, Ullah A, Rahman SU, Ahmad S. Pitavastatin and Lovastatin Exhibit Calcium Channel Blocking Activity Which Potentiate Vasorelaxant Effects of Amlodipine: A New Futuristic Dimension in Statin's Pleiotropy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1805. [PMID: 37893523 PMCID: PMC10608486 DOI: 10.3390/medicina59101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: We have recently reported that Fluvastatin, Atorvastatin, Simvastatin and Rosuvastatin have calcium channel antagonistic activities using rabbits' intestinal preparations. The current study is focused on the effects of Pitavastatin and Lovastatin for possible inhibition of vascular L-Type calcium channels, which may have vasorelaxant effect(s). Combined effects of Pitavastatin and Lovastatin in the presence of Amlodipine were also tested for vasorelaxation. Materials and Methods: Possible relaxing effects of Pitavastatin and Lovastatin on 80 mM Potassium chloride (KCL)-induced contractions and on 1 µM norepinephrine (N.E)-induced contractions were studied in isolated rabbit's aortic strips preparations. Relaxing effects on 80 mM KCL-induced vascular contractions were further verified by constructing Calcium Concentration Response Curves (CCRCs), in the absence and presence of three different concentrations of Pitavastatin and Lovastatin using CCRCs as negative control. Verapamil was used as a standard drug that has L-Type calcium channel binding activity. In other series of experiments, we studied drug interaction(s) among Pitavastatin, Lovastatin, and amlodipine. Results: The results of this study imply that Lovastatin is more potent than Pitavastatin for having comparatively lower EC50 (7.44 × 10-5 ± 0.16 M) in intact and (4.55 × 10-5 ± 0.10 M) in denuded aortae for KCL-induced contractions. Lovastatin amplitudes in intact and denuded aortae for KCL-induced contractions were, respectively, 24% and 35.5%; whereas amplitudes for Pitavastatin in intact and denuded aortae for KCL-induced contractions were 34% and 40%, respectively. A left shift in the EC50 values for the statins was seen when we added amlodipine in EC50 (Log Ca++ M). Right shift for CCRCs state that Pitavastatin and Lovastatin have calcium channel antagonistic effects. Lovastatin in test concentration (6.74 × 10-7 M) produced a right shift in relatively lower EC50 (-2.5 ± 0.10) Log Ca++ M as compared to Pitavastatin, which further confirms that lovastatin is relatively more potent. The right shift in EC50 resembles the right shift of Verapamil. Additive effect of Pitavastatin and Lovastatin was noted in presence of amlodipine (p < 0.05). Conclusions: KCL (80 mM)-induced vascular contractions were relaxed by Pitavastatin and Lovastatin via inhibitory effects on L-Type voltage-gated calcium channels. Lovastatin and Pitavastatin also relaxed Norepinephrine (1 µM)-induced contractions giving an insight for involvement of dual mode of action of Pitavastatin and Lovastatin.
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Affiliation(s)
- Wajid Ali
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Khyber Medical University, Hayatabad, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan;
| | - Niaz Ali
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Khyber Medical University, Hayatabad, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan;
- Department of Pharmacology, College of Medicine, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Abid Ullah
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir 18200, Khyber Pakhtunkhwa, Pakistan; (A.U.); (S.U.R.); (S.A.)
| | - Shafiq Ur Rahman
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir 18200, Khyber Pakhtunkhwa, Pakistan; (A.U.); (S.U.R.); (S.A.)
| | - Shujaat Ahmad
- Department of Pharmacy, Shaheed Benazir Bhutto University, Sheringal, Dir 18200, Khyber Pakhtunkhwa, Pakistan; (A.U.); (S.U.R.); (S.A.)
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Wang X, Feng Y, Yang L, Zhang G, Tian X, Ling Q, Tan J, Cai J. Association of baseline serum cholesterol with benefits of intensive blood pressure control. Chin Med J (Engl) 2023; 136:2058-2065. [PMID: 37525354 PMCID: PMC10476779 DOI: 10.1097/cm9.0000000000002474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear. METHODS The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to <130 mmHg) and standard (SBP target of 130 to <150 mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations. RESULTS Regardless of the randomized SBP intervention, baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level ( P for interaction = 0.80) and non-HDL-C level ( P for interaction = 0.95). Adjusted subgroup analysis using tertiles in LDL-C1 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.52-1.13; P = 0.18), LDL-C2 (HR, 0.81; 95% CI, 0.55-1.20; P = 0.29), and LDL-C3 (HR, 0.68; 95% CI, 0.47-0.98; P = 0.04) was provided, with an interaction P value of 0.49. Similar results were showed in non-HDL-C1 (HR, 0.87; 95% CI, 0.59-1.29; P = 0.49), non-HDL-C2 (HR, 0.70; 95% CI, 0.48-1.04; P = 0.08), and non-HDL-C3 (HR, 0.67; 95% CI, 0.47-0.95; P = 0.03), with an interaction P -value of 0.47. CONCLUSION High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome, but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03015311.
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Affiliation(s)
- Xiaoqi Wang
- Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510010, China
| | - Li Yang
- Department of Cardiology, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650051, China
| | - Guohui Zhang
- Department of Cardiology, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu 212021, China
| | - Xiaoyuan Tian
- Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Qianhui Ling
- Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Jiangshan Tan
- Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Jun Cai
- Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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Kozakova M, Morizzo C, Jamagidze G, Della Latta D, Chiappino S, Chiappino D, Palombo C. Association between Low-Density Lipoprotein Cholesterol and Vascular Biomarkers in Primary Prevention. Biomedicines 2023; 11:1753. [PMID: 37371848 DOI: 10.3390/biomedicines11061753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Several noninvasive vascular biomarkers have been proposed to improve risk stratification for atherothrombotic events. To identify biomarkers suitable for detecting intermediate-risk individuals who might benefit from lipid-lowering treatment in primary prevention, the present study tested the association of plasma LDL-cholesterol with coronary artery calcification (CAC) Agatston score, high carotid and femoral intima-media thickness (IMT), low carotid distensibility and high carotid-femoral pulse-wave velocity in 260 asymptomatic individuals at intermediate cardiovascular risk and without diabetes and lipid-lowering treatment. High or low vascular biomarkers were considered when their value was above the 95th or below the 5th percentile, respectively, of the distribution in the healthy or in the study population. LDL-cholesterol was independently associated with the CAC score = 0 (OR 0.67; 95%CI 0.48-0.92, p = 0.01), CAC score > 100 (1.59; 1.08-2.39, p = 0.01) and high common femoral artery (CFA) IMT (1.89; 1.19-3.06, p < 0.01), but not with other biomarkers. Our data confirm that in individuals at intermediate risk, lipid-lowering treatment can be avoided in the presence of a CAC score = 0, while it should be used with a CAC score > 100. CFA IMT could represent a useful biomarker for decisions regarding lipid-lowering treatment. However, sex- and age-specific reference values should be established in a large healthy population.
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Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Esaote SpA, 16152 Genova, Italy
| | - Carmela Morizzo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giuli Jamagidze
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Daniele Della Latta
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
- Bioengineering and Deep Health Units, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Sara Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Dante Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
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Ali N, Ali W, Ullah A, Ahmad S, Alsaiari AA, Almehmadi M, Abdulaziz O, Allahyani M, Aljuaid A. Atorvastatin and Fluvastatin Potentiate Blood Pressure Lowering Effect of Amlodipine through Vasorelaxant Phenomenon. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1023. [PMID: 37374229 DOI: 10.3390/medicina59061023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: We have recently reported that stains have calcium channel blocking activity in isolated jejunal preparations. In this study, we examined the effects of atorvastatin and fluvastatin on blood vessels for a possible vasorelaxant effect. We also studied the possible additional vasorelaxant effect of atorvastatin and fluvastatin, in the presence of amlodipine, to quantify its effects on the systolic blood pressure of experimental animals. Materials and Methods: Atorvastatin and fluvastatin were tested in isolated rabbits' aortic strip preparations using 80mM Potassium Chloride (KCl) induced contractions and 1 micro molar Norepinephrine (NE) induced contractions. A positive relaxing effect on 80 mM KCl induced contractions were further confirmed in the absence and presence of atorvastatin and fluvastatin by constructing calcium concentration response curves (CCRCs) while using verapamil as a standard calcium channel blocker. In another series of experiments, hypertension was induced in Wistar rats and different test concentrations of atorvastatin and fluvastatin were administered in their respective EC50 values to the test animals. A fall in their systolic blood pressure was noted using amlodipine as a standard vasorelaxant drug. Results: The results show that fluvastatin is more potent than amlodipine as it relaxed NE induced contractions where the amplitude reached 10% of its control in denuded aortae. Atorvastatin relaxed KCL induced contractions with an amplitude reaching 34.4% of control response as compared to the amlodipine response, i.e., 39.1%. A right shift in the EC50 (Log Ca++ M) of Calcium Concentration Response Curves (CCRCs) implies that statins have calcium channel blocking activity. A right shift in the EC50 of fluvastatin with relatively less EC50 value (-2.8 Log Ca++ M) in the presence of test concentration (1.2 × 10-7 M) of fluvastatin implies that fluvastatin is more potent than atorvastatin. The shift in EC50 resembles the shift of Verapamil, a standard calcium channel blocker (-1.41 Log Ca++ M). Conclusions: Atorvastatin and fluvastatin relax the aortic strip preparations predominantly through the inhibition of voltage gated calcium channels in high molar KCL induced contractions. These statins also inhibit the effects of NE induced contractions. The study also confirms that atorvastatin and fluvastatin potentiate blood pressure lowering effects in hypertensive rats.
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Affiliation(s)
- Niaz Ali
- Department of Pharmacology, College of Medicine, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Wajid Ali
- Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan
| | - Abid Ullah
- Department of Pharmacy, Shaheed Benazir Bhutto University Sheringal, Dir Upper 18000, Khyber Pakhtunkhwa, Pakistan
| | - Shujaat Ahmad
- Department of Pharmacy, Shaheed Benazir Bhutto University Sheringal, Dir Upper 18000, Khyber Pakhtunkhwa, Pakistan
| | - Ahad Amer Alsaiari
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Mazen Almehmadi
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Osama Abdulaziz
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Mamdouh Allahyani
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Abdulelah Aljuaid
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
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Song ZY, Kim MH, Lee HC, Park SJ, Rhee MY, Choi JI, Kim SH, Chae IH, Hong YJ, Lee NH, Hwang GS, Hur SH, Son JW, Chae JK, Kim HS. Efficacy and Safety of Coadministered Ezetimibe-Rosuvastatin plus Telmisartan in South Korean Patients with Dyslipidemia and Hypertension: A Multicenter, Randomized, Double-Blind, Active-Controlled, Phase III Trial. J Clin Med 2023; 12:jcm12062377. [PMID: 36983377 PMCID: PMC10053813 DOI: 10.3390/jcm12062377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The introduction of a fixed-dose combination (FDC) is expected to improve treatment compliance. METHODS There were 181 subjects who were randomized to three groups: ezetimibe-rosuvastatin 10/20 mg + telmisartan 80 mg, ezetimibe-rosuvastatin 10/20 mg, and telmisartan 80 mg. The primary outcomes were change in mean sitting systolic blood pressure (MSSBP) and percentage change in low-density-lipoprotein cholesterol (LDL-C) compared to baseline at week 8. RESULTS The least-square mean (SE) in MSSBP changes between the ezetimibe-rosuvastatin 10/20 mg + telmisartan 80 mg group and the ezetimibe-rosuvastatin 10/20 mg group were -25.81 (2.34) mmHg and -7.66 (2.45) mmHg. There was a significant difference between the two groups (-18.15 (2.83) mmHg, 95% CI -23.75 to -12.56, p < 0.0001). Changes in least-square mean (SE) in LDL-C between the ezetimibe-rosuvastatin 10/20 mg + telmisartan 80 mg group and the telmisartan 80 mg group were -63.82 (2.87)% and -2.48 (3.12)%. A significant difference was observed between the two groups (-61.34 (3.33)%, 95% CI -67.91 to -54.78, p < 0.0001). No serious adverse events were observed. CONCLUSIONS Ezetimibe-rosuvastatin plus telmisartan treatment is effective and safe when compared to either ezetimibe-rosuvastatin or telmisartan.
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Affiliation(s)
- Zhao-Yan Song
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Republic of Korea
| | - Moo-Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Republic of Korea
| | - Han-Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Young-Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju 61469, Republic of Korea
| | - Nam-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu 42601, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Seoul 26426, Republic of Korea
| | - Jei-Keon Chae
- Department of Cardiology, Chunbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul Naional University College of Medicine, Seoul 03080, Republic of Korea
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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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Costa GS, Julião-Silva LS, Belo VS, de Oliveira HCF, Chaves VE. A systematic review and meta-analyses on the effects of atorvastatin on blood pressure and heart rate. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 9:100-115. [PMID: 36138492 DOI: 10.1093/ehjcvp/pvac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
AIMS Considering the inconsistencies in the literature on the atorvastatin effect on blood pressure (BP), we performed these meta-analyses. METHODS AND RESULTS Through a search of the Excerpta Medica Database (EMBASE), PubMed, and Web of Science databases, 1412 articles were identified, from which 33 randomized clinical trials (RCT) and 44 pre-clinical were selected. Populations from RCT were stratified according to baseline BP and lipid levels. We performed meta-analyses of the effect of atorvastatin on systolic (SBP), diastolic and mean BP; heart rate (HR); HR variability, and baroreflex. Atorvastatin reduced SBP in the overall population (P = 0.05 vs. placebo; P = 0.03 vs. baseline), in normotensive and hyperlipidaemic (P = 0.04 vs. placebo; P = 0.0001 vs. baseline) and in hypertensive and hyperlipidaemic (P = 0.02 vs. placebo; P = 0.008 vs. baseline) individuals in parallel RCT, but it did not affect SBP in normotensive and normolipidaemic individuals (P = 0.51 vs. placebo; P = 0.4 vs. baseline). Although an effect of atorvastatin was detected in hyperlipidaemic individuals, the meta-regression coefficient for the association of low density lipoprotein (LDL)-cholesterol reduction with SBP reduction in the overall population demonstrated that SBP reduction is not dependent on the changes in LDL-cholesterol. A meta-analysis of preclinical reports demonstrated that SBP was reduced in atorvastatin-treated hypertensive and normolipidaemic rats (spontaneously hypertensive rats: P < 0.00001), but not in normotensive and normolipidaemic rats (control rats: P = 0.97). Atorvastatin also reduced the HR in spontaneously hypertensive rat. CONCLUSION Atorvastatin lowers BP independent of LDL-cholesterol levels. Additional studies are needed to estimate the involvement of the autonomic nervous system in the BP-lowering effect of atorvastatin.
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Affiliation(s)
- Gabriel S Costa
- Laboratory of Physiology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| | - Letícia S Julião-Silva
- Laboratory of Physiology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| | - Vinícius S Belo
- Laboratory of Parasitology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
| | - Helena C F de Oliveira
- Department of Structural and Functional Biology, Biology Institute, State University of Campinas, Monteiro Lobato Street, 255, 13.083-862, Campinas, São Paulo, Brazil
| | - Valéria E Chaves
- Laboratory of Physiology, Federal University of São João del-Rei, Avenue Sebastião Gonçalves Coelho, 400, 35.501-296, Divinópolis, Minas Gerais, Brazil
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11
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Integrating Health Data-Driven Machine Learning Algorithms to Evaluate Risk Factors of Early Stage Hypertension at Different Levels of HDL and LDL Cholesterol. Diagnostics (Basel) 2022; 12:diagnostics12081965. [PMID: 36010315 PMCID: PMC9407063 DOI: 10.3390/diagnostics12081965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose: Cardiovascular disease (CVD) is a major worldwide health burden. As the risk factors of CVD, hypertension, and hyperlipidemia are most mentioned. Early stage hypertension in the population with dyslipidemia is an important public health hazard. This study was the application of data-driven machine learning (ML), demonstrating complex relationships between risk factors and outcomes and promising predictive performance with vast amounts of medical data, aimed to investigate the association between dyslipidemia and the incidence of early stage hypertension in a large cohort with normal blood pressure at baseline. Methods: This study analyzed annual health screening data for 71,108 people from 2005 to 2017, including data for 27 risk-related indicators, sourced from the MJ Group, a major health screening center in Taiwan. We used five machine learning (ML) methods—stochastic gradient boosting (SGB), multivariate adaptive regression splines (MARS), least absolute shrinkage and selection operator regression (Lasso), ridge regression (Ridge), and gradient boosting with categorical features support (CatBoost)—to develop a multi-stage ML algorithm-based prediction scheme and then evaluate important risk factors at the early stage of hypertension, especially for groups with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels within or out of the reference range. Results: Age, body mass index, waist circumference, waist-to-hip ratio, fasting plasma glucose, and C-reactive protein (CRP) were associated with hypertension. The hemoglobin level was also a positive contributor to blood pressure elevation and it appeared among the top three important risk factors in all LDL-C/HDL-C groups; therefore, these variables may be important in affecting blood pressure in the early stage of hypertension. A residual contribution to blood pressure elevation was found in groups with increased LDL-C. This suggests that LDL-C levels are associated with CPR levels, and that the LDL-C level may be an important factor for predicting the development of hypertension. Conclusion: The five prediction models provided similar classifications of risk factors. The results of this study show that an increase in LDL-C is more important than the start of a drop in HDL-C in health screening of sub-healthy adults. The findings of this study should be of value to health awareness raising about hypertension and further discussion and follow-up research.
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12
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Role of Traditional Cardiovascular Risk Factors after Initiation of Statin Therapy: A PharmLines Inception Cohort Study. Cardiovasc Ther 2022; 2022:6587165. [PMID: 35676913 PMCID: PMC9155967 DOI: 10.1155/2022/6587165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Multiple studies and meta-analyses examined the role of traditional risk factors for cardiovascular events in statin treatment-naive patients. Nowadays, millions receive such therapy for the primary prevention of cardiovascular events (CVE). Objective CVEs still occur in patients on primary preventive statin therapy. Therefore, further risk stratification within these patients is urgently needed. Methods Using the unique linkage between biomedical data and prescription data from the PharmLines Initiative, we assessed the role of several risk factors used in cardiovascular risk models, using a time-dependent Cox PH model, in the occurrence of drug treatment of CVEs after initiation of statin therapy. Results Among 602 statin therapy starters, 11% received drug treatment for CVE within an average follow-up period of 832 days. After multivariable modelling, cholesterol levels and blood pressure at baseline were no longer associated, whereas self-reported diabetes and increasing age were highly associated with the outcome when on statin therapy (hazard ratio (HR): 3.01, 95% confidence interval (95% CI): 1.48-6.12 and 1.04; 95% CI: 1.01-1.07, respectively). Males, smokers, and nonadherent patients had increased risks (HR 1.6, 1.12, and 1.18, resp.), though not statistically significant. Conclusion Drug treatment for CVEs after statin initiation is increased in patients with diabetes type 2, in aged patients, males, smokers, and those with poor adherence, while there was no association with baseline cholesterol levels and blood pressure. These factors should be taken into account during the monitoring of statin therapy and may lead to changes in statin treatment or risk-related lifestyle factors.
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13
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Borghi C, Fogacci F, Agnoletti D, Cicero AFG. Hypertension and Dyslipidemia Combined Therapeutic Approaches. High Blood Press Cardiovasc Prev 2022; 29:221-230. [PMID: 35334087 PMCID: PMC9050771 DOI: 10.1007/s40292-022-00507-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 12/11/2022] Open
Abstract
Treating blood pressure (BP) alone may provide only limited benefits while it is recommendable to manage the total cardiovascular risk. To date, several studies have shown that concomitant treatment of hypertension and dyslipidemia with non-pharmacological approaches and/or metabolically neutral antihypertensive drugs and statins produce a significantly greater reduction of the risk of developing cardiovascular disease. Thus, in this review article, we summarize the available evidence regarding non-pharmacological and pharmacological approaches with a favourable effect on both BP and lipids.
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Affiliation(s)
- Claudio Borghi
- Medical and Surgical Sciences Department, Hypertension and Cardiovascular Risk Factors Research Center, Sant'Orsola-Malpighi University Hospital, U.O. Medicina Interna Cardiovascolare, Alma Mater Studiorum University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy. .,IRCCS AOU S. Orsola-Malpighi, Bologna, Italy.
| | - Federica Fogacci
- Medical and Surgical Sciences Department, Hypertension and Cardiovascular Risk Factors Research Center, Sant'Orsola-Malpighi University Hospital, U.O. Medicina Interna Cardiovascolare, Alma Mater Studiorum University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.,IRCCS AOU S. Orsola-Malpighi, Bologna, Italy
| | - Davide Agnoletti
- Medical and Surgical Sciences Department, Hypertension and Cardiovascular Risk Factors Research Center, Sant'Orsola-Malpighi University Hospital, U.O. Medicina Interna Cardiovascolare, Alma Mater Studiorum University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.,IRCCS AOU S. Orsola-Malpighi, Bologna, Italy
| | - Arrigo F G Cicero
- Medical and Surgical Sciences Department, Hypertension and Cardiovascular Risk Factors Research Center, Sant'Orsola-Malpighi University Hospital, U.O. Medicina Interna Cardiovascolare, Alma Mater Studiorum University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.,IRCCS AOU S. Orsola-Malpighi, Bologna, Italy
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14
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Borghi C, Levy BI. Synergistic actions between angiotensin-converting enzyme inhibitors and statins in atherosclerosis. Nutr Metab Cardiovasc Dis 2022; 32:815-826. [PMID: 35082055 DOI: 10.1016/j.numecd.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/31/2021] [Accepted: 11/25/2021] [Indexed: 01/09/2023]
Abstract
AIMS Hypertension and hypercholesterolemia are independent risk factors for atherosclerotic cardiovascular disease (ASCVD) by acting directly on the endothelium and activating the renin-angiotensin aldosterone system (RAAS) and mevalonate pathways. This review examines how the severity and duration of these risk factors may influence the cardiovascular risk through a reciprocal interplay leading to oxidative stress and pro-inflammatory response. DATA SYNTHESIS The review highlights the clinical evidence supporting the benefits of statins and angiotensin-converting enzyme (ACE) inhibitors for hypertension, lipid disorders and ASCVD management, both individually and combined, at all stages of the cardiovascular continuum. CONCLUSION Drug strategies incorporating an ACE-inhibitor and a statin, and in particular perindopril and atorvastatin, have consistently demonstrated reductions in the rate of ASCVD events in patients with hypertension and lipid disorders, cementing their position as first-line therapies for the management of atherosclerosis complications.
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Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, IRCCS-S.Orsola, University of Bologna, Italy.
| | - Bernard I Levy
- INSERM Unit 970, PARCC, 56 rue Leblanc, 75015 Paris, France
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15
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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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16
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Comparative efficacy of fixed-dose statin and antihypertensive agent combinations: A network meta-analysis of randomized controlled trials. Vascul Pharmacol 2021; 141:106900. [PMID: 34343694 DOI: 10.1016/j.vph.2021.106900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The concurrent administration of statins and antihypertensive agents has been associated with improved cardiovascular outcomes, although the optimal fixed-dose combination remains unclear. This meta-analysis aims to compare the blood pressure and lipid-lowering effects of various statin and antihypertensive drug combinations. METHODS PubMed, Scopus, Web of Science, CENTRAL and Clinicaltrials.gov were systematically searched from inception to 20 March 2021. Randomized controlled trials evaluating the effects of statin-antihypertensive agent combinations on systolic blood pressure or serum lipids were held eligible. A random-effects frequentist model was applied to provide estimates of mean difference of percentage change. RESULTS Overall, 18 studies were included, comprising 4450 patients. Compared to statin monotherapy no significant difference in the percentage change of low-density lipoprotein cholesterol was achieved by adding any antihypertensive agent. Compared to amlodipine monotherapy, the addition of moderate-intensity statin resulted in a significantly greater percentage reduction of systolic blood pressure (-2.22%, 95% confidence intervals: [-3.82 to -0.62]). Combined high-intensity statin and amlodipine lead to significant increase of high-density lipoprotein cholesterol (8.34%, 95% confidence intervals: [0.73 to 15.95]), while effective triglyceride reduction was achieved by adding amlodipine and telmisartan to high-intensity statin (-14.68%, 95% confidence intervals: [-28.48 to -0.89]). No significant difference of adverse effects was observed. CONCLUSION The present network meta-analysis suggests that the administration of fixed-dose combinations of statins and antihypertensive agents is safe and effective in reducing blood pressure and serum lipids. The optimal dosing strategy to prevent cardiovascular events remains to be determined.
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17
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He D, Fan F, Jia J, Jiang Y, Sun P, Wu Z, Li J, Huo Y, Zhang Y. Lipid profiles and the risk of new-onset hypertension in a Chinese community-based cohort. Nutr Metab Cardiovasc Dis 2021; 31:911-920. [PMID: 33549431 DOI: 10.1016/j.numecd.2020.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Dyslipidemia and hypertension, key risk factors for cardiovascular disease, may share similar pathophysiological processes. A longitudinal association was reported between dyslipidemia and new-onset hypertension, but few data were published in Asian. We aimed to investigate the association of lipid profiles with new-onset hypertension in a Chinese community-based non-hypertensive cohort without lipid-lowering treatment (n = 1802). METHODS AND RESULTS New-onset hypertension was defined as any self-reported history of hypertension, systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or receiving antihypertensive medications at follow-up. Logistic regression models were used to evaluate the associations. Participants were aged 53.97 ± 7.49 years, 31.19% were men, and 64.54% with dyslipidemia. During a median of 2.30 years follow-up, the incidence of new-onset hypertension was 12.99%. Multivariate adjusted risks of new-onset hypertension increased with triglyceride increases (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.03-1.27) and high-density lipoprotein cholesterol (HDL-C) decreases (OR = 0.47, 95% CI: 0.29-0.76) for one unit. However, threshold effects were observed for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and non-HDL-C. Compared with subjects with hyperlipidemia, in those with normal concentrations of TC, LDL-C, and non-HDL-C increased risks of new-onset hypertension were observed with OR (95% CI) of 1.65 (1.10-2.46), 1.58 (1.07-2.33), and 1.57 (1.15-2.15) for one unit increasement, respectively, after adjusting for all covariates. CONCLUSION Higher TG and lower HDL-C increased the risk of new-onset hypertension, but for TC, LDL-C and non-HDLC, the risk of new-onset hypertension was increased only at normal concentrations in a Chinese community-based cohort.
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Affiliation(s)
- Danmei He
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China.
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yimeng Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Pengfei Sun
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhongli Wu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China.
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18
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Weaver SR, Rendeiro C, McGettrick HM, Philp A, Lucas SJE. Fine wine or sour grapes? A systematic review and meta-analysis of the impact of red wine polyphenols on vascular health. Eur J Nutr 2021; 60:1-28. [PMID: 32303823 PMCID: PMC7867547 DOI: 10.1007/s00394-020-02247-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Red wine polyphenols (RWP) are plant-based molecules that have been extensively studied in relation to their protective effects on vascular health in both animals and humans. The aim of this review was to quantify and compare the efficacy of RWP and pure resveratrol on outcomes measures of vascular health and function in both animals and humans. METHODS Comprehensive database searches were carried out through PubMed, Web of Science and OVID for randomised, placebo-controlled studies in both animals and humans. Meta-analyses were carried out on acute and chronic studies of RWP in humans, alongside sub-group analysis where possible. Risk-of-bias assessment was carried out for all included studies based on randomisation, allocation, blinding, outcome data reporting, and other biases. RESULTS 48 animal and 37 human studies were included in data extraction following screening. Significant improvements in measures of blood pressure and vascular function following RWP were seen in 84% and 100% of animal studies, respectively. Human studies indicated significant improvements in systolic blood pressure overall (- 2.6 mmHg, 95% CI: [- 4.8, - 0.4]), with a greater improvement in pure-resveratrol studies alone (- 3.7 mmHg, 95% CI: [- 7.3, - 0.0]). No significant effects of RWP were seen in diastolic blood pressure or flow-mediated dilation (FMD) of the brachial artery. CONCLUSION RWP have the potential to improve vascular health in at risk human populations, particularly in regard to lowering systolic blood pressure; however, such benefits are not as prevalent as those observed in animal models.
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Affiliation(s)
- Samuel R Weaver
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Catarina Rendeiro
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, B15 2TT, UK
| | - Helen M McGettrick
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
| | - Andrew Philp
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, 2010, Australia
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, B15 2TT, UK
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19
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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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Wang Y, Jiang L, Feng SJ, Tang XY, Kuang ZM. Effect of Combined Statin and Antihypertensive Therapy in Patients with Hypertension: A Systematic Review and Meta-Analysis. Cardiology 2020; 145:802-812. [PMID: 33113537 DOI: 10.1159/000508280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This meta-analysis aimed to explore the preventive effects of combined statin and antihypertensive therapy on major cardiovascular outcomes in patients with hypertension. METHODS PubMed, Embase, and the Cochrane Library databases and reference lists of published studies were systematically searched throughout October 9, 2019. Studies designed as randomized controlled trials and investigating the effects of combined statin and antihypertensive therapy versus antihypertensive therapy alone were included. Data abstraction and quality of included studies were assessed by 2 independent authors. The summary results were calculated using relative risks (RRs) with 95% CIs employing a random-effects model. RESULTS A total of 8 randomized controlled trials including 38,618 patients were finally enrolled. The summary RRs indicated that the combined therapy significantly reduced the risk of major adverse cardiovascular events compared with antihypertensive therapy alone (RR 0.79; 95% CI 0.71-0.88; p < 0.001). Furthermore, the patients in the combined therapy group also experienced less myocardial infarction (RR 0.67; 95% CI 0.53-0.84; p = 0.001) and stroke risks (RR 0.82; 95% CI 0.72-0.94; p = 0.005), while no significant difference was observed between combined therapy and antihypertensive therapy alone regarding cardiac death (RR 0.96; 95% CI 0.84-1.08; p = 0.465) and all-cause mortality (RR 0.95; 95% CI 0.86-1.04; p = 0.277). CONCLUSION These findings suggested that combined statin and antihypertensive therapy was associated with more cardiovascular benefits compared with antihypertensive therapy alone.
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Affiliation(s)
- Ying Wang
- The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.,Department of Hypertension, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Long Jiang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shu-Jun Feng
- Hunan Province Key Laboratory of Tumor Cellular and Molecular Pathology, Cancer Research Institute, Hengyang School of Medicine, University of South China, Hengyang, China
| | - Xin-Ying Tang
- Department of Cardiology, Hospital of Chenzhou Affiliated to University of South China, Chenzhou, China
| | - Ze-Min Kuang
- Department of Hypertension, Beijing Anzhen Hospital of Capital Medical University, Beijing, China,
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21
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Jin X, Kim MH, Han KH, Hong SJ, Ahn JC, Sung JH, Cho JM, Lee HC, Choi SY, Lee K, Kim WS, Rhee MY, Kim JH, Hong SP, Yoo BS, Cho EJ, Lee JH, Kim PJ, Park CG, Hyon MS, Shin JH, Lee SH, Sung KC, Hwang J, Kwon K, Chae IH, Seo JS, Kim H, Lee H, Cho Y, Kim HS. Efficacy and safety of co-administered telmisartan/amlodipine and rosuvastatin in subjects with hypertension and dyslipidemia. J Clin Hypertens (Greenwich) 2020; 22:1835-1845. [PMID: 32937023 PMCID: PMC7692919 DOI: 10.1111/jch.13893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022]
Abstract
Single risk factors, such as hypertension and dyslipidemia, can combine to exacerbate the development and severity of cardiovascular disease. Treatment goals may be more effectively achieved if multiple disease factors are targeted with combination treatment. We enrolled 202 patients who were randomly divided into the following three groups: telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg, telmisartan 80 mg + rosuvastatin 20 mg, and telmisartan/amlodipine 80/5 mg. The primary efficacy variables were changes from baseline in mean sitting systolic blood pressure (MSSBP) between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg at 8 weeks, and the percent changes from baseline in low‐density lipoprotein (LDL) cholesterol between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg at 8 weeks. The secondary efficacy variables were changes in MSSBP, mean sitting diastolic blood pressure (MSDBP), LDL cholesterol and other lipid levels at 4 weeks and 8 weeks, as well as observed adverse events during follow‐up. There were no significant differences between the three groups in demographic characteristics and no significant difference among the three groups in terms of baseline characteristics for the validity evaluation variables. The mean overall treatment compliance in the three groups was, respectively, 98.42%, 96.68%, and 98.12%, indicating strong compliance for all patients. The Least‐Square (LS) mean (SE) for changes in MSSBP in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg) groups were −19.3 (2.68) mm Hg and −6.69 (2.76) mm Hg. The difference between the two groups was significant (−12.60 (2.77) mm Hg, 95% CI −18.06 to −7.14, P < .0001). The LS Mean for the percent changes from baseline in LDL cholesterol in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg) groups were −52.45 (3.23) % and 2.68 (3.15) %. The difference between the two groups was significant (−55.13 (3.20) %, 95% CI −61.45 to −48.81, P < .0001). There were no adverse events leading to discontinuation or death. Combined administration of telmisartan/amlodipine 80/5 mg and rosuvastatin 20 mg for the treatment of hypertensive patients with dyslipidemia significantly reduces blood pressure and improves lipid control. ClinicalTrials.gov identifier: NCT03067688.
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Affiliation(s)
- Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Ki Hoon Han
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Soon Jun Hong
- Division of Cardiology, Department of Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jeong-Cheon Ahn
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo-Shik Kim
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Pyo Hong
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pum-Joon Kim
- Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chang-Gyu Park
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Min Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Ho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Jinyong Hwang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Kihwan Kwon
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Sook Seo
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hana Lee
- Yuhan Research Institute, Yuhan Corporation, Yongin, Korea
| | - Yoonhwa Cho
- Yuhan Research Institute, Yuhan Corporation, Yongin, Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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22
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Alghamdi J, Alqadi A, Alharf A, Almuzzaini B, Mahmud A, Barhoumi T, Badreldin HA, Alaamery M, Padmanabhan S. Blood pressure–lowering activity of statins: a systematic literature review and meta-analysis of placebo-randomized controlled trials. Eur J Clin Pharmacol 2020; 76:1745-1754. [DOI: 10.1007/s00228-020-02965-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
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23
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Ayas NT, Foster GE, Shah N, Floras J, Laher I. Could Adjunctive Pharmacology Mitigate Cardiovascular Consequences of Obstructive Sleep Apnea? Am J Respir Crit Care Med 2020; 200:551-555. [PMID: 30875238 DOI: 10.1164/rccm.201811-2097pp] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Najib T Ayas
- Sleep Disorders Program.,Division of Respiratory Medicine and.,Division of Critical Care Medicine, Department of Medicine, and.,Canadian Sleep and Circadian Network and
| | - Glen E Foster
- Canadian Sleep and Circadian Network and.,Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Neomi Shah
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - John Floras
- Division of Cardiology, Department of Medicine, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Sleep and Circadian Network and
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24
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25
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Kim W, Chang K, Cho EJ, Ahn J, Yu CW, Cho K, Kim Y, Kang D, Kim S, Lee S, Kim U, Kim S, Ahn YK, Lee CH, Shin JH, Kim M, Park CG. A randomized, double‐blind clinical trial to evaluate the efficacy and safety of a fixed‐dose combination of amlodipine/rosuvastatin in patients with dyslipidemia and hypertension. J Clin Hypertens (Greenwich) 2020; 22:261-269. [DOI: 10.1111/jch.13774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Woohyeun Kim
- Cardiovascular Center Korea University Guro Hospital Seoul Korea
| | - Kiyuk Chang
- Division of Cardiology Seoul St. Mary's Hospital Seoul Korea
| | - Eun Joo Cho
- Division of Cardiology St. Paul's Hospital Seoul Korea
| | - Jeong‐Cheon Ahn
- Division of Cardiology Korea University Ansan Hospital Ansan Korea
| | - Cheol Woong Yu
- Division of Cardiology Korea University Anam Hospital Seoul Korea
| | - Kyoung‐Im Cho
- Division of Cardiology Maryknoll Medical Center Busan Korea
| | - Yong‐Jin Kim
- Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Duk‐Hyun Kang
- Valvular Heart Disease Center Asan Medical Center Heart Institute Seoul Korea
| | - Seok‐Yeon Kim
- Department of Cardiology Seoul Medical Center Seoul Korea
| | - Sang‐Hak Lee
- Division of Cardiology Severance Cardiovascular Hospital Seoul Korea
| | - Ung Kim
- Division of Cardiology Yeungnam University Medical Center Daegu Korea
| | - Shin‐Jae Kim
- Division of Cardiology Ulsan University Hospital Ulsan Korea
| | - Young Keun Ahn
- Heart Center of Chonnam National University Hospital Gwangju Korea
| | - Chang Hoon Lee
- Division of Cardiology Veterans Health Service Medical Center Seoul Korea
| | - Jin Ho Shin
- Division of Cardiology Hanyang University Hospital Seoul Korea
| | - Mikyung Kim
- Yuhan Research Institute Yuhan Corporation Yongin Korea
| | - Chang Gyu Park
- Cardiovascular Center Korea University Guro Hospital Seoul Korea
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26
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Ruszkowski P, Masajtis-Zagajewska A, Nowicki M. Effects of combined statin and ACE inhibitor therapy on endothelial function and blood pressure in essential hypertension - a randomised double-blind, placebo controlled crossover study. J Renin Angiotensin Aldosterone Syst 2020; 20:1470320319868890. [PMID: 31486700 PMCID: PMC6728690 DOI: 10.1177/1470320319868890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: The aim of this study was to compare the influence of
3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors on endothelial
function and blood pressure in patients with essential hypertension on
long-term angiotensin-converting enzyme inhibitor therapy. Method: The study was designed as a prospective, double-blind, randomised, placebo
controlled, crossover clinical trial. Twenty patients with essential
hypertension were treated with an angiotensin-converting enzyme inhibitor;
the control group included 10 healthy subjects. Hypertensive patients
received in random order 80 mg of fluvastatin daily or placebo for 6 weeks.
The following parameters were assessed at baseline and after each treatment
period: serum lipids, flow-mediated vasodilation, activity of von Willebrand
factor, concentration of vascular endothelial growth factor, C-reactive
protein and 24-hour blood pressure profile. Results: Hypertensive patients did not differ from healthy subjects with respect to
age, body mass and biochemical parameters, with the exception of C-reactive
protein, which was higher in hypertensive patients
(P=0.02). After statin therapy, low-density lipoprotein
cholesterol (P<0.0001), C-reactive protein
(P=0.03), von Willebrand factor
(P=0.03) and vascular endothelial growth factor
(P<0.01) decreased and flow-mediated vasodilation
improved (P<0.001). Statins had no significant effect on
blood pressure. Conclusions: Statins added to angiotensin-converting enzyme inhibitors may improve
endothelial function and ameliorate inflammation independently of blood
pressure.
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Affiliation(s)
- Piotr Ruszkowski
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
| | - Anna Masajtis-Zagajewska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
| | - Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
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27
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Does Co-administration of Antihypertensive Drugs and Statins Alter Their Efficacy and Safety? A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol 2019; 73:352-358. [DOI: 10.1097/fjc.0000000000000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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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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29
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Antihypertensive Treatment Patterns and Blood Pressure Control in Older Adults: Results from the Berlin Aging Study II. Drugs Aging 2019; 35:993-1003. [PMID: 30187292 DOI: 10.1007/s40266-018-0580-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hypertension is highly prevalent in older adults and represents a major public health issue since recognition, awareness, treatment and control are insufficient. Analyses of prescription patterns in conjunction with clinical parameters can provide novel insights into the current practice of hypertension management and help to identify barriers to sufficient hypertension control. METHODS A cross-sectional analysis was conducted. Prevalence of hypertension, patterns of antihypertensive therapy, and determinants of blood pressure (BP) control were examined in the Berlin Aging Study II cohort, including 1654 community-dwelling older adults (60-85 years of age). RESULTS Of the participants, 75.9% had hypertension; 40.6% of these were not prescribed BP medications. Lack of hypertension awareness, younger age, absence of comorbidities, not being on a statin, and not having visited a physician in the past 3 months were associated with lack of treatment. Forty-two percent of treated hypertensive individuals received monotherapy and 58.0% received combination therapy. Renin-angiotensin-aldosterone system (RAAS) inhibitors, and β-blockers were most commonly prescribed, while calcium channel blockers were least prescribed. Only 38.5% of treated hypertensive individuals had their BP controlled to < 140/90 mmHg. Number and choice of BP medications were not predictive of BP control; neither were age, glycated hemoglobin (HbA1c), kidney function, or number of healthcare visits. However, female sex, lower low-density lipoprotein cholesterol (LDL-C) levels and current smoking, amongst others, were positively associated with BP control. There was evidence of significant effect modification by statins in the association of LDL-C and BP. CONCLUSION The majority of older adults do not reach BP goals. Antihypertensive prescription patterns do not conform to current guidelines. Using more BP medications was not associated with higher odds of BP control. Lowering LDL-C might be favorable in terms of BP control.
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Choudhary MK, Eräranta A, Tikkakoski AJ, Koskela J, Hautaniemi EJ, Kähönen M, Mustonen J, Pörsti I. LDL cholesterol is associated with systemic vascular resistance and wave reflection in subjects naive to cardiovascular drugs. Blood Press 2018; 28:4-14. [PMID: 30369274 DOI: 10.1080/08037051.2018.1521263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Low density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerosis, but it is also associated with elevated blood pressure (BP) and future development of hypertension. We examined the relationship between LDL-C and haemodynamic variables in normotensive and never-treated hypertensive subjects. METHODS We recruited 615 volunteers (19-72 years) without lipid-lowering and BP-lowering medication. Supine haemodynamics were recorded using continuous radial pulse wave analysis, whole-body impedance cardiography, and single channel electrocardiogram. The haemodynamic relations of LDL-C were examined using linear regression analyses with age, sex, body mass index (BMI) (or height and weight as appropriate), smoking status, alcohol use, and plasma C-reactive protein, sodium, uric acid, high density lipoprotein cholesterol (HDL-C), triglycerides, estimated glomerular filtration rate, and quantitative insulin sensitivity check index as the other included variables. RESULTS The mean (SD) characteristics of the subjects were: age 45 (12) years, BMI 27 (4) kg/m2, office BP 141/89 (21/13) mmHg, creatinine 74 (14) µmol/l, total cholesterol 5.2 (1.0), LDL-C 3.1 (0.6), triglycerides 1.2 (0.8), and HDL-C 1.6 (0.4) mmol/l. LDL-C was an independent explanatory factor for aortic systolic and diastolic BP, augmentation index, pulse wave velocity (PWV), and systemic vascular resistance index (p < 0.05 for all). When central BP was included in the model for PWV, LDL-C was no longer an explanatory factor for PWV. CONCLUSIONS LDL-C is independently associated with BP via systemic vascular resistance and wave reflection. These results suggest that LDL-C may play a role in the pathogenesis of primary hypertension.
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Affiliation(s)
| | - Arttu Eräranta
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Antti J Tikkakoski
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Clinical Physiology , Tampere University Hospital , Tampere , Finland
| | - Jenni Koskela
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Elina J Hautaniemi
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Mika Kähönen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Clinical Physiology , Tampere University Hospital , Tampere , Finland
| | - Jukka Mustonen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,c Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Ilkka Pörsti
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,c Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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31
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Diebold J. The Effects of Medicare Part D on Health Outcomes of Newly Covered Medicare Beneficiaries. J Gerontol B Psychol Sci Soc Sci 2018; 73:890-900. [PMID: 27154961 DOI: 10.1093/geronb/gbw030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 02/23/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives To estimate the impact of Medicare Part D on cost-related prescription nonadherence and health outcomes among the newly covered medicare beneficiaries. Method Difference-in-differences analyses of data from a balanced panel of Medicare beneficiaries observed in each wave of the Health and Retirement Study from 2000 to 2010 were carried out. The differences in the pre- and post-Part D changes in these outcomes are calculated for previously uncovered Part D enrollees and a comparison group of previously covered Medicare beneficiaries. Results The results from this analysis indicate that Part D reduced cost-related nonadherence rates among the newly covered by 7 percentage points and that this decline was sustained through 2010. Part D was also associated with a 5 percentage points increase in the likelihood that a newly covered enrollee reported to be in good or better health and a 4-percentage point decline in the likelihood of being diagnosed with high blood pressure. These improvements were also sustained through 2010 but were only evident among those newly covered beneficiaries who remained enrolled in a Part D plan through 2010. However, there is insufficient evidence to conclude that Part D improved the blood pressure of newly covered, hypertensive beneficiaries. Discussion Part D has had a sustained impact on cost-related nonadherence rates and the health status of newly covered beneficiaries. However, the change in health status is conditional on remaining enrolled in a Part D plan over time.
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Affiliation(s)
- Jeffrey Diebold
- Department of Public Administration, North Carolina State University, Raleigh
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32
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Del Pinto R, Ferri C, Borghi C. Letter by Del Pinto et al Regarding Article, "Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)". Circulation 2018; 137:2654-2655. [PMID: 29891621 DOI: 10.1161/circulationaha.117.032448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rita Del Pinto
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy (R.D.P., C.F.).,Division of Internal Medicine & Nephrology, San Salvatore Hospital, L'Aquila, Italy (R.D.P., C.F.).,The Italian Society of Hypertension, Milan, Italy (R.D.P., C.F., C.B.)
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy (R.D.P., C.F.).,Division of Internal Medicine & Nephrology, San Salvatore Hospital, L'Aquila, Italy (R.D.P., C.F.).,The Italian Society of Hypertension, Milan, Italy (R.D.P., C.F., C.B.)
| | - Claudio Borghi
- The Italian Society of Hypertension, Milan, Italy (R.D.P., C.F., C.B.).,Department of Medical and Surgical Sciences, Division of Internal Medicine, Alma Mater Studiorum University of Bologna, Policlinico S. Orsola-Malpighi, Italy (C.B.)
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33
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Packer M. Role of the sodium-hydrogen exchanger in mediating the renal effects of drugs commonly used in the treatment of type 2 diabetes. Diabetes Obes Metab 2018; 20:800-811. [PMID: 29227582 DOI: 10.1111/dom.13191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 01/19/2023]
Abstract
Diabetes is characterized by increased activity of the sodium-hydrogen exchanger (NHE) in the glomerulus and renal tubules, which contributes importantly to the development of nephropathy. Despite the established role played by the exchanger in experimental studies, it has not been specifically targeted by those seeking to develop novel pharmacological treatments for diabetes. This review demonstrates that many existing drugs that are commonly prescribed to patients with diabetes act on the NHE1 and NHE3 isoforms in the kidney. This action may explain their effects on sodium excretion, albuminuria and the progressive decline of glomerular function in clinical trials; these responses cannot be readily explained by the influence of these drugs on blood glucose. Agents that may affect the kidney in diabetes by virtue of an action on NHE include: (1) insulin and insulin sensitizers; (2) incretin-based agents; (3) sodium-glucose cotransporter 2 inhibitors; (4) antagonists of the renin-angiotensin system (angiotensin converting-enzyme inhibitors, angiotensin receptor blockers and angiotensin receptor neprilysin inhibitors); and (5) inhibitors of aldosterone action and cholesterol synthesis (spironolactone, amiloride and statins). The renal effects of each of these drug classes in patients with type 2 diabetes may be related to a single shared biological mechanism.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
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34
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Favourable impact of statin use on diastolic blood pressure levels: analysis of a large database of 24-hour ambulatory blood pressure monitoring. J Hypertens 2018; 35:2086-2094. [PMID: 28582284 DOI: 10.1097/hjh.0000000000001419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Assumption of lipid-lowering drugs, mostly statins, is recommended at bed-time and evidence demonstrated a strong and independent correlation between night-time blood pressure (BP) and increased risk of cardiovascular events. AIM To evaluate the effects of statins on night-time BP levels. METHODS We analysed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic and ambulatory BP monitoring at our Unit. All BP measurements were performed and BP thresholds were set according to recommendations from European guidelines. Study population was stratified according to statin use. RESULTS We included an overall sample of 5634 adult individuals (women 48.9%, age 60.5 ± 11.6 years, BMI 27.0 ± 4.6 kg/m, clinic BP 144.3 ± 18.4/90.9 ± 12.4 mmHg, 24-h BP 130.7 ± 13.4/79.0 ± 9.7 mmHg), among whom 17.3% received and 82.7% did not received statins. Treated outpatients were older, had higher BMI and prevalence of risk factors and comorbidities than those who were untreated (P < 0.001 for all). Patients treated with statins showed lower DBP levels at all BP measurements, including night-time (67.3 ± 9.4 vs. 70.9 ± 9.7 mmHg; P < 0.001) periods, than those observed in untreated patients. Also, statin use resulted an independent factor associated with 24-h [odds ratio (95% confidence interval): 1.513(1.295-1.767); P < 0.001] and night-time [odds ratio (95% confidence interval): 1.357(1.161-1.587); P < 0.001] BP control, even after adjusting for age, sex, BMI, diabetes, number of antihypertensive drugs (model 1) or presence/absence of antihypertensive treatment (model 2). CONCLUSION Statin use was associated with significantly lower DBP levels. These effects were independently observed, even after correction for cardiovascular risk factors and comorbidities, as well as number of antihypertensive drugs.
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Lamarche F, Agharazii M, Nadeau-Fredette AC, Madore F, Goupil R. Central and Brachial Blood Pressures, Statins, and Low-Density Lipoprotein Cholesterol: A Mediation Analysis. Hypertension 2018; 71:415-421. [PMID: 29295849 DOI: 10.1161/hypertensionaha.117.10476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/25/2017] [Accepted: 12/09/2017] [Indexed: 01/20/2023]
Abstract
Central blood pressure may be a better predictor of cardiovascular disease than brachial pressure. Although statins reduce brachial pressure, their impact on central pressure remains unknown. Furthermore, whether this effect is mediated through a decrease in low-density lipoprotein cholesterol (LDL-c) is unknown. This study aims to characterize the association of statins and LDL-c with central and brachial blood pressures and to quantify their respective effects. Of the 20 004 CARTaGENE participants, 16 507 had available central blood pressure, LDL-c, and Framingham risk score. Multivariate analyses were used to evaluate the association between central pressure and LDL-c in subjects with or without statins. The impact of LDL-c on the association between statin and pressure parameters was determined through mediation analyses. LDL-c was positively associated with systolic and diastolic central pressure in nonusers (β=0.077 and 0.106; P<0.001) and in participants with statins for primary (β=0.086 and 0.114; P<0.001) and secondary prevention (β=0.120 and 0.194; P<0.003). Statins as primary prevention were associated with lower central systolic, diastolic, and pulse pressures (-3.0, -1.6, and -1.3 mm Hg; P<0.001). Mediation analyses showed that LDL-c reduction contributed to 15% of central systolic and 44% of central diastolic pressure changes associated with statins and attenuated 22% of the effects on central pulse pressure. Similar results were found with brachial pressure components. In conclusion, reduction of LDL-c was associated with only a fraction of the lower blood pressures in statin user and seemed to be mostly associated with improvement of steady (diastolic) pressure, whereas non-LDL-c-mediated pathways were mostly associated with changes in pulsatile pressure components.
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Affiliation(s)
- Florence Lamarche
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Mohsen Agharazii
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Annie-Claire Nadeau-Fredette
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - François Madore
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Rémi Goupil
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.).
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Canepa M, Artom N, Ameri P, Carbone F, Montecucco F, Ghigliotti G, Brunelli C, Dallegri F, Pende A, Pisciotta L. Short-term effect of rosuvastatin treatment on arterial stiffness in individuals with newly-diagnosed heterozygous familial hypercholesterolemia. Int J Cardiol 2017; 255:215-220. [PMID: 29290422 DOI: 10.1016/j.ijcard.2017.12.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/04/2017] [Accepted: 12/16/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Marco Canepa
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Nathan Artom
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Pietro Ameri
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Giorgio Ghigliotti
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Claudio Brunelli
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Aldo Pende
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Livia Pisciotta
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy.
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Freitas F, Estato V, Reis P, Castro-Faria-Neto HC, Carvalho V, Torres R, Lessa MA, Tibirica E. Acute simvastatin treatment restores cerebral functional capillary density and attenuates angiotensin II-induced microcirculatory changes in a model of primary hypertension. Microcirculation 2017; 24. [DOI: 10.1111/micc.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Felipe Freitas
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Vanessa Estato
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Patricia Reis
- Laboratory of Immunopharmacology; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Hugo C. Castro-Faria-Neto
- Laboratory of Immunopharmacology; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
- Estácio de Sá University; Rio de Janeiro Brazil
| | - Vinícius Carvalho
- Laboratory of Inflammation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Rafael Torres
- Laboratory of Inflammation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Marcos A. Lessa
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Eduardo Tibirica
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro RJ Brazil
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Otsuka T, Mizuno K, Shinozaki T, Kachi Y, Nakamura H. Preventive effect of pravastatin on the development of hypertension in patients with hypercholesterolemia: A post-hoc analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study. J Clin Lipidol 2017; 11:998-1006. [PMID: 28655522 DOI: 10.1016/j.jacl.2017.05.015] [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: 01/13/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND It remains unclear whether treatment of dyslipidemia with 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) reduces the risk of developing hypertension. OBJECTIVE In this post-hoc analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, a large-scale primary prevention trial with pravastatin, we examined the preventive effect of pravastatin on the future development of hypertension in patients with hypercholesterolemia. METHODS Of the overall (MEGA) Study population, 3397 nonhypertensive patients at baseline were enrolled in this study. The patients were randomly assigned to either the diet alone group (n = 1722) or the diet plus pravastatin group (n = 1675) and then were followed-up for a median of 36 months to determine new-onset hypertension. RESULTS During the follow-up period, 1595 patients developed hypertension (49.1% in the diet alone group and 44.7% in the diet plus pravastatin group). After adjusting for multiple covariates, the diet plus pravastatin group showed a 10% reduction in the risk of developing hypertension (hazard ratio 0.90, 95% confidence interval 0.81-0.998), compared with the diet alone group. Subgroup analyses revealed that the preventive effect of pravastatin on the development of hypertension was pronounced in patients aged ≥60 years, men, those with chronic kidney disease or diabetes mellitus and those without obesity. CONCLUSIONS Pravastatin reduced the risk of developing hypertension in Japanese patients with hypercholesterolemia. The risk reduction of cardiovascular disease with statins could be partly explained by their preventive effect on the development of hypertension.
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Affiliation(s)
- Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan.
| | | | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yuko Kachi
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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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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Borghi C, Urso R, Cicero AF. Renin-angiotensin system at the crossroad of hypertension and hypercholesterolemia. Nutr Metab Cardiovasc Dis 2017; 27:115-120. [PMID: 27745933 DOI: 10.1016/j.numecd.2016.07.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/30/2016] [Accepted: 07/31/2016] [Indexed: 01/24/2023]
Abstract
AIM The aim of this study is to discuss the reliable scientific evidence of an interactive link between hypertension and hypercholesterolemia considering the metabolic pathways and the pathogenetic mechanisms connecting the two risk factors. DATA SYNTHESIS Hypertension and hypercholesterolemia are highly prevalent in the general population and their coexistence in the same subjects additively increases the risk of cardiovascular disease. Probably, hypercholesterolemia is also a risk factor for the development of hypertension. On the other side, it is also possible that lipid-lowering treatment could improve blood pressure control. Although the mechanisms of interaction between these two risk factors have not been completely elucidated thus far, there is rapidly growing evidence that the involvement of the renin-angiotensin system (RAS) can be considered as the common link between hypertension and hypercholesterolemia. In particular, hypercholesterolemia seems to promote the upregulation of type 1 angiotensin II (AT1) receptor genes because of an increase in the stability of mRNA followed by structural overexpression of vascular AT1 receptors for angiotensin II. The treatment of both risk factors greatly improves individual risk profile, especially when statins and RAS blockers are used together. CONCLUSIONS Hypertension and hypercholesterolemia are highly coprevalent and strongly related from a pathophysiological point of view. The RAS could be the main mediator of this link.
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Affiliation(s)
- C Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - R Urso
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A F Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Hogan DR, Danaei G, Ezzati M, Clarke PM, Jha AK, Salomon JA. Estimating The Potential Impact Of Insurance Expansion On Undiagnosed And Uncontrolled Chronic Conditions. Health Aff (Millwood) 2017; 34:1554-62. [PMID: 26355058 DOI: 10.1377/hlthaff.2014.1435] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Policy makers have paid considerable attention to the financial implications of insurance expansion under the Affordable Care Act (ACA), but there is little evidence of the law's potential health effects. To gain insight into these effects, we analyzed data for 1999-2012 from the National Health and Nutrition Examination Survey to evaluate relationships between health insurance and the diagnosis and management of diabetes, hypercholesterolemia, and hypertension. People with insurance had significantly higher probabilities of diagnosis than matched uninsured people, by 14 percentage points for diabetes and hypercholesterolemia and 9 percentage points for hypertension. Among those with existing diagnoses, insurance was associated with significantly lower hemoglobin A1c (-0.58 percent), total cholesterol (-8.0 mg/dL), and systolic blood pressure (-2.9 mmHg). If the number of nonelderly Americans without health insurance were reduced by half, we estimate that there would be 1.5 million more people with a diagnosis of one or more of these chronic conditions and 659,000 fewer people with uncontrolled cases. Our findings suggest that the ACA could have significant effects on chronic disease identification and management, but policy makers need to consider the possible implications of those effects for the demand for health care services and spending for chronic disease.
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Affiliation(s)
- Daniel R Hogan
- Daniel R. Hogan is a technical officer at the World Health Organization, in Geneva, Switzerland
| | - Goodarz Danaei
- Goodarz Danaei is an assistant professor of global health at the Harvard T.H. Chan School of Public Health, in Boston, Massachusetts
| | - Majid Ezzati
- Majid Ezzati is chair in global environmental health in the Faculty of Medicine, School of Public Health, at Imperial College London, in the United Kingdom
| | - Philip M Clarke
- Philip M. Clarke is a professor in the Health Economics Research Unit at the University of Melbourne, in Australia
| | - Ashish K Jha
- Ashish K. Jha is a professor of health policy and management at the Harvard T.H. Chan School of Public Health
| | - Joshua A Salomon
- Joshua A. Salomon is a professor of global health at the Harvard T.H. Chan School of Public Health
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Sluyter JD, Hughes AD, Lowe A, Camargo CA, Scragg RKR. Statin utilisation in a real-world setting: a retrospective analysis in relation to arterial and cardiovascular autonomic function. Pharmacol Res Perspect 2017; 4:e00276. [PMID: 28097009 PMCID: PMC5226288 DOI: 10.1002/prp2.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 01/09/2023] Open
Abstract
Randomized trials suggest that statin treatment may lower blood pressure and influence cardiovascular autonomic function (CVAF), but the impact of duration of usage, discontinuation, and adherence to this therapy is unknown. We examined these issues with regard to blood pressure (BP)-related variables in a large, population-based study. Participants were 4942 adults (58% male; aged 50-84 years): 2179 on statin treatment and 2763 untreated. Days of utilization, adherence (proportion of days covered ≥0.8), and discontinuation (non-use for ≥30 days immediately prior to BP measurement) of three statins (atorvastatin, pravastatin, and simvastatin) over a period of up to 2 years was monitored retrospectively from electronic databases. Systolic BP (SBP), diastolic BP (DBP), augmentation index, excess pressure, reservoir pressure, and CVAF (pulse rate and BP variability) parameters were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. Days of statin treatment had inverse relationships with pulse rate variability parameters in cardiac arrhythmic participants (20-25% lower than in statin non-users) and with most arterial function parameters in everyone. For example, compared to untreated participants, those treated for ≥659 days had 3.0 mmHg lower aortic SBP (P < 0.01). Discontinuation was associated with higher brachial DBP and aortic DBP (for both, β = 2.0 mmHg, P = 0.008). Compared to non-adherent statin users, adherent users had lower levels of brachial SBP, brachial DBP, aortic DBP, aortic SBP, and peak reservoir pressure (β = -1.4 to -2.6 mmHg). In conclusion, in a real-world setting, statin-therapy duration, non-discontinuation and adherence associate inversely with BP variables and, in cardiac arrhythmias, CVAF parameters.
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Affiliation(s)
- John D Sluyter
- School of Population Health University of Auckland Auckland New Zealand
| | - Alun D Hughes
- Institute of Cardiovascular Sciences University College London London United Kingdom
| | - Andrew Lowe
- Institute for Biomedical Technologies Auckland University of Technology Auckland New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston USA
| | - Robert K R Scragg
- School of Population Health University of Auckland Auckland New Zealand
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Singh RS, Chaudhary DK, Mohan A, Kumar P, Chaturvedi CP, Ecelbarger CM, Godbole MM, Tiwari S. Greater efficacy of atorvastatin versus a non-statin lipid-lowering agent against renal injury: potential role as a histone deacetylase inhibitor. Sci Rep 2016; 6:38034. [PMID: 27901066 PMCID: PMC5128790 DOI: 10.1038/srep38034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022] Open
Abstract
Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors have been shown to improve diabetic nephropathy. However, whether they provide protection via Histone deacetylases (HDAC) inhibition is not clear. We conducted a comparative evaluation of Atorvastatin (AT) versus the non-statin cholesterol-lowering drug, Ezetimibe (EZT) on severity of diabetic nephropathy. Streptozotocin-treated male Wistar rats were fed a cholesterol-supplemented diet and gavaged daily with vehicle, AT or EZT. Control rats received normal diet and gavaged vehicle (n = 8-9/group). Diabetes increased blood glucose, urine albumin-to-creatinine ratio (ACR), kidney pathology and HDAC activity, and reduced renal E-cadherin levels. Both AT and EZT reduced circulating cholesterol, attenuated renal pathology, and did not lower blood glucose. However, AT was significantly more effective than EZT at reducing kidney pathology and HDAC activity. Chromatin immunoprecipitation revealed a significantly higher association of acetylated H3 and H4 with the E-cadherin promoter in kidneys from AT-, relative to EZT- or vehicle-treated rats. Moreover, we demonstrated a direct effect of AT, but not EZT, on HDAC-inhibition and, H3 and H4- acetylation in primary glomerular mesangial cells. Overall, both AT and EZT attenuated diabetic nephropathy; however, AT exhibited greater efficacy despite a similar reduction in circulating cholesterol. HDAC-inhibition may underlie greater efficacy of statins in attenuating kidney injury.
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Affiliation(s)
- Ravi Shankar Singh
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Dharmendra Kumar Chaudhary
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Aradhana Mohan
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Praveen Kumar
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Madan M. Godbole
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Swasti Tiwari
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Ikdahl E, Rollefstad S, Hisdal J, Olsen IC, Pedersen TR, Kvien TK, Semb AG. Sustained Improvement of Arterial Stiffness and Blood Pressure after Long-Term Rosuvastatin Treatment in Patients with Inflammatory Joint Diseases: Results from the RORA-AS Study. PLoS One 2016; 11:e0153440. [PMID: 27093159 PMCID: PMC4836743 DOI: 10.1371/journal.pone.0153440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Patients with inflammatory joint diseases (IJD) have a high prevalence of hypertension and increased arterial stiffness. The aim of the present study was to evaluate the effect of long-term rosuvastatin treatment on arterial stiffness, measured by augmentation index (AIx) and aortic pulse wave velocity (aPWV), and blood pressure (BP) in IJD patients with established atherosclerosis. METHODS Eighty-nine statin naïve IJD patients with carotid atherosclerotic plaque(s) (rheumatoid arthritis n = 55, ankylosing spondylitis n = 23, psoriatic arthritis n = 11) received rosuvastatin for 18 months to achieve low-density lipoprotein cholesterol goal ≤1.8 mmol/L. Change in AIx (ΔAIx), aPWV (ΔaPWV), systolic BP (ΔsBP) and diastolic BP (ΔdBP) from baseline to study end was assessed by paired samples t-tests. Linear regression was applied to evaluate associations between cardiovascular disease (CVD) risk factors, rheumatic disease specific variables and medication, and ΔAIx, ΔaPWV, ΔsBP and ΔdBP. RESULTS AIx, aPWV, sBP and dBP were significantly reduced from baseline to study end. The mean (95%CI) changes were: ΔAIx: -0.34 (-0.03, -0.65)% (p = 0.03), ΔaPWV: -1.69 (-0.21, -3.17) m/s2 (p = 0.03), ΔsBP: -5.27 (-1.61, -8.93) mmHg (p = 0.004) and ΔdBP -2.93 (-0.86, -5.00) mmHg (p = 0.01). In linear regression models, ∆aPWV was significantly correlated with ΔsBP and ΔdBP (for all: p<0.001). CONCLUSIONS There is an unmet need of studies evaluating CVD prevention in IJD patients. We have shown for the first time that long-term intensive lipid lowering with rosuvastatin improved arterial stiffness and induced a clinically significant BP reduction in patients with IJD. These improvements were linearly correlated and may represent novel insight into the pleiotropic effects by statins. TRIAL REGISTRATION ClinicalTrials.gov NCT01389388.
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Affiliation(s)
- Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- * E-mail:
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - Inge C. Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Terje R. Pedersen
- Centre of Preventive Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K. Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Heo YA, Son M, Park K. Blood pressure lowering effect of statin drugs with an application to rosuvastatin. Transl Clin Pharmacol 2016. [DOI: 10.12793/tcp.2016.24.3.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Young-A Heo
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Mijeong Son
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Kyungsoo Park
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Korea
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Gismondi RA, Bedirian R, Pozzobon CR, Ladeira MC, Oigman W, Neves MF. Renin-Angiotensin System Blockade Associated with Statin Improves Endothelial Function in Diabetics. Arq Bras Cardiol 2015; 105:597-605. [PMID: 26465872 PMCID: PMC4693664 DOI: 10.5935/abc.20150123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 05/11/2015] [Indexed: 01/22/2023] Open
Abstract
Background Studies suggest that statins have pleiotropic effects, such as reduction in blood
pressure, and improvement in endothelial function and vascular stiffness. Objective To analyze if prior statin use influences the effect of
renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial
function, and vascular stiffness. Methods Patients with diabetes and hypertension with office systolic blood pressure
≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their
antihypertensive medications replaced by amlodipine during 6 weeks. They were then
randomized to either benazepril or losartan for 12 additional weeks while
continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure
monitoring), endothelial function (brachial artery flow-mediated dilation), and
vascular stiffness (pulse wave velocity) were evaluated before and after the
combined treatment. In this study, a post hoc analysis was performed to compare
patients who were or were not on statins (SU and NSU groups, respectively). Results The SU group presented a greater reduction in the 24-hour systolic blood pressure
(from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated
dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137
to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no
statistically significant difference in pulse wave velocity (SU group: from 9.95
to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). Conclusion Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system
inhibitors improves the antihypertensive response and endothelial function in
patients with hypertension and diabetes.
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Affiliation(s)
| | - Ricardo Bedirian
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Wille Oigman
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Krishnan SM, Sobey CG, Latz E, Mansell A, Drummond GR. IL-1β and IL-18: inflammatory markers or mediators of hypertension? Br J Pharmacol 2015; 171:5589-602. [PMID: 25117218 PMCID: PMC4290704 DOI: 10.1111/bph.12876] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 12/11/2022] Open
Abstract
Chronic inflammation in the kidneys and vascular wall is a major contributor to hypertension. However, the stimuli and cellular mechanisms responsible for such inflammatory responses remain poorly defined. Inflammasomes are crucial initiators of sterile inflammation in other diseases such as rheumatoid arthritis and gout. These pattern recognition receptors detect host-derived danger-associated molecular patterns (DAMPs), such as microcrystals and reactive oxygen species, and respond by inducing activation of caspase-1. Caspase-1 then processes the cytokines pro-IL-1β and pro-IL-18 into their active forms thus triggering inflammation. While IL-1β and IL-18 are known to be elevated in hypertensive patients, no studies have examined whether this occurs downstream of inflammasome activation or whether inhibition of inflammasome and/or IL-1β/IL-18 signalling prevents hypertension. In this review, we will discuss some known actions of IL-1β and IL-18 on leukocyte and vessel wall function that could potentially underlie a prohypertensive role for these cytokines. We will describe the major classes of inflammasome-activating DAMPs and present evidence that at least some of these are elevated in the setting of hypertension. Finally, we will provide information on drugs that are currently used to inhibit inflammasome/IL-1β/IL-18 signalling and how these might ultimately be used as therapeutic agents for the clinical management of hypertension.
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Affiliation(s)
- S M Krishnan
- Department of Pharmacology, Monash University, Clayton, Vic, Australia
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Campbell D, Weir MR. Defining, Treating, and Understanding Chronic Kidney Disease--A Complex Disorder. J Clin Hypertens (Greenwich) 2015; 17:514-27. [PMID: 25917313 PMCID: PMC8031501 DOI: 10.1111/jch.12560] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 12/20/2022]
Abstract
Chronic kidney disease (CKD) is prevalent in more than 20 million people in the United States. The majority of care provided to patients with this disease comes from primary care physicians, although it is often poorly understood. After an extensive literature review, it is clear that it can be difficult to classify and there are many barriers to care. Risk factors for both incident CKD and disease progression include hypertension, poor glycemic control, sociodemographic factors, acute kidney injury, metabolic acidosis, and possibly hyperuricemia and dietary factors. Treatment of patients with CKD should focus on mitigating risk factors, as well as common comorbidities such as cardiovascular disease, anemia, and bone mineral disease. Novel therapies such as pirfenidone, pentoxifylline, and endothelin-1 antagonists are being investigated with promising results.
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Affiliation(s)
- Dean Campbell
- Department of Internal MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Matthew R. Weir
- Division of NephrologyDepartment of MedicineUniversity of Maryland School of MedicineBaltimoreMD
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