ESH Meeting Highlights 2006

 
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June 14

Statins associated with small blood pressure reduction in meta-analysis

 

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The investigators stated it was unclear whether this was a class effect or a property of one or more single substances. The study was reported at the16th European Meeting of Hypertension in Madrid, Spain by Dr. P. Strazzullo of Naples, Italy in a clinical trials session (abstract).

Of the 20 trials in the meta-analysis (reported before October 2005 and meeting inclusion criteria), with a total of 889 patients, 18 were randomized controlled trials and 2 were crossover trials (one compared statin to probuchol and the other statin to orlistat). The length of the trials was from 1 week to 1 year. Of the 18 trials, 8 were with pravastatin, 6 with simvastatin, 3 with fluvastatin, 2 with cerivistatin, 2 with atorvastatin, and 1 with lovastatin. The main outcome measure of the meta-analysis was the change in blood pressure with a statin compared to placebo or control.

Systolic blood pressure (SBP) was lower in 14 of the 20 trials in patients on a statin, and overall SBP was significantly 1.9 mmHg lower with a statin, with significant heterogeneity between trials. Diastolic blood pressure (DBP) was lower on a statin in 14 of the 20 trials and significantly lower in 3 of those 14 trials. Overall, there was a
0.9 mmHg lower DBP with a statin, with significant between-trial heterogeneity.

Blood pressure response to statin therapy seemed to be predicted by average baseline blood pressure. In studies with a baseline blood pressure >130 mmHg, there was a significant 4 mmHg lower SBP with no significant between-study heterogeneity. In studies with a DBP >80 mmHg, a significant 1.2 mmHg lower DBP was found with no significant heterogeneity between trials.

A greater reduction (6/3 mmHg) in blood pressure was found in patients with diabetes and hypercholesterolemia, and the investigators concluded that these results have possible clinical implications for blood pressure control in patients with comorbidities who require statin therapy.

The meta-regression analysis showed a relation between baseline blood pressure and blood pressure response and this significant for DBP, but no relation for age, diabetes, change in serum cholesterol, or concomitant therapy for hypertension. No publication or system bias was found in their analysis.

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