Abstract
We previously demonstrated lower diastolic blood pressure (BP) levels under statin therapy in adult individuals who consecutively underwent 24‐hour ambulatory BP monitoring and compared their levels to untreated outpatients. Here we evaluated systolic/diastolic BP levels according to different statin types and dosages. 987 patients (47.5% female, age 66.0 ± 10.1 years, BMI 27.7 ± 4.6 kg/m2, clinic BP 146.9 ± 19.4/86.1 ± 12.1 mm Hg, 24‐hour BP 129.2 ± 14.4/74.9 ± 9.2 mm Hg) were stratified into 4 groups: 291 (29.5%) on simvastatin 10‐80 mg/d, 341 (34.5%) on atorvastatin 10‐80 mg/d, 187 (18.9%) on rosuvastatin 5‐40 mg/d, and 168 (17.0%) on other statins. There were no significant BP differences among patients treated by various statin types and dosages, except in lower clinic (P = .007) and daytime (P = .013) diastolic BP in patients treated with simvastatin and atorvastatin compared to other statins. Favorable effects of statins on systolic/diastolic BP levels seem to be independent of types or dosages, thus suggesting a potential class effect of these drugs.
Keywords: ambulatory blood pressure monitoring, hypertension, nighttime blood pressure, statins
1. INTRODUCTION
Essential hypertension is related to an increased risk of major cardiovascular events such as myocardial infarction, stroke, congestive heart failure, and end‐stage renal disease, making it the most common cardiovascular risk factor in the global adult population.1 Risk related to hypertension can be reduced by achieving the recommended clinic blood pressure (BP) targets2 and evidence show that to reduce the burden of hypertension‐related cardiovascular morbidity and mortality, effective and sustained (24‐hour period) BP control should be pursued in a clinical practice setting.3, 4 For this reason, closer scrutiny has been progressively devoted to out‐of‐office BP measurements and antihypertensive strategies aimed at maintaining BP reductions and control over an entire 24‐hour period.5, 6 This is because cardiovascular risk often remains elevated in out of office‐treated hypertensive patients, suggesting that other factors might be implied.
Hypercholesterolemia is frequently observed in hypertensive populations,7, 8, 9 further contributing to the enhancement of individual global cardiovascular risk profiles and enhancing individual susceptibility to major cardiovascular complications, especially coronary artery disease.10 An integrated pharmacological approach based on the concomitant use of BP and total cholesterol‐lowering drugs has been shown to reduce the risk of major cardiovascular complications in large randomized controlled clinical trials performed in high‐risk individuals11, 12, 13, 14, 15, 16 and diabetic patients.17, 18, 19, 20 However, these trials were based on the assessment of clinic BP levels; thus, the effects of combined pharmacological interventions on 24‐hour BP levels (mostly during nighttime) and their potential implications on the risk of cardiovascular diseases remain to be clarified.
In this latter regard, we have recently demonstrated that use of statin therapy is associated with significantly lower diastolic BP levels during 24‐hour ambulatory BP monitoring, independent of the presence or absence of antihypertensive therapy or any number of antihypertensive drug classes.21 Of note, the favorable effects of statin therapy on diastolic BP was consistently observed during both clinic and ambulatory BP measurements, particularly so during the nighttime period, when no significant differences were observed with regard to the clinic and 24‐hour ambulatory systolic BP levels.21 The latter may have potential clinical implications, due to the well‐known correlation between nighttime BP levels and increased risk of cardiovascular and cerebrovascular events.22, 23
In this predefined analysis, we focused our attention on the subgroups of patients under statin therapy with the aim of identifying potential differences among drugs and molecules with regard to systolic/diastolic BP levels by analyzing data derived from the same database of adult patients undergoing 24‐hour ambulatory BP monitoring at our hypertension unit.
2. METHODS
2.1. Study population
As applied in the previous analysis,21 we extracted data from the same medical database, which included clinical records derived from adult individuals who were consecutively evaluated for full BP assessment (home, clinic, and 24‐hour ambulatory BP monitoring) at the outpatient service of our hypertension unit at Sant'Andrea Hospital between January 2007 and December 2016. 24‐hour ambulatory BP monitoring is a common practice at our unit and applied for both diagnostic and therapeutic purposes to either hypertensive outpatients or high‐risk individuals. To be included in the study protocol, participants had to present the following inclusion criteria: (1) individuals aged more than 30 years and (2) signature of informed consent for study participation. In addition, the following exclusion criteria were considered: (1) recent (< 6 months) history of acute cardiovascular disease, including at least one of the following: coronary artery disease, stroke, congestive heart failure, severe valve disease, or peripheral artery disease; (2) any neurological or psychiatric disease which may at least, in part, affect the BP assessment or the signature of the informed consent.
Once included in the analysis, patients were initially stratified into 2 groups, depending on the presence or the absence of statin therapy.21 In this regard, time for drug assumption was indicated in patients’ diary and then reported in the database for the analysis. Thus, in our population sample, all statins have been assumed between 20.00 and 22.00.
In the present analysis, only patients on statin therapy were considered and stratified into different groups, depending on type (simvastatin 10‐80 mg daily, atorvastatin 10‐80 mg daily, rosuvastatin 5‐40 mg daily, others) and dosages (low, medium, full dose) of statins. In particular, daily dosages of statins were considered as follows: (1) low dose: simvastatin 10 mg, atorvastatin 10 mg, rosuvastatin 5 mg, (2) medium dose: simvastatin 20 mg, atorvastatin 20 mg, rosuvastatin 10 mg, (3) full dose: simvastatin 40‐80 mg, atorvastatin 40‐80 mg, rosuvastatin 20‐40 mg.24
The study conformed to the Declaration of Helsinki and its subsequent modifications. The confidentiality of the data of each patient included in the present study was carefully and strictly protected. Informed consent was obtained from all individuals included in the present study, which was approved by the local ethics committee.
2.2. Home, clinic, and 24‐hour ambulatory blood pressure measurements
As applied in the previous analysis,21 all BP measurements were performed according to recommendations by European guidelines.25 In particular, clinic BP measurements were performed in the hypertension clinic during the morning section (8:00 am to 10:00 am). Sequential BP measurements were performed after 10 minutes of rest on the same arm with the participant in the sitting position in a quiet room using an automated oscillometric device (Omron 705 IT). The average of 3 consecutive BP measurements and heart rate was considered as clinic systolic/diastolic BP levels.25
ABPM was performed using an oscillometric device (Spacelabs 90207) in the hypertension unit after completion of the clinic BP measurements and started at approximately 10:00 am. Automatic BP readings were obtained every 15 minutes during the daytime period (6:00 am to 22:00 pm) and every 30 minutes during the nighttime period (from 22:00 pm to 6:00 am) over the 24 hours.25 Each patient was instructed not to alter her/his usual schedule during the monitoring period, to avoid unusual physical activities, and to maintain stillness of the arm during the BP measurements. Average values for the 24‐hour, daytime and nighttime systolic and diastolic BP levels, and heart rate were reported. Also, BP load, defined as the number of BP measurements above the normal BP thresholds, was reported for each time period (24‐hour, daytime, and nighttime) in each participant.25
2.3. Definition of cardiovascular risk factors and comorbidities
Diagnosis of hypertension was made in the presence of clinic systolic/diastolic BP levels ≥ 140/90 mm Hg or in the presence of stable (>6 months) antihypertensive drug treatment in subsequent visits.25 Diagnosis of hypercholesterolemia was made in the presence of total cholesterol levels ≥ 190 mg/dL or LDL cholesterol levels ≥ 130 mg/dL, while hypertriglyceridemia for triglyceride levels ≥ 150 mg/dL or stable lipid‐lowering drug treatment in both conditions.26 Diabetes was defined in the presence of plasma glucose levels ≥ 126 mg/dL or in the presence of glucose‐lowering therapy.27
Coronary artery disease (CAD), including non‐fatal myocardial infarction (MI), was defined as the presence of the 2 of the following 3 items: (1) symptoms (eg, chest pain) lasting longer than 15 min, (2) transient increase in serum concentrations of enzymes indicating cardiac damage (more than twice the upper limit of normal), and (3) electrocardiographic changes typical of myocardial ischemia (new persistent ST‐segment elevation or pathological Q waves in 2 contiguous leads).28, 29 The diagnosis of CAD may also include other coronary events, including acute coronary syndrome, recurrent angina, and coronary revascularization.30
Non‐fatal stroke was defined as a neurological deficit with sudden onset and persistence of symptoms for more than 24 hours or leading to death with no apparent causes other than vascular ones.31 Transient ischemic attack (TIA) was defined as a neurological event with the signs and symptoms of stroke that go away within a short period (typically lasting 2‐30 minutes).32
2.4. Statistical analysis
All data were entered into Microsoft Access for Windows (Microsoft Office). Given the retrospective, descriptive nature of the study, no calculation sample analysis was made, and all patients included in the medical database were initially considered. Baseline characteristics of patients are presented as number and percentage for dichotomous variables and mean ± standard deviation of the mean for continuous variables. Normal distribution of data was assessed using histograms and Kolmogorov‐Smirnov test. Differences between continuous variables were assessed using either Student's t‐test (comparison between 2 samples) or ANOVA test (comparisons among more than 2 groups). Differences for systolic/diastolic BP levels among various statin groups were also adjusted for potential confounding factors, including age, gender, BMI, diabetes, and presence of antihypertensive therapy, by adopting univariate general linear model with least square deviation for multiple comparisons. Categorical variables were compared among groups by the chi‐squared test. All tests were two‐sided, and a P value of less than .05 was considered statistically significant. All calculations were generated using SPSS, version 20.0.
3. RESULTS
3.1. Study population
Flowchart for selecting the study population is illustrated in Figure S1. From an overall population sample of 7216 adult outpatients who underwent full BP assessment at our hypertension unit, 415 (5.7%) individuals aged less than 30 years were excluded, and 301 (4.2%) items were omitted due to partial or missing BP data, thus leading to a remaining sample of 6500 adult outpatients aged 30 years or more, which represents the 90.1% of the initial population. This population was initially stratified into 2 groups, depending on the presence (n = 987; 15.2%) or absence (n = 5,513; 84.8%) of statin therapy. In the present analysis, we considered only patients under statin therapy, who were further stratified into 4 groups, depending on drug type: 291 (29.5%) received simvastatin 10‐80 mg daily, 341 (34.5%) atorvastatin 10‐80 mg daily, 187 (18.9%) rosuvastatin 5‐40 mg daily, and 168 (17.0%) other statins (mostly including pravastatin, lovastatin, fluvastatin).
In those patients in whom data on daily dosage prescriptions of statins were available (n = 819; 82.9%), we observed the following distribution of different statin types and dosages: (1) low dose (n = 163; 19.9%): simvastatin 10 mg (n = 50; 30.7%), atorvastatin 10 mg (n = 74; 45.4%), rosuvastatin 5 mg (n = 39; 23.9%), (2) medium dose (n = 518; 63.2%): simvastatin 20 mg (n = 209; 40.3%), atorvastatin 20 mg (n = 207; 40.0%), rosuvastatin 10 mg (n = 102; 19.7%), (3) full dose (n = 138; 16.8%): simvastatin 40‐80 mg (n = 32; 23.2%), atorvastatin 40‐80 mg (n = 60; 43.5%), rosuvastatin 20‐40 mg (n = 46; 33.3%).
3.2. Distribution of cardiovascular risk factors and comorbidities
General characteristics of the patients treated with different statin types are reported in Table 1 and characteristics of patients treated or not treated with statins are reported in Table S1. Patients treated with simvastatin and atorvastatin were significantly older (P < .001) and more frequently male (P = .004) compared to those treated with other statins. In addition, they showed significantly higher prevalence of major cardiovascular risk factors, including older age (P = .002) and hypertension (P < .001), as well as higher prevalence of coronary artery disease (P = .001) and cerebrovascular disease (P = .007), compared to those treated with other types of statins. Patients treated with 3 major statins (simvastatin, atorvastatin, and rosuvastatin) also received significantly more antihypertensive drugs, mostly in dual, triple, or more complex combination therapies compared to those treated with other types of statins (P < .001 for all comparisons).
Table 1.
General characteristics of the patients treated with different statin types
| Parameters | Simvastatin | Atorvastatin | Rosuvastatin | Other statins | P value |
|---|---|---|---|---|---|
| Individuals (%) | 291 (29.5) | 341 (34.5) | 187 (18.9) | 168 (17.0) | ‐ |
| Female (%) | 133 (45.7) | 144 (42.2) | 93 (49.7) | 99 (58.9) | .004 |
| Age (y) | 67.2 ± 9.0a | 67.1 ± 10.3a | 65.1 ± 9.9 | 62.7 ± 11.1 | <.001 |
| BMI (kg/m2) | 27.7 ± 4.6 | 27.8 ± 4.6 | 27.9 ± 4.8 | 27.4 ± 4.6 | .803 |
| Elderly (%) | 182 (62.5) | 215 (63.0) | 100 (53.5) | 80 (47.6) | .002 |
| Smoking (%) | 51 (22.2) | 66 (19.3) | 49 (26.3) | 13 (7.7) | .608 |
| Obesity (%) | 203 (69.8) | 238 (69.8) | 129 (69.0) | 111 (66.1) | .837 |
| Hypertension (%) | 280 (99.3) | 327 (99.4) | 176 (98.9) | 123 (78.3) | <.001 |
| Dyslipidaemia (%) | 284 (97.6) | 336 (98.5) | 187 (100.0) | 165 (98.2) | .213 |
| Diabetes (%) | 78 (26.8) | 93 (27.3) | 44 (23.5) | 29 (17.3) | .071 |
| CAD (%) | 23 (7.9) | 44 (12.9) | 13 (7.0) | 5 (3.0) | .001 |
| Stroke (%) | 15 (5.2) | 24 (7.0) | 2 (1.1) | 4 (2.4) | .007 |
| Antihypertensive Tx (%) | 287 (98.6) | 336 (98.5) | 184 (98.4) | 72 (42.9) | <.001 |
| Antihypertensive Drugs (num) | 2.45 ± 1.2 | 2.52 ± 1.3 | 2.61 ± 1.2 | 1.01 ± 1.3 | <.001 |
| Monotherapy (%) | 73 (25.1) | 68 (19.8) | 27 (14.4) | 14 (8.3) | |
| Dual therapy (%) | 80 (27.5) | 112 (32.8) | 62 (33.2) | 34 (20.2) | |
| Triple therapy (%) | 79 (27.1) | 87 (25.5) | 58 (31.0) | 15 (8.9) | |
| ≥3 drugs (%) | 55 (18.9) | 69 (20.2) | 37 (19.8) | 10 (6.0) |
BMI, body mass index; CAD, coronary artery disease; Tx, therapy.
P < .005 compared to other statins.
3.3. Blood pressure levels and control
Average BP levels in patients treated with different statin types are reported in Table 2, while BP levels in patients treated or not treated with statins are reported in Table S2.
Table 2.
Average BP levels in patients treated with different statin types
| Parameters | Simvastatin | Atorvastatin | Rosuvastatin | Other statins | P value | |
|---|---|---|---|---|---|---|
| (Unadjusted) | (Adjusted)a | |||||
| Home SBP (mm Hg) | 139.2 ± 18.3 | 140.6 ± 21.2 | 137.2 ± 21.1 | 135.8 ± 12.0 | .339 | .256 |
| Home DBP (mm Hg) | 79.7 ± 11.0 | 81.4 ± 13.0 | 80.8 ± 12.4 | 83.0 ± 9.9 | .307 | .478 |
| Clinic SBP (mm Hg) | 144.1 ± 18.7 | 143.9 ± 20.7 | 143.7 ± 19.3 | 143.6 ± 17.8 | .994 | .568 |
| Clinic DBP (mm Hg) | 85.8 ± 11.1 | 84.7 ± 12.6b | 87.0 ± 12.1 | 88.6 ± 12.1 | .007 | .365 |
| Clinic PP (mm Hg) | 58.3 ± 16.4 | 59.1 ± 17.1 | 56.7 ± 16.3 | 55.0 ± 14.3 | .047 | .474 |
| 24‐h SBP (mm Hg) | 128.9 ± 13.9 | 130.2 ± 16.2 | 129.0 ± 13.4 | 128.1 ± 12.2 | .450 | .491 |
| 24‐h DBP (mm Hg) | 74.4 ± 9.0 | 74.4 ± 9.5 | 75.4 ± 9.0 | 76.2 ± 8.9 | .128 | .951 |
| 24‐h PP (mm Hg) | 54.5 ± 11.8 | 55.7 ± 13.2b | 53.6 ± 10.7 | 51.9 ± 10.0 | .006 | .262 |
| Daytime SBP (mm Hg) | 133.3 ± 14.7 | 133.1 ± 16.8 | 132.1 ± 13.7 | 132.0 ± 12.9 | .834 | .386 |
| Daytime DBP (mm Hg) | 77.2 ± 9.5b | 77.0 ± 10.3b | 78.0 ± 9.5 | 79.9 ± 9.7 | .013 | .768 |
| Daytime PP (mm Hg) | 55.1 ± 12.2 | 56.0 ± 13.4b | 54.1 ± 10.8 | 52.1 ± 10.1 | .005 | .404 |
| Nighttime SBP (mm Hg) | 119.6 ± 14.3 | 121.8 ± 17.9 | 120.9 ± 14.8 | 118.1 ± 14.3 | .069 | .533 |
| Nighttime DBP (mm Hg) | 66.4 ± 9.0 | 67.0 ± 9.5 | 67.9 ± 10.0 | 67.2 ± 8.2 | .368 | .566 |
| Nighttime PP (mm Hg) | 53.2 ± 11.7 | 54.8 ± 13.8b | 52.9 ± 10.9 | 50.9 ± 12.6 | .009 | .487 |
DBP, diastolic blood pressure; PP, pulse pressure; SBP, systolic blood pressure.
Adjusted for the following covariates: age, gender, BMI, diabetes, dyslipidaemia, antihypertensive therapy.
P < .005 compared to other statins.
In the overall study sample, there were no significant differences with regard to the proportions of patients who had clinic systolic/diastolic BP levels below the recommended thresholds of less than 140/90 mm Hg among those treated with either simvastatin (34.4%), atorvastatin (34.3%), rosuvastatin (34.8%), or other statin types (36.3%; P = .234). Also, there were no significant BP differences among patients treated with various statin types (Figure 1) and dosages (Figure 2) with regard to clinic, 24‐hour, and daytime and nighttime BP levels, even after adjustment for potential confounding factors, including age, gender, BMI, dyslipidaemia, diabetes, and antihypertensive therapy.
Figure 1.
24‐hour ambulatory (left) and nighttime (right) systolic (panel A) and diastolic BP (panel B) levels in patients under different statin types. BP, blood pressure; simva, simvastatin; atorva, atorvastatin; rosuva, rosuvastatin
Figure 2.
24‐hour ambulatory (left) and nighttime (right) systolic (panel A) and diastolic BP (panel B) BP levels in patients under different statin dosages. BP, blood pressure
Post hoc analyses showed significantly lower clinic diastolic BP levels in patients treated with atorvastatin compared to those treated with other statins (P < .007). Also, patients treated with simvastatin and atorvastatin showed significantly lower diastolic daytime BP levels compared to those reported in patients treated with other statins (P < .013). These results were paralleled by significantly higher PP levels in patients treated with atorvastatin compared to those treated with different statins at both clinic (P = .047), 24‐hour (P = .006) and daytime (P = .005) and nighttime (P = .009) BP measurements.
4. DISCUSSION
In the recent years, randomized clinical trials performed in adult patients with hypertension and mild hypercholesterolemia have consistently demonstrated that combined treatment with BP and cholesterol‐lowering agents is associated with reduced incidence of major complications and improved event‐free survival rate.11, 12, 13, 14, 15, 16 In the Anglo‐Scandinavian Cardiac Outcomes Trial (ASCOT), which involved 10 305 patients with hypertension and average total cholesterol levels of 252 mg/dL, were randomly assigned to atorvastatin 10 mg daily or a placebo. Treatment with atorvastatin was associated with significantly lower BP levels and 36% fewer incidence of fatal and non‐fatal coronary events compared to the placebo.14 Similar data have been obtained in the San Diego Statin Study, in which treatment with simvastatin or pravastatin produced significantly greater BP reductions compared to placebo.33 More recently, in a sub‐analysis of the Heart Outcomes Prevention Evaluation‐3 (HOPE‐3) trial that included more than 500 patients at intermediate cardiovascular risk, combined treatment with rosuvastatin 10 mg daily and antihypertensive therapy produced a decrease in systolic BP 6.2 mm Hg greater in the combined‐therapy group than in the dual‐placebo group.34
These clinical trials suggested potentially reciprocal and beneficial interactions between antihypertensive drugs and statins. However, the same trials, as well as other clinical studies,35, 36 were mostly based on conventional clinic BP assessment. The potential effects of statins on home and 24‐hour ambulatory BP levels have been tested in some clinical studies.37, 38, 39 Since 24‐hour and (mostly) nighttime BP levels have demonstrated to be strictly related to increased risk of cardiovascular and cerebrovascular accidents compared to clinic BP measurements,40, 41 the evaluation of out‐of‐office BP levels in patients treated or not treated with statins may provide useful information for planning therapeutic interventions aimed at reducing the risk of major cardiovascular complications.
In this predefined analysis of our database of adult patients undergoing 24‐hour ambulatory BP monitoring at our hypertension unit, we confirmed that statin therapy could be associated with lower diastolic BP levels, as also reported in other independent meta‐analyses.42, 43 Indeed, we observed reduced diastolic BP levels in patients treated with statins independently by how BP levels were measured (home, clinic, 24‐hour, daytime and nighttime ambulatory) and by the presence or absence of concomitant antihypertensive therapies. In particular, even if not statistically significant, we reported the lowest diastolic BP levels in those patients treated with simvastatin and low‐intensity statin group and compared them to others. These differences cannot be explained by a relatively lower cardiovascular risk profile in the former than in the latter groups, since the prevalence of cardiovascular risk factors and comorbidities, as well as the use of antihypertensive therapies, were significantly higher in patients treated with simvastatin and atorvastatin than in other groups.
In our study, we also observed favorable effects on diastolic BP levels in patients treated with atorvastatin compared to those treated with other statins, which translated into significantly higher levels of PP at both clinic and 24‐hour ambulatory BP measurements. Although the retrospective nature of our analysis does not allow any speculation, these observations further support a specific favorable impact provided by statins on reduced diastolic BP without relevant effects on systolic BP levels. Indeed, similar findings were reported in a recent double‐blind, randomized, placebo‐controlled study, which involved 50 patients with mild hypertension and hypercholesterolemia, who were randomized to either 10 mg atorvastatin or a placebo for 26 weeks.38 In this active study, atorvastatin significantly reduced 24‐hour diastolic BP as compared with placebo.38
Favorable effects provided by statins might be related to reduced peripheral vascular resistance, thus promoting sustained diastolic BP reductions. In addition, several studies demonstrated that statins reduced levels of LDL/VLDL particles, which may improve blood viscosity, reduce the burden of free oxygen radicals and pro‐inflammatory cytokines and reduce peripheral vascular resistance, thus resulting in reduced BP levels, mostly diastolic BP.44 These effects may have potential clinical implications, mostly in view of the strict and significant relationship between nighttime BP levels and increased risk of cardiovascular and cerebrovascular events.45, 46, 47, 48 Our findings, in fact, demonstrated that statin use was associated with a reduced diastolic BP load during both 24‐hour and nighttime periods, which may translate into effective cardiovascular disease prevention.
Our results are also in line with several other experimental and clinical studies that demonstrated favorable effects of statin use in hypertensive patients of different cardiovascular risk profiles regarding reduced sympathetic nerve over‐activity,49 reduced oxidative stress,50 improved endothelial function,51, 52 and insulin sensitivity.53
4.1. Potential limitations
The present study has some potential limitations that should be acknowledged.21 First, the observational study design and the applied cross‐sectional analysis cannot provide cause‐and‐effect associations. Second, data were retrospetically extracted from our medical database, not prospectically collected during clinical consultations. We arbitrarily excluded young patients aged less than 30 years because: (1) proportions of statins users in young individuals were relatively low in our study population, (2) young patients under statins therapy were often affected by familial hypercholesterolemia and very high cardiovascular risk. Also, information on pharmacological therapies, predominately antihypertensive and lipid‐lowering drugs, was collected from individual patient records and not evaluated at the time of the BP assessment. For this reason, potential bias related to missing data and incomplete or partial self‐recording by enrolled patients must be acknowledged. Another potential explanation of the observed differences in nighttime BP levels would be a different distribution of sleep apnea syndrome, which is more common in hypertensive than in normotensive patients. However, given the retrospective nature of our analysis, any generalization of the observed results to the general hypertensive population should be considered with caution. As also reported in the previous analysis from the same database,21 we cannot assess adherence to pharmacological therapies, since data have been spontaneously declared by enrolled patients in their clinical diaries. Indeed, patients on statin therapy may be more likely to take their BP lowering meds as well. It should also be noted, however, that patients included in the present analysis—adult outpatients who were referred to an excellence center for hypertension diagnosis and control—would be highly motivated to be compliant to prescribed medications during clinical consultations. Finally, data on metabolic and renal parameters, as well as markers of organ damage and other non‐cardiovascular comorbidities have not been addressed, being out of the intention of the present analysis.
5. CONCLUSIONS
This analysis demonstrated for the first time that there were no significant differences among different statin types and dosages about systolic/diastolic BP levels during 24‐hour ambulatory BP monitoring, particularly during the nighttime period. Also, favorable effects provided by statins on BP levels (mostly diastolic BP) seem to be, at least in part, independent based on the presence or absence of concomitant antihypertensive therapies, as well as other clinical parameters and comorbidities, thus suggesting a potential class effect of these drugs. Further prospective studies are needed to evaluate the potential clinical implications of reduced 24‐hour and nighttime systolic and diastolic BP levels observed in patients treated with statins concerning the reduced incidence of major cardiovascular and cerebrovascular events.
CONFLICT OF INTEREST
Authors have no conflicts of interest to disclose on the contents of the present manuscript.
Supporting information
Presta V, Figliuzzi I, Citoni B, et al. Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24‐hour ambulatory blood pressure database. J Clin Hypertens. 2018;20:967–975. 10.1111/jch.13283
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