Reduction in blood pressure with statins: results from the UCSD Statin Study, a randomized trial

Abstract

Background: Some studies have suggested reductions in blood pressure (BP)with statin treatment, particularly in persons with hypertension. Randomized trial evidence is limited.

Methods: We performed a randomized, double-blind, placebo-controlled trial with equal allocation to simvastatin, 20 mg; pravastatin sodium,40 mg; or placebo for 6 months. Nine hundred seventy-three men and women without known cardiovascular disease or diabetes mellitus, with low-density lipoprotein cholesterol screening levels of 115 to 190 mg/dL, had assessment of systolic and diastolic BP (SBP and DBP, respectively). Blood pressure values were compared for placebo vs statins by intention-to-treat (ITT) analysis. Additional analyses were performed that (1) were confined to subjects with neither high baseline BP (SBP>140 mm Hg or DBP>90 mm Hg) nor receiving BP medications, to exclude groups in whom BP medications or medication changes may have influenced results, and (2) separately evaluated simvastatin and pravastatin (vs placebo). The time course of BP changes after statin initiation and the effect of stopping statins on BP were examined.

Results: Statins modestly but significantly reduced BP relative to placebo,by 2.2 mm Hg for SBP (P=.02) and 2.4 mm Hg for DBP (P<.001) in ITT analysis. Blood pressure reductions ranged from 2.4 to 2.8 mm Hg for both SBP and DBP with both simvastatin and pravastatin, in those subjects with full follow-up, and without potential for influence by BP medications (ie, neither receiving nor meriting BP medications).

Conclusions: Reductions in SBP and DBP occurred with hydrophilic and lipophilic statins and extended to normotensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported on statins. Trial Registration clinicaltrials.gov Identifier: NCT00330980.

Figure 1

Flowchart of participants.

Figure 2

Difference between the statin and placebo groups. A, Systolic blood pressure (SBP), change from baseline. This figure shows values for subjects who were not hypertensive at baseline, were never prescribed BP medications, and had BP measured through the 8-month visit. This mitigates the influence of changes distinct from treatment assignment across time. The change values differed significantly from placebo (P <.05) at month 6 (only) for both pravastatin sodium and simvastatin. Standard errors for pravastatin: month 1, 1.3; month 6, 1.2; month 8, 1.2. Standard errors for simvastatin: month 1, 1.2; month 6, 1.2; month 8, 1.2. P values for pravastatin: month 1, P = .18; month 6, P = .04; month 8, P = .69. P values for simvastatin: month 1, P = .30; month 6, P = .02; month 8, P = .18. B, DBP, change from baseline. This figure shows values for subjects who were not hypertensive at baseline, were never prescribed BP medications, and had BP measured through the 8-month visit. This mitigates the influence of changes distinct from treatment assignment across time. The change values differed significantly from placebo (P ≤.01) at month 6 (only) for both pravastatin and simvastatin. Standard errors for pravastatin: month 1, 0.98; month 6, 0.96; month 8, 1.0. Standard errors for simvastatin: month 1, 0.97; month 6, 0.98; month 8, 1.0. P values for pravastatin: month 1, P = .06; month 6, P = .004; month 8, P = .06. P values for simvastatin: month 1, P = .46; month 6, P = .01; month 8, P = .66.