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CHD: Lipoprotein Affects Development of Hypertension
By lipidhealth
CHD: Lipoprotein Affects Development of Hypertension
One team of researchers had surmised that factors affecting the endothelium (ie, lipoproteins) might play a role in the development of hypertension. They found that, among 73 patients with recently discovered and never-treated arterial hypertension, those in the highest tertile of serum TC level experienced significant increases in BP during isometric exercise. 2 Investigators who examined 803 asymptomatic individuals aged 40 or older in the Rochester Family Heart Study found that hypertensive men, as compared with their normotensive counterparts, had a significantly lower level of HDL-C and a significantly higher prevalence and amount of coronary artery calcification. 7Palmiero et al, who studied 200 postmenopausal women with previously untreated hypertension, found that those who also had diastolic dysfunction had significantly higher levels of TC and LDL-C and significantly lower levels of HDL-C. 5 The research of Sander and Giles has elucidated one of the biochemical mechanisms that may connect hypertension and dyslipidemia: LDL-C has been shown to upregulate the angiotensin (AT)-I receptor, resulting in an increase in BP. 8
Statins Effects on BP Control
Three reviews suggest that statins—either alone or in combination with certain antihypertensive agents—may lower BP in patients with coexisting hypertension and hypercholesterolemia.1,3,4 All of these reviews cited a variety of studies demonstrating the BP-lowering effect of statins in patients with untreated hypertension, including some with type 2 diabetes. In some of these studies, reductions in diastolic and systolic BP were found to be independent of plasma TC reductions. Borghi also described studies in which retrospective analyses found that statins enhanced the antihypertensive effect of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB), but not that of ß-blockers or diuretics. 3 The mechanism responsible for the statins' BP-lowering effect appears to be largely independent of their effect on plasma TC levels, and may be due to their effects on endothelial function and AT-II receptors. 4 In addition, statins may enhance the ability of ACE inhibitors and CCBs to reduce peripheral vascular tone and improve peripheral vasodilator capacity. 3
Statins Effect on Arterial Stiffness
A recent double-blind crossover study showed that atorvastatin reduced BP and large artery stiffness in 22 normolipidemic patients with isolated systolic hypertension. 9 Patients received a 3-month course of atorvastatin 80 mg daily or placebo. Along with its favorable effect on lipid profiles (even in a normolipidemic population), atorvastatin, when compared with placebo, increased systemic arterial compliance, as measured by carotid applanation tonometry and Doppler velocimetry of the ascending aorta. It also significantly reduced brachial systolic BP by an average of 6 mm Hg ( P =0.03) and diastolic BP by an average of 2 mm Hg ( P =0.04).
Statins Effects on Mortality/CHD in Hypertensive Patients
Substudies of two large trials have assessed the effects of statins in patients with hypertension. (See "Two Major Clinical Trials…," below, for a description of the main elements of the trials.)
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