Effect of the HMG-CoA reductase inhibitors on blood pressure in patients with essential hypertension and primary hypercholesterolemia

Certain hydroxymethylglutaryl coenzyme A reductase inhibitors, ie, statins, may cause vasodilation by restoring the endothelial dysfunction that frequ ently accompanies hypertension and hypercholesterolemia. Several studies ha ve found that a blood pressure reduction is associated with the use of stat ins, but conclusive evidence from controlled trials is lacking. After an 8- week placebo and diet run-in period, 30 persons with moderate hypercholeste rolemia and untreated hypertension (total cholesterol 6.29+/-0.52 mmol/L, s ystolic and diastolic blood pressure 149+/-6 and 97+/-2 mm Hg) were randomi zed in a double-blind manner to placebo or pravastatin (20 to 40 mg/d) in a crossover design. In 25 participants who completed the 32-week trial, prav astatin decreased total and LDL cholesterol (both -1.09 mmol/L, P=0.001), s ystolic and diastolic blood pressure (-8 and -5 mm Hg, both P=0.001), and p ulse pressure (-3 mm Hg, P=0.011) and blunted the blood pressure increase c aused by the cold presser test (-4 mm Hg, P=0.005) compared with placebo. I t also reduced the level of circulating endothelin-l (P=0.001). The blood p ressure results were virtually unchanged in stratified analyses according t o gender and age and in intention-to-treat analyses that included the 5 pat ients who dropped out of the study. When the participants were taking eithe r placebo or pravastatin, blood pressure was not significantly correlated w ith total or LDL cholesterol or with circulating endothelin-l. Pravastatin decreases systolic, diastolic, and pulse pressures in persons with moderate hypercholesterolemia and hypertension. This antihypertensive effect may co ntribute to the documented health benefits of certain statins.