EFFECTS OF CHOLESTEROL REDUCTION ON BP RESPONSE TO MENTAL STRESS IN PATIENTS WITH HIGH CHOLESTEROL

Impaired endothelium-dependent vascular relaxation has been reported i n patients with high cholesterol(HC), but the systemic effects of elev ated cholesterol on blood pressure (BP) and BP reactivity to stress ha ve not been studied. We examined the BP response to a standard mental arithmetic test (MAT) in 37 healthy, normotensive HC subjects and 33 n ormal cholesterol controls (NC). Both groups had similar age, body mas s index, and gender distribution. HC had slightly higher systolic BP a t baseline (122 v 118 mm Hg, P<.05) than NC and systolic BP response d uring MAT was significantly higher in HC compared to NC (18 +/- 8 v 10 +/- 5 mm Hg, P<.05). Maximal changes in systolic BP were significantl y correlated with cholesterol(R = 0.41, P<.001), whereas heart rate an d diastolic BP changes were unrelated to serum cholesterol. To confirm that BP reactivity was dependent on cholesterol, MAT was repeated aft er treatment with 20 mg/day of lovastatin, a hepatic hydroxymethyl glu taryl coenzyme A (HMG-CoA) reductase inhibitor, for 6 weeks using a cr oss-over design in 26 HC subjects. Lovastatin significantly altered li pid profiles (-26% total cholesterol, +8% HDL, -34% LDL). A small decr ease in systolic BP at baseline (-3 mm Hg, P = NS) and significantly l ower systolic BP (-8 mm Hg, P <.05) during MAT was observed after the treatment with lovastatin. In conclusion, patients with high cholester ol had an exaggerated systolic BP response to MAT. Decreased BP reacti vity during HMG-CoA reductase inhibitor therapy suggests that lowering cholesterol may have a role in the overall control of BP. (C) 1997 Am erican Journal of Hypertension, Ltd.