DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20164104

Study of lipid and non-lipid effects of statins in hypertensive patients

Shashikala E., Raghawa Rao B. N. V.

Abstract


Background: Hypertension is one of the commonest diseases affecting the mankind which is associated with endothelial dysfunction and left ventricular dysfunction and hence the study is aimed to observe the effects of statins on endothelial and left ventricular dysfunction.

Methods: 15 hypertensive patients were given atorvastatin for 4 weeks and compared with sex and aged matched 15 controls after a detailed Clinical history, clinical examination, biochemical investigations, chest X-ray, electrocardiogram, echocardiogram and Doppler study of brachial artery.

Results: Both study group and control group consisted of 10 males and 5 females who have dyslipidemia, endothelial and ventricular dysfunction. After a 4 weeks of study, in study group, flow mediated brachial artery diameter (FMD%) increased significantly (11.39%, P<0.01) from 7.37% to 18.76%, mean LV systolic function (EF) improved significantly (10.73%, P:<0.01) from 54.6% to 60.65%, LV diastolic function was normalized in 7 (46.67%) and improved in 5 (33.33%) patients, the mean systolic and diastolic BP decreased significantly (12.03%, P<0.01, 10.29%, P<0.01) from 149.66mmHg to 131.66mmHg and from 90.66mmHg to 81.33mmHg respectively, while in control group FMD increased marginally (1.07%) from 7.50% to 8.57%, LV EF marginally improved (1.47%) to 54.86% from 54.06%; no improvement in diastolic dysfunction, mean systolic and diastolic BP decreased marginally (6.25%, 0.74%) from 149.33 mmHg to 140mmHg and from 90.33mmHg to 89.66mmHg respectively.

Conclusions: Statins improve not only lipid profile but also endothelial and LV functions which resulted in significant reduction of systolic and diastolic BP. Hence it is reasonable to treat all hypertensive patients with statins besides concurrent hypertension treatment.


Keywords


Atorvostatin, Endothelial dysfunction, Hypertension, Lipid and non-lipid effects, LV dysfunction

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References


Kaplan NM. Systematic hypertension. Mechanisms and Diagnosis. In Braunwald’s Heart disease 5th ed. Philadelphia: W. B. Saunders Company. 1997;26:807-40.

Chobanian AV, Bakris GL, Black HR. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003;289:2560-72.

Rakowskiv H, Appleton C, Chan KL. Canadian consensus recommendations for measurement and reporting of diastolic dysfunction by echocardiography. J Am Soc Echocardiogr. 1996;9:736-60.

Celermajer DS, Sorenesen KE, Gooch VM, Spiegelhalter DJ, Miller OI. Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111-15.

Sever PS, Dahlof B, Poulter NR. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower the average cholesterol concentrations, in the Anglo Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): A multicentre randomized controlled trial. Lancet. 2003;361:1149-58.

Schwartz GG. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndrome. The MIRCL study: a randomized control trial. JAMA. 2001;285:1711.

Cannon CP. Intensive versus moderate lipid lowering with statins after acute coronary syndrome: PROVE-IT trial. N Eng J Med. 2004;350:1945-504.

Jones PH, Kafonek S, Laurora I. Comparative dose efficacy study of atorvastatin with that of lovastatin, pravastatin, simvastatin and fluvastatin in patients with hypercholesterolemia: The CURVES study. Am J Cardiol. 1998;81:582-7.

Kelm M, Preik M, Hafner DJ, Strauer BE. Evidence for a multifactorial process involved in the impaired flow response to nitricoxide in hypertensive patients with endothelial dysfunction. Hypertension. 1996;27:346-53.

Iiyama K, Nagano M, Yo Y, Nagono N, Kamide K. Impaired endothelial function with essential hypertension assessed by ultrasonography. Am Heart J. 1996;132:77-82.

Li J, Zhao SP, Li XP, Zhuo QC, Gao M, Lu SK. Noninvasive detection of endothelial dysfunction in patients with essential hypertension. Int J Cardiology. 1997;61:165-9.

Hunan Y, Ke D. Noninvasive detection of endothelial dependent dilation dysfunction in patients with essential hypertension. Xue Xue Bao. 1998;23(6):590-2.

Atkovo OY, Balahonova TV, Pogorelova OA. Noninvasive USG Detection of endothelial function. Eur J Ultrasound. 1998:7(1):37-45.

Kinlay S, Selwyn AP, Delagrange D. Biological mechanisms for the clinical success of lipid lowering in coronary artery disease and the use of surrogate end points. Curr Opin Lipidol. 1996;7:389-97.

Inoue T, Saniabadi AR, Matsunaga R. Impaired endothelial dependent acetylcholine induced coronary artery relaxation in patients with high serum remnant lipoprotein particles. Atherosclerosis. 1998;139:363-7.

Leung WH, Lau CP, Wong CK. Beneficial effect of cholesterol lowering therapy on coronary endothelium dependent relaxation in hypercholesterolaemic patients. Lancet. 1993;341:1496-1500.

O’Driscoll G, Green D, Taylor RR. Simvastatin, an HMG-Coenzyme A reductase inhibitor, improves endothelial function within 1 month. Circulation. 1997;95:1126-31.

Treasure CB, Klein JL, Weintraub WS. Beneficial effects of cholesterol lowering therapy on the coronary endothelium in patients with coronary artery disease. N Eng J Med. 1995;332:481-7.

Egashira K, Hiroka Y, Kai H. Reduction in serum cholesterol with pravastatin improves endothelium dependent coronary vasomotion in patients with hypercholesterolemia. Circulation. 1994;89:2519-24.

Frohlich ED, Tarazi RC, Dustan HP. Clinical-physiological correlations in the development of hypertensive heart disease. Circulation. 1971;4:446-55.

Dunn FG, Chandraratna P, de Carvalho JGR, Basta LL, Frohlich ED. Pathophsyiologic assessment of hypertensive heart disease with echocardiography. Am J Cardiol. 1977;39:789-95.

Dreslinski GR, Frohlich ED, Dunn FG, Messerli FG, Suarez DH, Reisin E. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: Atrial emptying index. Am J Cardiol. 1981;47:1087-90.

Inouye I, Massie B, Loge D, Topic N, Silverstein D, Simpson P. Abnormal left ventricular filling: An early finding in mild to moderate systemic hypertension. Am J Cardiol. 1984;53:120-6.

Fouad FM, Slominski JM, Tarazi RC. Left ventricular diastolic function in hypertension: Relation to left ventricular mass and systolic function. J Am Coll Cardiol. 1984;3:1500-6.