Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup
Keywords:Beta-blockers, Blood pressure, Essential hypertension, Lipid profile, Statins
Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup.
Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant.
Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p<0.01). At 4 and 16 weeks DBP in Group I was 79.6±2.37 and 81±0.54 mmHg (p>0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p<0.05) have been observed and no significant changes in BMI and WHR in Groups I and II (p>0.05), respectively.
Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension.
Boos CJ, Beevers GD, Lip GY. Assessment of platelet activation indices using the ADVIATM 120 amongst ‘high-risk’ patients with hypertension. Ann Med. 2007;39(1):72-8.
Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21(11):1983-92.
Kapoor S, Tyagi R, Saluja K, Chaturvedi A, Kapoor AK. Emerging health threats among a primitive tribal group of Central India. J Public Health Epidemiol. 2010;2:13-9.
Wilson PW, Kannel WB, Silbershatz H, D’Agostino RB. Clustering of metabolic factors and coronary heart disease. Arch Intern Med. 1999;159(10):1104-9.
Carlos A. Feldstein statins in hypertension. Are they a new class of antihypertensive agents. Rev Latino Am Hypertens. 2008;3(2):33-8.
Michel T, Hoffman BB. Treatment of myocardial Ischemia and hypertension. In: Brunton LL, Chabner B, Knollman BC, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 12th Edition. New York: McGraw-Hill; 2011: 745-88.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-52.
Kotchen TA. Disorders of the cardiovascular system; Vascular disease. Hypertensive vascular disease. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 18th Edition, Section 5. New York: McGraw-Hill; 2012: 2042-59.
Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995;25(3):305-13.
Awoke A, Awoke T, Alemu S, Megabiaw B. Prevalence and associated factors of hypertension among adults in Gondar, Northwest Ethiopia: a community based cross-sectional study. BMC Cardiovasc Disord. 2012;12:113.
Mgonda YM, Ramaiya KL, Swai AB, McLarty DG, Alberti KG. Insulin resistance and hypertension in non-obese Africans in Tanzania. Hypertension. 1998;31(1):114-8.
Radhika G, Sathya RM, Sudha V, Ganesan A, Mohan V. Dietary salt intake and hypertension in an urban south Indian population – [CURES - 53]. J Assoc Physicians India. 2007;55:405-11.
Ibrahim MM, Mossallam R. Clinical evaluation of atenolol in hypertensive patients. Circulation. 1981;64(2):368-74.
Hashimoto S, Urushihara H, Hinotsu S, Kosugi S, Kawakami K. Effect of HMG-CoA reductase inhibitors on blood pressure in hypertensive patients treated with blood pressure-lowering agents: retrospective study using an anti-hypertensive drug database. Eur Rev Med Pharmacol Sci. 2012;16(2):235-41.
Ikeda T, Sakurai J, Nakayama D, Takahashi Y, Matsuo K, Shibuya Y, et al. Pravastatin has an additional depressor effect in patients undergoing long-term treatment with antihypertensive drugs. Am J Hypertens. 2004;17(6):502-6.
Briasoulis A, Agarwal V, Valachis A, Messerli FH. Antihypertensive effects of statins: a meta-analysis of prospective controlled studies. J Clin Hypertens (Greenwich). 2013;15(5):310-20.
Mancia G, Parati G, Revera M, Bilo G, Giuliano A, Veglia F, et al. Statins, antihypertensive treatment, and blood pressure control in clinic and over 24 hours: evidence from PHYLLIS randomised double blind trial. BMJ. 2010;340:c1197.
Simons LA, Sullivan D, Simons J, Celermajer DS. Effects of atorvastatin monotherapy and simvastatin plus cholestyramine on arterial endothelial function in patients with severe primary hypercholesterolaemia. Atherosclerosis. 1998;137(1):197-203.