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Statins and hypertension

Journal of Human Hypertension volume 20, pages 554–556 (2006)Cite this article

Statins (2-hydroxy-methy-glutaryl-CoA enzyme inhibitors) are well-established therapies for coronary heart disease. A large number of studies, grouped into a pre-specified meta-analysis, have shown a reduction of 20–22% in coronary events per 1 mmol/l reduction in LDL-cholesterol (LDL-C).1 However, in contrast to previous studies of other lipid-lowering agents in 450 000 patients, which showed no benefit of cholesterol reduction on stroke,2 statins have shown a consistent 20–25% reduction in stroke or transient ischaemic effects.3 Only the PROSPER trial failed to show any effect of statins on the pre-specified end point of stroke (relative risk (RR) 1.03, confidence interval (CI) 0.81–1.31) but did show a 20 (CI 0–45)% reduction in transient ischaemic attacks.4 Notably, this trial showed the poorest degree of control of blood pressure with an average blood pressure of 155/84 mm Hg in contrast to other statin trials where blood pressure was controlled to <140/80 mm Hg.5

The efficacy of statins in preventing strokes raises questions about the mechanism of this action of these drugs.6, 7 Statins have a multiplicity of actions including lowering LDL-C, reducing triglycerides and small effects on HDL-cholesterol. In addition to these primary actions, statins have ancillary actions, often termed pleiotropic effects, that include reductions in isoprenoid cholesterol intermediates and reductions in dolichols, geranylgeranoic acid and farnesyl-farnesoic acid.8 The latter intermediates are involved in the regulation of inflammation including C-reactive protein and intercellular adhesion molecules through modulation of the rho kinase pathway. This pathway provides a plausible pleiotropic mechanism for statins and may be relevant to the association between inflammation and hypertension as well target organ damage associated with hypertension.9, 10, 11, 12

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  1. St Thomas' Hospital, London, UK

    A S Wierzbicki

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Wierzbicki, A. Statins and hypertension. J Hum Hypertens 20, 554–556 (2006). https://doi.org/10.1038/sj.jhh.1002032

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