Does the Blood Pressure-lowering Effect of Statins Contribute to Their Beneficial Cardiovascular Effects?

Not all cardiovascular protection provided by statins is explained by their beneficial effects on lipoproteins. Old (e.g., clofibrate) and new (e.g., torcetrapib and ezetimibe) agents, with similar or more intense beneficial effect over lipoproteins, do not reproduce the beneficial effects of statins. Besides their anti-inflammatory and other pleiotropic effects, a blood pressure-lowering effect could be an additional mechanism of cardiovascular protection of statins. Large trials of statins in the primary and secondary prevention of cardiovascular disease did not report an effect on blood pressure, but the use of blood pressure-lowering agents was left to the discretion of physicians during the trial. Post hoc analyses of small trials and a meta-analysis of some of them have suggested that statins could lower systolic blood pressure by approximately 4 mmHg, particularly in patients with high blood pressure. Most studies, however, had small samples and were not blinded. Others had a cross-over or observational design. The overall view of these studies rules out a substantial blood pressure-lowering effect of statins. An effect restricted to subjects with high blood pressure could ultimately derive from the anti-inflammatory effect of statins, since higher levels of C-reactive protein are associated with higher blood pressure. An unequivocal demonstration of an antihypertensive effect of statins, however, is still lacking, and a randomized trial with enough power to evaluate blood pressure variation in a large range of blood pressure values is required to demonstrate whether statins definitely have an antihypertensive effect.