Publié par Preuves & Pratiques

Statines et réductions de la pression artérielle.

Résultats d'une étude incluant 973 patient(e)s ayant initialement des niveaux de cholestérol LDL de 115-190 mg/dl,

indemnes de maladies cardio-vasculaires ou de diabète
et traités par statine pendant 6 mois :

 des diminutions de la PAS (2,4 mm Hg) et de la PAD (2,8 mm Hg) sont apparues sous statines,
qu'elles soient hydrophiles ou lipophiles.

Ces effets modestes pourraient contribuer à la réduction des risques d'AVC et d'événements cardiovasculaires observés sous statines.

 Golomb & Coll., Archives of Internal Medicine, 14 avril 2008 ; 168 (7) : 721-727.


Reduction in Blood Pressure With Statins
Results From the UCSD Statin Study, a Randomized Trial

Beatrice A. Golomb, MD, PhD; Joel E. Dimsdale, MD; Halbert L. White, PhD; Janis B. Ritchie, BSN; Michael H. Criqui, MD, MPH
Arch Intern Med. 2008;168(7):721-727.

Background  Some studies have suggested reductions in blood pressure (BP)with statin treatment, particularly in persons with hypertension. Randomized trial evidence is limited.

Methods  We performed a randomized, double-blind, placebo-controlled trial with equal allocation to simvastatin, 20 mg; pravastatin sodium,40 mg; or placebo for 6 months. Nine hundred seventy-three men and women without known cardiovascular disease or diabetes mellitus, with low-density lipoprotein cholesterol screening levels of 115 to 190mg/dL, had assessment of systolic and diastolic BP (SBP and DBP, respectively). Blood pressure values were compared for placebo vs statins by intention-to-treat (ITT) analysis. Additional analyses were performed that (1) were confined to subjects with neither high baseline BP (SBP >140 mm Hg or DBP >90mm Hg) nor receiving BP medications, to exclude groups in whom BP medications or medication changes may have influenced results, and (2) separately evaluated simvastatin and pravastatin (vs placebo). The time course of BP changes after statin initiation and the effect of stopping statins on BP were examined.

Results  Statins modestly but significantly reduced BP relative to placebo,by 2.2 mm Hg for SBP (P = .02) and 2.4mm Hg for DBP (P < .001) in ITT analysis.Blood pressure reductions ranged from 2.4 to 2.8 mm Hg for both SBP and DBP with both simvastatin and pravastatin, in those subjects with full follow-up, and without potential for influence by BP medications (ie, neither receiving nor meriting BP medications).

Conclusions  Reductions in SBP and DBP occurred with hydrophilic and lipophilic statins and extended to normotensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported on statins.

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