CHICAGO — Statin therapy does not significantly influence central aortic pressures or hemodynamics in patients with treated hypertension, Dr. Bryan Williams reported at the annual meeting of the American Society of Hypertension.
He presented data from the lipid-lowering arm of the Conduit Artery Function Evaluation (CAFE-LLA) study, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).
Overall, 891 patients were recruited from the statin arm of the ASCOT trial in which patients were treated with atorvastatin 10 mg/day or placebo. ASCOT was stopped early when it became clear that atorvastatin had benefits over placebo in reducing major cardiovascular events and stroke.
The CAFE-LLA investigators hypothesized that this benefit could arise from a favorable effect of statins on large-artery function. They used radial artery pulse-wave analysis to derive central aortic pressures and hemodynamic indexes on repeated visits over a 2.5-year follow-up with the same treatment regimen.
The patients' mean age was 63 years; 86% were men, and 85% were white. At baseline, average total cholesterol level was 210 mg/dL, LDL cholesterol 130 mg/dL, and HDL cholesterol 50 mg/dL.
Atorvastatin lowered the LDL cholesterol level by 32.5 mg/dL, compared with placebo. Time-averaged brachial BP was similar in people receiving atorvastatin or placebo (brachial systolic BP changed by 0.1 mm Hg and brachial pulse pressure changed by 0.02 mm Hg).
The drug had no influence on central aortic BP, compared with placebo (the change in aortic systolic BP was −0.5 mm Hg and the change in aortic pulse pressure was −0.4 mm Hg).
It also did not alter augmentation index or heart rate, compared with placebo, said Dr. Williams, professor of medicine, department of cardiovascular sciences, University of Leicester (England).
The atorvastatin given to 147 patients previously treated with placebo did not subsequently influence brachial or central systolic pressure after 1.4 years of follow-up.
“The benefits of atorvastatin in the ASCOT trial, in significantly reducing coronary heart disease and stroke in hypertensive patients, are not dependent on changes in central aortic pressures or pressure-grade reflections,” he said. The results suggest that “statin effects cannot be reproduced by blood pressure-lowering agents, thereby supporting the use of these two strategies to reduce risk in high-risk hypertensives.”
Dr. Williams has received research support from Pfizer and Merck.