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CLINICAL STUDY: HYPERTENSION

Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension

^* Alfred and Baker Medical Unit, Baker Medical Research Institute, Melbourne, Victoria, Australia

Manuscript received July 31, 2001; revised manuscript received December 20, 2001, accepted January 2, 2002.

^* Reprint requests and correspondence: Dr. Bronwyn Kingwell, Alfred and Baker Medical Unit, Baker Medical Research Institute, P.O. Box 6492, St. Kilda Road Central, Melbourne, Victoria 8008, Australia.
b.kingwell{at}alfred.org.au

OBJECTIVES: We sought to investigate the effects of intensive cholesterol reduction on large artery stiffness and blood pressure in normolipidemic patients with isolated systolic hypertension (ISH).

BACKGROUND: Isolated systolic hypertension is associated with elevated cardiovascular morbidity and mortality and is primarily due to large artery stiffening, which has been independently related to cardiovascular mortality. Cholesterol-lowering therapy has been efficacious in reducing arterial stiffness in patients with hypercholesterolemia, and thus may be beneficial in ISH.

METHODS: In a randomized, double-blinded, cross-over study design, 22 patients with stage I ISH received three months of atorvastatin therapy (80 mg/day) and three months of placebo treatment. Systemic arterial compliance was measured noninvasively using carotid applanation tonometry and Doppler velocimetry of the ascending aorta.

RESULTS: Atorvastatin treatment reduced total and low-density lipoprotein cholesterol and triglyceride levels by 36 ± 2% (p < 0.001), 48 ± 3% (p < 0.001) and 23 ± 5% (p = 0.003), respectively, and increased high density lipoprotein cholesterol by 7 ± 3% (p = 0.03). Systemic arterial compliance was higher after treatment (placebo vs. atorvastatin: 0.36 ± 0.03 vs. 0.43 ± 0.05 ml/mm Hg, p = 0.03). Brachial systolic blood pressure was lower after atorvastatin treatment (154 ± 3 vs. 148 ± 2 mm Hg, p = 0.03), as were mean (111 ± 2 vs. 107 ± 2 mm Hg, p = 0.04) and diastolic blood pressures (83 ± 1 vs. 81 ± 2 mm Hg, p = 0.04). There was a trend toward a reduction in pulse pressure (71 ± 3 vs. 67 ± 2 mm Hg, p = 0.08).

CONCLUSIONS: Intensive cholesterol reduction may be beneficial in the treatment of patients with ISH and normal lipid levels, through a reduction in large artery stiffness.

Abbreviations and Acronyms   LVIDD   ALT   alanine aminotransferase   AST   aspartate aminotransferase   DBP   diastolic blood pressure   HDL   high density lipoprotein   ISH   isolated systolic hypertension   LDL   low density lipoprotein   LVIDD   left ventricular internal end-diastolic diameter   LVIDS   left ventricular internal end-systolic diameter   MAP   mean arterial pressure   SAC   systemic arterial compliance   SBP   systolic blood pressure   TPR   total peripheral resistance

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