Abstract 2524: Statins Lower BP Differentially Across Different Classes of Antihypertensive Drugs
Background: We and others have shown that statins lower blood pressure (BP), though not invariably. We explored the hypothesis that the statin BP lowering effect differs by antihypertensive (anti-HTN) drug class.
Methods: Eligible patients at an academic hypertension clinic had an initial BP reading above their JNC goal and at least one follow-up visit between 1/1/2001 and 6/1/2006. Mixed effects linear regression models were utilized to determine main and interactive effects of statins and selected antihypertensive drug classes (diuretics, calcium antagonists, angiotensin receptor blockers (ARB), angiotensin converting enzyme inhibitors (ACEI), and beta blockers) after adjustment for months of follow-up, age, ethnicity, sex, and diabetes status. Therapeutic intensity scores (TIS = daily dose/maximum FDA approved dose) were created for statins and anti-HTN drug classes.
Results: Five hundred and sixty patients were included. Most (498 [88.9%]) were African American and +88 [69.3%] were female. Mean age was 56 years. Baseline BP averaged 171/99 mm Hg. Per 1-unit higher class-specific TIS the longitudinal change in SBP (mm Hg) was:
diuretic (-5.0, P < 0.0001),
calcium antagonist (-6.0, P < 0.0001),
beta blocker (+8.4, P = 0.0017);
longitudinal DBP changes were:
statin (-6.0, P = 0.026),
diuretic (-3.6, P < 0.0001),
calcium antagonist (-4.2, P < 0.0001),
beta blocker (+5.3, P = 0.0017).
No interaction was detected between statins and calcium antagonists or ACEI’s for longitudinal SBP change; however, interactions were observed with diuretics (+5.1, P = 0.013), ARB’s (-11.4, P = 0.047), and beta blockers (-17.7, P = 0.014). There was no interaction between statins and calcium antagonists, ACEI’s, or ARB’s for longitudinal DBP change; however, interactions with diuretics (+4.4, P = 0.0007) and beta blockers (-8.8, P = 0.04) were documented.
Summary: Statins appear to potentiate the BP lowering of beta blockers and ARB’s but not other anti-HTN drug classes. We propose that differential BP lowering across anti-HTN drug classes provides insight into the likely mechanism(s) by which statins lower BP.