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Effect of pravastatin on blood pressure in people with cardiovascular disease

Journal of Human Hypertension volume 20, pages 560–565 (2006)Cite this article

Abstract

Experimental evidence and several small studies in humans suggest that HMG-CoA (3-hydroxy 3-methylglutaryl coenzyme A) reductase inhibitors (statins) reduce blood pressure, perhaps through effects on endothelial function or by reducing inflammation. We tested the hypothesis that pravastatin would reduce blood pressure at 3 months and the risk of developing new hypertension over a follow-up period of 5 years. This was a post hoc subgroup analysis of a randomized double-blind placebo-controlled trial of pravastatin 40 mg daily vs placebo in 4159 participants with previous myocardial infarction and total plasma cholesterol <240 mg/dl (6.2 mmol/l). The primary outcome was the unadjusted change in mean arterial pressure (MAP) from baseline to 3 months. We also considered systolic and diastolic blood pressure (SBP and DBP) and pulse pressure. Analysis of covariance was used to calculate the adjusted effect of treatment on change in these outcomes at 3, 6, 12 and 24 months postrandomization, after controlling for potential confounders. Logistic regression was used to calculate the adjusted effect of treatment on incident hypertension (blood pressure ⩾140/90 in those without known hypertension at baseline). This analysis included 4126/4159 (99.2%) participants for whom blood pressure was measured at baseline and during at least one follow-up visit. Median duration of follow-up was 57.8 months. The unadjusted and adjusted change in MAP, SBP, DBP or pulse pressure from baseline was not significantly different for pravastatin or placebo recipients at 3, 6, 12 or 24 months after randomization, or at last follow-up. Pravastatin did not reduce the adjusted risk of incident systolic hypertension (odds ratio 0.99, 95% CI 0.80–1.23), or incident diastolic hypertension (odds ratio 0.97, 95% CI 0.73–1.27). In summary, pravastatin 40 mg daily did not reduce blood pressure in survivors of myocardial infarction without overt hypercholesterolaemia.

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Acknowledgements

The CARE trial was an investigator-initiated study funded by Bristol-Myers-Squibb, but this post hoc analysis on blood pressure was not supported by industry. We had unlimited access to the data used in this analysis. The sponsor is entitled to comment on manuscripts before submission, and the we may consider these comments, but the rights to publication reside contractually with the investigators. The sponsor maintained information on adverse events and other trial data, as required by federal regulation. Dr Tonelli was supported by a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research.

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Authors and Affiliations

  1. Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada

    M Tonelli

  2. Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada

    M Tonelli

  3. Department of Public Health Sciences, Edmonton, Alberta, Canada

    M Tonelli & G S Jhangri

  4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    F Sacks

  5. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    F Sacks

  6. Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA

    M Pfeffer & G Curhan

  7. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

    F Lopez-Jimenez

  8. Channing Laboratory, Brigham and Women's Hospital, Boston, MA, USA

    G Curhan

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for the Cholesterol and Recurrent Events (CARE) Trial Investigators

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Correspondence to M Tonelli.

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Tonelli, M., Sacks, F., Pfeffer, M. et al. Effect of pravastatin on blood pressure in people with cardiovascular disease. J Hum Hypertens 20, 560–565 (2006). https://doi.org/10.1038/sj.jhh.1002036

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  • DOI: https://doi.org/10.1038/sj.jhh.1002036

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