Abstract
Introduction. Nicotinic acid (NA) and statins have been associated with reductions in blood pressure (BP). Patients and Methods. We recruited 68 normotensive and hypertensive dyslipidemic patients who were treated with a conventional statin dose and had not achieved lipid targets. Patients were randomized to switch to high-dose rosuvastatin (40 mg/day) or to add-on current statin treatment with extended release (ER) NA/laropiprant (1000/20 mg/day for the first 4 weeks followed by 2000/40 mg/day for the next 8 weeks) for 3 months. Results. Switching to rosuvastatin 40 mg/day was not associated with significant BP alterations. In contrast, the addition of ER-NA/laropiprant to current statin treatment resulted in a 7% reduction of systolic BP (from 134 ± 12 to 125 ± 10 mmHg, P < .001 versus baseline and P = .01 versus rosuvastatin group) and a 5% reduction of diastolic BP (from 81 ± 9 to 77 ± 6 mmHg, P = .009 versus baseline and P = .01 versus rosuvastatin group). These reductions were significant only in the subgroup of hypertensives and were independent of the hypolipidemic effects of ER-NA/laropiprant. Conclusions. Contrary to the switch to high-dose rosuvastatin, the addition of ER-NA/laropiprant to statin treatment was associated with significant reductions in both systolic and diastolic BP.
Highlights
Nicotinic acid (NA) and statins have been associated with reductions in blood pressure (BP)
We aimed to compare the possible BP effects of switching to high-dose rosuvastatin with add-on-current statin ERNA/laropiprant in normotensive and hypertensive patients with primary dyslipidemia who were currently treated with a conventional statin regimen but had not achieved the treatment goals
Consecutive subjects with primary hypercholesterolemia (n = 70) attending the Outpatient Lipid and Obesity Clinic of the University Hospital of Ioannina, Ioannina, Greece were recruited. Eligible patients were those treated for at least 3 months with a conventional statin dose (10–40 mg simvastatin or 10–20 mg atorvastatin or 5–20 mg rosuvastatin) and their low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol levels were above those recommended by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP) III based on each patient risk factors [16]
Summary
Nicotinic acid (NA) and statins have been associated with reductions in blood pressure (BP). The addition of ER-NA/laropiprant to current statin treatment resulted in a 7% reduction of systolic BP (from 134 ± 12 to 125 ± 10 mmHg, P < .001 versus baseline and P = .01 versus rosuvastatin group) and a 5% reduction of diastolic BP (from 81 ± 9 to 77 ± 6 mmHg, P = .009 versus baseline and P = .01 versus rosuvastatin group) These reductions were significant only in the subgroup of hypertensives and were independent of the hypolipidemic effects of ER-NA/laropiprant. The mainstay of lipid-lowering therapy, result in a significant clinical benefit both in primary and secondary cardiovascular prevention [4] In addition to their hypolipidemic capacity, other properties may contribute to statin-induced benefits, including a reduction of blood pressure (BP) [5,6,7,8,9]. The European Medicine Agency approved a fixed combination of extended release (ER) NA with laropiprant (a prostaglandin D2 receptor antagonist) which reduces NA-induced flushing without altering the beneficial effects of NA on lipid profile or BP [13,14,15]
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