A new study published in the Journal of the American College of Cardiology suggests that intensive therapy with atorvastatin (one of the statin drugs) can significantly reduce systolic hypertension. Systolic hypertension is now recognized to be a much more common problem than previously thought, a problem that leads to significant cardiovascular problems, and a problem that is only poorly treated by much of the medical community.
In the Australian study, investigators enrolled 22 patients with systolic hypertension and elevated cholesterol levels. The patients were randomized to two groups. The first group received atorvastatin (80 mg/day) for three months, then placebo for three months. The second group received placebo for the first three months, then atorvastatin for the second three month period.
When patients were taking atorvastatin, their cholesterol levels (as expected) were significantly lower than when they were taking placebo. The new finding provided by this study was that, when patients were taking atorvastatin, their systolic blood pressures were also significantly reduced. If these findings are confirmed in larger trials, then statin therapy may become an accepted tool for treating systolic hypertension.
How might statins benefit systolic hypertension?
The systolic blood pressure is the "upper number" reported when a doctor or nurse takes your blood pressure. It represents the pressure inside the arteries at the moment the heart is contracting. In a young, healthy person, arteries are quite elastic, and during "systole" (that is, when the heart is contracting) the arteries thus expand to accommodate the momentary increase in blood flow. As people get older, though, the arteries get "stiffer." They are unable to expand as efficiently, and the increase in blood flow that occurs during systole ends up increasing the "systolic" pressure.It appears that statins, presumably by reducing some of the lipid deposits that tend to line the major arteries in older individuals, actually reduce the "stiffness" of the arteries. This reduction in arterial stiffness makes the arteries behave "younger," and the systolic blood pressure drops.
Why might this new finding be important?
Treating systolic hypertension is very important, as it is one of the major risk factors for cardiovascular disease. However, doctors so far have proven not to be particularly adept at treating systolic hypertension. This is because a) most doctors were "raised" on the notion that it is the diastolic blood pressure that is important, and systolic hypertension can be largely ignored; b) if, in treating systolic hypertension, the doctor reduces the diastolic blood pressure too much, problems can occur; c) many of the drugs used to treat hypertension act primarily on the diastolic pressure.If it turns out in larger studies that statins reliably reduce systolic blood pressure when it it too high, doctors would have an important new weapon to use in treating this difficult and common problem.
