Effect of Statin use on Patients with Hypertension: A Systematic Review and Meta-analysis

Abstract

Abstract Introduction This meta-analysis focused on the effects of statin use (either alone or in combination with antihypertensive drugs) on hypertension-related outcome measures, including systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein-cholesterol (LDL-C), low-density lipoprotein- cholesterol (HDL-C), triglyceride (TG), total cholesterol, TG and total cholesterol. Methods We searched the PubMed, EMBASE, and Cochrane databases before October1 2023.Studies designed as cohort study or randomized controlled trials and investigating the effects of statin use or combined with antihypertensive therapy versus no statin use or antihypertensive therapy alone were included. Authors extracted the data independently; differences were decided to discussion. we use random-effects models to evaluate the merged outcomes. Due to the high heterogeneity of HDL-C group, we performed subgroup analysis according to the type of statin. We use sensitivity analysis, Egger’s test and Funnel plots to evaluate the stability and publication bias of our study. Results 23 trials were included in this meta-analysis. The primary outcomes revealed that (1) administering statins did not significantly impact the SBP of hypertensive patients (MD,-1.77; 95% CI, -4.82 to 1.27). Subgroup analyses revealed a decrease in SBP in patients who received rosuvastatin (MD,-1.70; 95% CI,-2.75 to -0.65) and pravastatin (MD,-8.00; 95% CI,-10.79 to -5.21); (2) no significant effect of statin treatment on DBP in hypertensive patients (MD,-2.04; 95% CI,-4.11 to 0.02). However, subgroup analyses suggest that simvastatin (MD,-2.49; 95% CI, -4.91 to -0.07) and pravastatin (MD,-5.00; 95% CI, -6.60 to -3.40) significantly reduced DBP in hypertensive patients. The secondary outcomes revealed that (1) the use of statins resulted in a significant reduction in LDL-C in hypertensive patients (MD, -0.95; 95% CI, -1.32 to -0.65), while significantly increasing HDL-C (MD, 0.39; 95% CI, 0.15 to 0.64); (2) statins were shown to significantly reduce TG levels in hypertensive patients (MD -0.14, 95% CI -0.23 to -0.05); (3) statins significantly reduced total cholesterol in those hypertensive patients (MD, -1.75; 95% CI, -2.66 to -0.83); (4) statins significantly reduced the incidence of cardiovascular events (HR, 0.73; 95% CI, 0.62 to 0.85) and mortality (HR, 0.47; 95% CI, 0.33 to 0.60). Conclusion Statin use did not modulate SBP and DBP of patients with hypertension, but SBP was decreased in rosuvastatin or pravastatin subgroup and DBP was decreased in simvastatin or pravastatin subgroup. Statin treatment reduced LDL-C, increased HDL-C, reduced TG and total cholesterol, reduced the incidence of cardiovascular events and mortality compared to control groups.