Consciousness of Blood Pressure Is Rising

Denny CH, Greenlund KJ, Ayala C, et al. Prevalence of actions to control high blood pressure--20 states, 2005; MMWR Morb Mortal Wkly Rep. 2007;56:420-423. Abstract
Kanavos P, Ostergren J, Weber, MA, eds. High blood pressure and health policy: Where we are and where we need to go next a global assessment of current efforts to control high blood pressure and an analysis of future options to prevent a silent epidemic affecting hundreds of millions worldwide. New York: Ruder Finn; 2007. Available at: http://www.nature.com/isn/media/High_Blood_Pressure_and_Health_Policy.pdf Accessed May 17, 2007.
Chobanian AV, Bakris GL, Black HR, et al; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-1252. Abstract
Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217-223. Abstract
Wang YR, Alexander GC, Stafford RS. Outpatient hypertension treatment, treatment intensification and control in Western Europe and the United States. Arch Intern Med. 2007;167:141-147. Abstract
Goldenberg I, Moss AJ, McNitt S; for the MADIT-II Investigators. Inverse relationship of blood pressure levels to sudden cardiac mortality and benefit of the implantable cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2007;49:1427-1433. Abstract
Singh JP, Hall WJ, McNitt S, et al; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Factors influencing appropriate firing of the implanted defibrillator for ventricular tachycardia/fibrillation: findings from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). J Am Coll Cardiol. 2005;46:1712-1720. Abstract
Moss AJ, Zareba W, Hall WJ, et al., Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877-883. Abstract
Butler J, Leon A. The elusive scourge of sudden cardiac death is rational decision making possible? Should there be standards of risks and predictions in medicine? J Am Coll Cardiol. 2007;49:1434-1435.
Mochizuki S, Dahlof B, Shimizu M, et al; for the Jikei Heart Study group. Valsartan in a Japanese population with hypertension and other cardiovascular disease (Jikei Heart Study): a randomised, open-label, blinded endpoint morbidity-mortality study. Lancet 2007;369:1431-1439.
Mochizuki S, Shimizu M, Taniguchi I, et al; the JIKEI HEART Study Group. JIKEI HEART Study -- A morbi-mortality and remodeling study with valsartan in Japanese patients with hypertension and cardiovascular disease. Cardiovasc Drugs Ther. 2004;18:305-309. Abstract
Staessen JA, Richart T. Sum and substance in the Jikei Heart Study. Lancet. 2007;369:1407-1408. Abstract
Blood Pressure Lowering Treatment Trialists' Collaboration. Blood pressure dependent and independent effects of agents that inhibit the renin-angiotensin system. J Hypertens. 2007;25:951-958. Abstract
Casas JP, Chua W, Loukogoergakis S, et al. Effects of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet. 2005;366:2026-2033. Abstract
Strazzullo P, Kerry SM, Barbato A, et al. Do statins reduce blood pressure? A meta-analysis of randomized, controlled trials. Hypertension. 2007;49:792-798. Abstract
Strazzullo P, Kerry SM, Barbato A, et al. Blood pressure reduction with statins: a meta-analysis of randomised controlled trials. J Hypertens. 2006;24(suppl 4):S151. Abstract 4D.5.
Dahlof B, Poulter N, Sever PS. Do statins lower blood pressure? Evidence from the Anglo-Scandinavian Cardiac Outcomes Trial -- Lipid-Lowering Arm (ASCOT-LLA). Circulation. 2004;118(17):III-402. Abstract 1905.
Golomb BA, Ritchie JB, Criqui MH, Dimsdale JE. Statins lower blood pressure: Results from the UCSD Statin Study. Circulation. 2004;118(17):III-402. Abstract 1904.
Taubert D, Roesen R, Schomig S. Effect of cocoa and tea intake on blood pressure a meta-analysis. Arch Intern Med. 2007;167:626-634. Abstract
West SG, Kay CD, Gebauer SK, et al. Pistachios reduce blood pressure and vascular responses to acute stress in healthy adults. FASEB J. 2007;21:Abstract 682.
Gebauer SK, Kay CD, West SG. Pistachios beneficially affect multiple lipid and apolipoprotein CVD risk factors. FASEB J. 2007;21:Abstract 682.6
Mackraj I, Ramesar S. ACE inhibitor activity of nutritive plants in KwaZulu Natal. FASEB J. 2007;21:Abstract 906.13
Mackraj I, Ramesar S, Singh R. T. violacea lowers blood pressure and downregulates AT1a gene expression in a hypertensive rat model. FASEB J. 2007;21:Abstract 906.12
Duncan A, Jager AK, van Staden J. Screening of Zulu medicinal plants for angiotensin converting enzyme (ACE) inhibitors. J Ethnopharmacol. 1999;68:63-70. Abstract
CardioMEMS announces first patient implant of wireless pressure sensor for hypertension monitoring. March 22, 2007. Available at: http://www.cardiomems.com/content.asp?display=news&view=10 Accessed May 17, 2007.

processing....

Statins Have Small but Statistically Significant Blood Pressure-Lowering Effect

Statins have been linked to benefits in hypertension as a result of pleiotropic effects on endothelial function, their interactions with the renin-angiotensin system, and their influence on large artery compliance. In contrast, differing effects of statins on blood pressure have been shown in large-scale trials that have recruited patients with significant atherosclerosis or large numbers of risk factors, as well as in small-scale studies in primary prevention. Now a recently published meta-analysis of clinical trials has concluded that statin therapy has a "relatively small, but statistically significant and clinically meaningful effect on blood pressure." The study, which was a collaboration between researchers in Naples, Italy, and London and Coventry, United Kingdom, is published in the April issue of Hypertension.^[15] The results were first presented at the 2006 European Meeting of Hypertension in Madrid, Spain (see Related Links).^[16]

Lead researcher Pasquale Strazzullo, MD (Federico II University Medical School, Naples) and colleagues identified 18 randomized controlled trials of statins, reported as original articles in peer-reviewed English-language scientific journals from online databases (PUBMED, EMBASE, and HTA -- the database of the International Network of Agencies for Health Technology Assessment) and other database sources. All of the trials compared a statin with a placebo or another hypolipidemic drug, and concomitant antihypertensive treatment was kept constant for the duration of each trial. Two of the trials had 2 pairs of control and treatment groups and were each regarded as 2 trials each, making the final total 20 trials.

The studies involved a total of 828 patients, of whom 291 patients were given statins, 272 were given a placebo, and 265 were on crossover trials. Some of the studies recruited only hypertensive patients, some only normotensive patients, and some either normotensive or hypertensive patients in "reasonably good control." Most of the studies included hypercholesterolemic patients (serum total cholesterol ≥ 5.2 mmol/L [201 mg/dL]). In all but 7 studies the participants received drugs different from statins or control medications.

The researchers calculated that that overall, statins produced reduction of 1.9 mm Hg in systolic blood pressure (SBP) and 0.9 mm Hg in diastolic blood pressure (DBP). The effect was even more pronounced in patients with high baseline blood pressure. Statin therapy in patients with baseline SBP > 130 mm Hg showed an average reduction in 4.0 mm Hg, and those with DBP > 80 mm Hg a 1.2-mm Hg reduction. In patients with SBP ≤ 130 mm Hg and/or DBP ≤ 80 mm Hg, the average effect of statin therapy on blood pressure was negligible.

Meta-regression analysis indicated that the effect of statins on blood pressure was independent of response to statin therapy, age, length of trial, baseline serum cholesterol, change in total serum cholesterol, or low-density lipoprotein cholesterol, whether the patient had diabetes or not, or whether patients were taking antihypertensive medication or not.

Two other studies involving a total of 64 patients could not be included in the meta-analysis because of insufficient blood pressure data, but showed mean blood pressure reductions of 4.0 mm Hg and 2.0 mm Hg, respectively.

Prof. Strazzullo and colleagues note that the studies selected for their meta-analysis did not include any of the well-known large-scale outcomes trials that demonstrated the value of statins in primary and secondary prevention, because of insufficient reporting of blood pressure values and/or antihypertensive treatment in the patients with hypertension. However, their results are consistent with an analysis of data from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)^[17] and the University of California San Diego (UCSD) Statin Study,^[18] both of which showed lower blood pressures in patients on statins compared with patients taking placebo (see Related Links).

They suggest several mechanisms for the effect of statins on blood pressure, including increasing endothelial production of nitric oxide (NO), with corresponding upregulation of NO synthase expression, leading to increased NO availability, and downregulation of endothelin-1. These effects on endothelial function appear early after statin administration and are therefore probably unrelated to the effects of statins on cholesterol, Prof. Strazullo and his coauthors suggest. Statins have also been shown to reduce large artery stiffness and improve systemic arterial compliance and to reduce expression of the angiotensin II type-1 receptor, which is overexpressed in hypercholesterolemic patients. "Whatever the mechanism(s), our meta-analysis provided evidence of a favorable effect of statins on blood pressure, particularly SBP, and indicated that the effect was larger in individuals with elevated blood pressure," the authors conclude.