A systematic review and meta-analyses on the effects of atorvastatin on blood pressure and heart rate. Issue 1 (22nd September 2022)

• Record Type: Journal Article
• Authors: Costa, Gabriel S; Julião-Silva, Letícia S; Belo, Vinícius S; de Oliveira, Helena C F; Chaves, Valéria E
• Is Part Of: European heart journal. Volume 9:Issue 1(2023)
• Page Start: 100
• Page End: 115
• Publication Date: 2022-09-22
• Subjects: Atorvastatin -- Autonomic modulation -- Blood pressure -- Cholesterol; Cardiovascular pharmacology -- Periodicals; 615.71
• DOI: 10.1093/ehjcvp/pvac053
• Languages: English
• ISSNs: 2055-6837

Abstract

Abstract: Aims: Considering the inconsistencies in the literature on the atorvastatin effect on blood pressure (BP), we performed these meta-analyses. Methods and results: Through a search of the Excerpta Medica Database (EMBASE), PubMed, and Web of Science databases, 1412 articles were identified, from which 33 randomized clinical trials (RCT) and 44 pre-clinical were selected. Populations from RCT were stratified according to baseline BP and lipid levels. We performed meta-analyses of the effect of atorvastatin on systolic (SBP), diastolic and mean BP; heart rate (HR); HR variability, and baroreflex. Atorvastatin reduced SBP in the overall population ( P = 0.05 vs. placebo; P = 0.03 vs. baseline), in normotensive and hyperlipidaemic ( P = 0.04 vs. placebo; P = 0.0001 vs. baseline) and in hypertensive and hyperlipidaemic ( P = 0.02 vs. placebo; P = 0.008 vs. baseline) individuals in parallel RCT, but it did not affect SBP in normotensive and normolipidaemic individuals ( P = 0.51 vs. placebo; P = 0.4 vs. baseline). Although an effect of atorvastatin was detected in hyperlipidaemic individuals, the meta-regression coefficient for the association of low density lipoprotein (LDL)-cholesterol reduction with SBP reduction in the overall population demonstrated that SBP reduction is not dependent on the changes in LDL-cholesterol. A meta-analysis of preclinical reports demonstrated that SBP was reduced in atorvastatin-treated hypertensive and normolipidaemic rats (spontaneously hypertensive rats: P < 0.00001), but not in normotensive and normolipidaemic rats (control rats: P = 0.97). Atorvastatin also reduced the HR in spontaneously hypertensive rat. Conclusion: Atorvastatin lowers BP independent of LDL-cholesterol levels. Additional studies are needed to estimate the involvement of the autonomic nervous system in the BP-lowering effect of atorvastatin.