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Simvastatin in the treatment of hypercholesterolaemia in patients with essential hypertension
T Morgan1, A Anderson, P McDonald
1Epidemiology Unit, Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Insights
Simvastatin effectively lowers high cholesterol in hypertensive patients without significant side effects. This study shows simvastatin improves lipid profiles, offering a potential therapeutic option for managing cardiovascular risk in this population.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Lipidology
Background:
- Hypertension is a significant risk factor for coronary artery disease mortality.
- Elevated cholesterol levels are prevalent in treated hypertensive patients.
- Effective cholesterol management is crucial for reducing cardiovascular events in this demographic.
Purpose of the Study:
- To evaluate the efficacy and safety of simvastatin in lowering cholesterol in patients with treated hypertension.
- To assess the impact of simvastatin on lipid profiles, including triglycerides, low-density lipoproteins (LDL), and high-density lipoproteins (HDL).
- To determine if simvastatin can improve the total cholesterol to HDL cholesterol ratio.
Main Methods:
- Forty-nine patients with treated hypertension and cholesterol > 5.5 mmol/l participated.
- Patients initially followed a reduced-fat diet for 3 months.
- Eligible patients were randomized to receive either simvastatin (40 mg/day) or a placebo.
Main Results:
- Simvastatin significantly reduced total cholesterol (6.85 to 4.75 mmol/l), LDL (4.6 to 2.6 mmol/l), and triglycerides (2.7 to 2.1 mmol/l).
- HDL levels increased (1.09 to 1.18 mmol/l) with simvastatin treatment.
- The drug was well-tolerated, with a similar side-effect profile to placebo.
Conclusions:
- Simvastatin is effective in lowering total cholesterol and improving the overall lipoprotein profile in treated hypertensive patients.
- The medication was well-tolerated, suggesting it may be a suitable option for managing dyslipidemia in this high-risk group.
- Further studies are warranted to confirm if simvastatin improves prognosis in hypertensive patients with dyslipidemia.
Abstract:
Mortality from coronary artery disease is a common problem in treated hypertensive patients, and these people have a high prevalence of elevated cholesterol levels. A study was undertaken to determine whether cholesterol could be lowered effectively without major side effects in patients with treated hypertension. Forty-nine patients (mean age 67.6 years) with cholesterol greater than 5.5 mmol/l were placed on a reduced-fat (less than 30% of calories from fat with a ratio of polyunsaturated to saturated fats of less than 1) diet for 3 months. If the cholesterol was between 5.5 and 7.5 mmol/l and total cholesterol divided by high-density lipoprotein cholesterol was greater than 4.5, the patients were randomly allocated either to the simvastatin (24 patients) or the placebo group (25 patients). Diet and placebo caused minor and insignificant falls in cholesterol and no change in triglycerides or lipids. Treatment with simvastatin reduced cholesterol levels from 6.85 to 4.75 mmol/l (P less than 0.001), triglycerides from 2.7 to 2.1 mmol/l (P less than 0.01), low-density lipoproteins from 4.6 to 2.6 mmol/l (P less than 0.001) and high-density lipoproteins rose from 1.09 to 1.18 mmol/l (P less than 0.01). Total cholesterol divided by high-density lipoprotein cholesterol fell from 6.3 to 4.0 (P less than 0.001). The drug was well tolerated and the side-effect profile did not differ from the placebo in clinical or biochemical events. The active drug was stopped in one patient (abdominal pain, dizziness, headache, tiredness) and in two patients taking the placebo (elevated creatine phosphokinase, cardiovascular collapse). Simvastatin effectively lowered total cholesterol and improved the lipoprotein profile. The dose required in most patients was 40 mg/day. Simvastatin may be an acceptable drug to improve the lipoprotein profile in order to determine whether this improves the prognosis in patients treated for hypertension.