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Effects of cholesterol reduction on BP response to mental stress in patients with high cholesterol
B H Sung1, J L Izzo, M F Wilson
1Department of Medicine, State University of New York and Millard Fillmore Health Care System, Buffalo 14209, USA.
Insights
High cholesterol (HC) is linked to exaggerated systolic blood pressure (BP) increases during mental stress. Lowering cholesterol with HMG-CoA reductase inhibitors reduced this heightened BP reactivity.
Area of Science:
- Cardiovascular Physiology
- Metabolic Disorders
- Pharmacology
Background:
- Endothelium-dependent vascular relaxation is impaired in high cholesterol (HC).
- Systemic effects of elevated cholesterol on blood pressure (BP) and BP reactivity to stress are not well understood.
Purpose of the Study:
- To investigate the effects of high cholesterol on BP response to mental stress.
- To determine if cholesterol-lowering therapy impacts BP reactivity.
Main Methods:
- Compared BP response to a mental arithmetic test (MAT) in HC and normal cholesterol (NC) subjects.
- Administered lovastatin to HC subjects and repeated MAT to assess BP changes.
- Utilized a cross-over design for cholesterol-lowering intervention.
Main Results:
- HC subjects exhibited a significantly higher systolic BP response during MAT compared to NC.
- Maximal systolic BP changes during MAT correlated significantly with cholesterol levels.
- Lovastatin treatment reduced systolic BP response during MAT and improved lipid profiles.
Conclusions:
- High cholesterol is associated with an exaggerated systolic BP response to mental stress.
- Cholesterol-lowering therapy with HMG-CoA reductase inhibitors may help modulate BP reactivity.
- Lowering cholesterol could play a role in overall blood pressure management.
Abstract:
Impaired endothelium-dependent vascular relaxation has been reported in patients with high cholesterol (HC), but the systemic effects of elevated cholesterol on blood pressure (BP) and BP reactivity to stress have not been studied. We examined the BP response to a standard mental arithmetic test (MAT) in 37 healthy, normotensive HC subjects and 33 normal cholesterol controls (NC). Both groups had similar age, body mass index, and gender distribution. HC had slightly higher systolic BP at baseline (122 v 118 mm Hg, P < .05) than NC and systolic BP response during MAT was significantly higher in HC compared to NC (18 +/- 8 v 10 +/- 5 mm Hg, P < .05). Maximal changes in systolic BP were significantly correlated with cholesterol (R = 0.41, P < .001), whereas heart rate and diastolic BP changes were unrelated to serum cholesterol. To confirm that BP reactivity was dependent on cholesterol, MAT was repeated after treatment with 20 mg/day of lovastatin, a hepatic hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitor, for 6 weeks using a cross-over design in 26 HC subjects. Lovastatin significantly altered lipid profiles (-26% total cholesterol, +8% HDL, -34% LDL). A small decrease in systolic BP at baseline (-3 mm Hg, P = NS) and significantly lower systolic BP (-8 mm Hg, P < .05) during MAT was observed after the treatment with lovastatin. In conclusion, patients with high cholesterol had an exaggerated systolic BP response to MAT. Decreased BP reactivity during HMG-CoA reductase inhibitor therapy suggests that lowering cholesterol may have a role in the overall control of BP.