By Jonathan Springston, Editor, Relias Media
Statins usually are prescribed to lower cholesterol, but how efficacious are those drugs in lowering blood pressure (BP), if at all? And is pharmacotherapy the best way to address high BP and cholesterol, or is that only one part of a larger strategy? These are some of the questions raised through recently published papers.
One group of researchers analyzed how effective statins may be in lowering BP. Through a retrospective observational study, these authors examined more than 1,800 consecutive essential hypertensive patients evaluated with 24-hour ambulatory BP monitoring.
The researchers explained their methodology: “Antihypertensive treatment intensity was calculated to compare different drug associations. We used propensity score matching to compare two equally sized cohorts of patients with similar characteristics according to statin therapy. Matching was performed on log-transformed propensity score in a 1:1 fashion with a caliper of 0.1 in order to account for the different baseline characteristics between statin and no-statin group.”
Among 402 patients on statin therapy, investigators observed lower daytime and nighttime BP readings and better ambulatory BP control. “Statin therapy is associated with better ambulatory BP control in essential hypertensive patients,” the authors concluded. “This result is not affected by the intensity of the antihypertensive treatment or by the several cofactors analyzed.”
However, the authors of an editorial accompanying this report poked several holes in these conclusions. For starters, the editorial highlighted other research that produced mixed results on the question of statins’ power to lower BP. The editorialists took particular issue with the use of propensity score matching.
“Although propensity score matching is quite popular, and many investigators have the false belief that this statistical tool can resolve the drawbacks related to the observational nature of the studies, the selection of the variables to use together with the retrospective nature of data collection (i.e., only the collected confounders were available) makes the potential for confounding from factors that were not measured in the study still substantive,” the editorialists wrote. “The study by Spannella et al cannot provide definitive answers for the BP-lowering effect of statins in hypertension, but may stimulate future randomized research in the field.”
Another group of researchers widened the lens when they evaluated whether lifestyle factors change in relation to starting antihypertensive medication or statins. In a data analysis of more than 40,000 patients from a Finnish registry, investigators found plenty of patients who reduced alcohol consumption and quit smoking after they started taking cholesterol- or blood pressure-lowering medications. However, these patients also were more likely to reduce activity levels and gain weight. Compared to those who did not start medications, those who did were 8% more likely to become physically inactive and 82% more likely to become obese.
“Medication shouldn’t be viewed as a free pass to continue or start an unhealthy lifestyle,” Maarit J. Korhonen, PhD, lead author and senior researcher at the University of Turku in Finland, said in a statement. “People starting on medications should be encouraged to continue or start managing their weight, be physically active, manage alcohol consumption, and quit smoking.”
The authors acknowledged certain limitations, such as the fact that most of those observed were white women who worked in the public sector of a country where a national effort to prevent diabetes started during the study period. Thus, the authors noted their results may not be generalizable to a more diverse population or in countries without similar prevention programs. Further research in this area will be likely.
For more on this debate and other critical analysis of clinical research in cardiovascular medicine, please read the latest issues of Clinical Cardiology Alert.