P1.02 Comparison of the Effects on Central Blood Pressure of a Combination of Atorvastatin with Amlodipine-Based or Atenolol-Based Antihypertensive Therapy: An ASCOT-LLA Substudy

Abstract

Background

HMG CoA reductase inhibitors (statins) lower serum cholesterol and reduce cardiovascular events in hypertensive subjects. It has been suggested that statins may also reduce brachial blood pressure (BP) modestly, but their effect on central (aortic) BP is unknown. We investigated the effect of atorvastatin on central BP in a substudy of the lipid lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA).

Methods

142 (age = 43–79 years; 127 male) hypertensive patients with total cholesterol ≤6.5mmol/L were randomized to atorvastatin 10mg or placebo in combination with amlodipine-based or atenolol-based antihypertensive treatment in a 2 × 2 factorial design. Central BP was measured by carotid artery tonometry. Data are means ± SE.

Results

Brachial BP was similar between atorvastatin and placebo groups. Carotid systolic BP was slightly lower in the atorvastatin group but there was a statistically significant interaction between lipid-lowering and antihypertensive regimen; carotid SBP was lower in people randomized to atorvastatin + amlodipine-based therapy (placebo + atenolol = 130.6 ± 2.4mmHg; atorvastatin + atenolol = 132.1 ± 2.3mmHg; placebo + amlodipine = 131.0 ± 2.8 mmHg; atorvastatin + amlodipine = 122.5 ± 2.3 mmHg; Interaction p = 0.04; comparison placebo + amlodipine vs. atorvastatin + amlodipine p < 0.01).

Conclusions

The combination of atorvastatin with amlodipine-based antihypertensive treatment lowers central BP. This effect may contribute to the reduced incidence of cardiovascular events seen in people receiving this combination in ASCOT-LLA.