Blood pressure-lowering effects of statins: who benefits?

OBJECTIVES To evaluate if the effect of statins on blood pressure is similar in patients grouped by use of antihypertensive medication, level of blood pressure, and high-density lipoprotein cholesterol (HDL-C). METHODS Blood pressure was compared in statins users (n = 995) and nonusers (n = 9536) from the National Health and Nutrition Examination Surveys. The overall effect of statins and their interactions with antihypertensive medication, blood pressure, and HDL-C were estimated using multiple linear and quantile regression. RESULTS Adjusted systolic blood pressure was on average 1.8 mmHg lower in statins users than in nonusers (P = 0.05). Although statins had no significant effect among nonusers, it decreased systolic blood pressure by 3.3 mmHg among users of antihypertensive medication (interaction P = 0.02). The effect of statins on systolic blood pressure was similar in individuals with HDL-C levels above and below the median (49 mg/dl). Statins also lowered diastolic blood pressure by an average of 1.9 mmHg (P < 0.01), regardless of antihypertensive medication use. Among individuals with high HDL-C statins did not lower diastolic blood pressure, whereas in those with low HDL-C diastolic blood pressure was reduced by 3.4 mmHg. The effect of statins on systolic and diastolic blood pressure increased with higher blood pressure and changed little with adjustment for total cholesterol. CONCLUSION Statins lower blood pressure by cholesterol-independent mechanisms, and the reduction is larger in individuals with higher blood pressure and those with low HDL-C. Statins may be beneficial in preventing hypertension and may contribute to better blood pressure control in hypertensive patients.