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Pravastatin, blood pressure, and stroke.

To the Editor: 

We read with interest the recent paper in Hypertension by Glorioso et al1 demonstrating that the HMG-CoA reductase inhibitor pravastatin significantly lowers blood pressure in patients with coexisting essential hypertension and primary hypercholesterolemia. This is an important finding that may, in part, explain the significant reduction in stroke observed in both the CARE2 and LIPID3 studies, as previously suggested.4 

Although epidemiological observations do not suggest any relationship between serum cholesterol and stroke,5 several studies have reported a positive correlation between blood pressure and cholesterol.6 Moreover, indirect evidence from several trials investigating cholesterol-lowering regimens suggests that lowering cholesterol may reduce blood pressure by between 2 and 5 mm Hg.6 Although such an effect is small, it is similar to the reduction in diastolic blood pressure of 5 mm Hg observed by Glorioso et al and, if sustained for 5 years, would be expected to reduce the incidence of stroke by ≈34%.7 Therefore, we believe that the 31% and 19% reduction in stroke reported in the CARE and LIPID studies, respectively, may be, in part, attributable to a blood pressure–lowering effect of pravastatin although, unfortunately, changes in blood pressure were not recorded in either trial.

One inconsistency in this argument is that some studies have failed to show any effect of pravastatin on blood pressure, as discussed by Glorioso et al, who suggest that, as with traditional antihypertensive agents, statins may only reduce blood pressure in hypertensive individuals and not normotensive subjects. They go on to …