Influence of statin therapy on 24-hour blood pressure monitoring indices in patients with arterial hypertension combined with subclinical hypothyroidism
DOI:
https://doi.org/10.14739/2310-1210.2020.1.194470Keywords:
hypertension, subclinical hypothyroidism, 24-hour blood pressure monitoring, statin therapyAbstract
The high prevalence of arterial hypertension (AH) and the proportion of patient category with inadequate blood pressure control, mainly leading to cardiovascular complications of hypertension, necessitate a further study of reasons for antihypertensive therapy ineffectiveness. There are data on subclinical hypothyroidism (SH) influence on systemic hemodynamics, in particular, on arterial blood pressure. However, there is a lack of information regarding the effect of concomitant SH on systemic hemodynamics and antihypertensive therapy effectiveness in AH patients. There is also an outstanding issue related to the influence of statins on 24-hour blood pressure monitoring parameters in the first-line antihypertensive drugs treatment for patients with AH and concomitant SH.
The aim of this work: to study the effect of statins on the parameters of 24-hour blood pressure monitoring in patients with AH combined with SH.
Materials and methods. After an informed consent was signed, 74 patients with stage II AH, grade 1–3, high and very high additional cardio-vascular risk were included in the study, of whom 43 were patients without and 31 patients with concomitant SH. Depending on the therapy assigned, the patients were divided into three groups. The first group included 22 patients with AH without concomitant SH who were prescribed only antihypertensive drugs without statin add-on therapy. The second group consisted of 21 patients with AH and without concomitant SH who were prescribed antihypertensive drugs with statin add-on therapy. The third group was composed of 31 patients with AH and concomitant SH who were prescribed antihypertensive drugs with statin add-on therapy. The groups were matched for age, gender and main anthropometric indices. Prior to treatment and after an one-year follow-up, all patients underwent 24-h blood pressure monitoring on a bifunctional device “Kardiotechnica-04” (“INCART”, St. P., the RF) with simultaneous registration of blood pressure and ECG. Statistical processing of the material was performed using the software package Statistica 13.0 (Statsoft, USA), license number JPZ8041382130ARCN10-J). The normality of quantitative signs distribution was analyzed by the Shapiro–Wilk test. Parameters with a normal distribution were presented as an arithmetic mean and standard deviation (M ± SD). For indices that had a different from normal distribution, descriptive statistics data were provided as medians and lower and upper quartiles, Me (Q25; Q75). Comparison of quantitative indices in groups was performed using Student’s and Mann–Whitney criteria, depending on the distribution character. Qualitative indices were compared using Pearson's χ2. A difference of P < 0.05 was considered statistically significant. All tests were two-sided.
Results. In 82 % (18/22) patients with AH without concomitant SH on long-term antihypertensive treatment without statin add-on therapy, the target blood pressure level as well as a significant 5.3 % (P = 0.013) decrease in the mean daytime SBP and a 7 % (P = 0.009) decrease in the mean nighttime SBP was achieved. There were no significant changes in the daily profiles of SBP and DBP, indices of hypertension and hypotension, SBP and DBP variability during the day and night.
In patients with AH without concomitant SH on the long-term antihypertensive treatment with statin add-on therapy over a period of one-year, there was a significant 6.6 % (P = 0.025) decrease in the mean daytime SBP, 11.8 % (P = 0.002) in the mean nighttime SBP, 7.7% (P = 0.037) in the mean nighttime DBP, 23 % (P = 0.010) in the daytime SBP hypertension index, 34 % (P = 0.035) in the index of daytime percentage DBP increase, 21 % (P = 0.035) in the index of daytime SBP load in the absence of changes in pulse pressure indices, SBP and DBP variability during the day and night as well as daily profiles of SBP and DBP.
The target level of arterial blood pressure was achieved in 86 % (18/21) of patients with AH without concomitant SH on antihypertensive treatment with statin add-on therapy.
The patients with AH and concomitant SH on the long-term antihypertensive treatment with statin add-on therapy over a period of one-year demonstrated a significant decrease in the mean daytime SBP by 4.4 % (P = 0.044), mean daytime DBP by 9.8 % (P = 0.034), index of daytime percentage SBP increase by 31 % (P = 0.029), index of daytime percentage DBP increase by 27 % (P = 0.031), index of daytime SBP load by 33 % (P = 0.031) in the absence of changes in circadian rhythms of pressure, SBP and DPB variability during the day and night. As a result of the treatment, the target daytime and nighttime SBP levels were achieved in 74 % (23/31) and 65 % (20/31) of patients, respectively; the target daytime and nighttime DBP levels were achieved in 87 % (27/31) and 71 % (22/31) of patients, respectively.
Conclusions. Subclinical hypothyroidism is an additional cardio-vascular risk factor that reduces the effectiveness of antihypertensive therapy, while the addition of statins to antihypertensive treatment regimens contributes to an improvement in results.
References
Working Group on Hypertension of the Ukrainian Association of Cardiologists. (2012). Arterialna hipertenziia. Onovlena ta adaptovana klinichna nastanova, zasnovana na dokazakh (2012 rik) [Hypertension. Updated and adapted evidence-based clinical setting (2012)]. Arteryalnaia hypertenzyia, (1), 96 152. [in Ukranian].
Conen, D., & Bamberg, F. (2008). Noninvasive 24-h ambulatory blood pressure and cardiovascular disease: a systematic review and meta-analysis. Journal of Hypertension, 26(7), 1290–1299. https://doi.org/10.1097/hjh.0b013e3282f97854
Ward, A. M., Takahashi, O., Stevens, R., & Heneghan, C. (2012). Home measurement of blood pressure and cardiovascular disease. Journal of Hypertension, 30(3), 449–456. https://doi.org/10.1097/hjh.0b013e32834e4aed
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., Roccella, E. J., National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, & National High Blood Pressure Education Program Coordinating Committee. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA, 289(19), 2560–2572. https://doi.org/10.1001/jama.289.19.2560
Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. (2000). The Lancet, 356(9246), 1955–1964. https://doi.org/10.1016/s0140-6736(00)03307-9
Psaty, B. M., Smith, N. L., Siscovick, D. S., Koepsell, T. D., Weiss, N. S., Heckbert, S. R., Lemaitre, R. N., Wagner, E. H., & Furberg, C. D. (1997). Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA, 277(9), 739 745.
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., Galderisi, M., Grobbee, D. E., Jaarsma, T., Kirchhof, P., Kjeldsen, S. E., Laurent, S., Manolis, A. J., Nilsson, P. M., Ruilope, L. M., … Zannad, F. (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal Of Hypertension, 31(7), 1281 1357. https://doi.org/10.1097/01.hjh.0000431740.32696.cc
Kovalenko, V. M., & Kornatskyi, V. M. (Eds.). (2014). Khvoroby systemy krovoobihu yak medyko-sotsialna i suspilno-politychna problema [Circulatory system diseases as a medico-social and socio-political problem]. Kyiv. [in Ukranian].
Demidova, T., & Galieva, O. (2008). K voprosu lecheniya subklinicheskogo gipotireoza u bol'nykh ozhireniem [Treatment of Subclinical Hypothyroidism in Obese Patients]. Klinicheskaya i eksperimental'naya tireoidologiya, 4(1), 48 52. [in Russian].
Kravez, E. V., Idrisova, E. M., Damdindorsh, D., Latypova, V. N., & Stolarova, V. A. (2008). Osobennosti sutochnogo profilya arterial'nogo davleniya u bol'nykh s autoimmunnym tireoiditom v faze subklinicheskogo gipotireoza [Daily Rhythm of Arterial Pressure in Patients with Autoimmune Thyroidite in a Phase Subclinical Hypothyroidism]. Klinicheskaya i eksperimental'naya tireoidologiya, 4(3), 50 54. [in Russian].
Iqbal, A., Figenschau, Y., & Jorde, R. (2006). Blood pressure in relation to serum thyrotropin: the Tromsø study. Journal of Human Hypertension, 20(12), 932–936. https://doi.org/10.1038/sj.jhh.1002091
Ittermann, T., Thamm, M., Wallaschofski, H., Rettig, R., & Völzke, H. (2012). Serum Thyroid-Stimulating Hormone Levels Are Associated with Blood Pressure in Children and Adolescents. The Journal of Clinical Endocrinology & Metabolism, 97(3), 828–834. https://doi.org/10.1210/jc.2011-2768
Völzke, H., Alte, D., Dörr, M., Wallaschofski, H., John, U., Felix, S. B., & Rettig, R. (2006). The association between subclinical hyperthyroidism and blood pressure in a population-based study. Journal of Hypertension, 24(10), 1947–1953. https://doi.org/10.1097/01.hjh.0000244942.57417.8e
Walsh, J. P., Bremner, A. P., Bulsara, M. K., O’Leary, P., Leedman, P. J., Feddema, P., & Michelangeli, V. (2006). Subclinical thyroid dysfunction and blood pressure: a community-based study. Clinical Endocrinology, 65(4), 486–491. https://doi.org/10.1111/j.1365-2265.2006.02619.x
Nekrasova, T. A., Strongin, L. G., Morozova, E. P., Durigina, E. M., & Kasakova, L. V. (2015). Modifitsiruyushchee vliyanie subklinicheskogo gipotireoza na techenie arterial'noi gipertenzii: vzaimosvyazi so skrytoi neeffektivnost'yu lecheniya, sutochnym profilem arterial'nogo davleniya i sostoyaniem organov-mishenei [Modifying influence of subclinical hypothyroidism on arterial hypertension: relationship to masked treatment failure, circadian blood pressure profile and target organs status]. Klinicheskaya i eksperimental'naya tireoidologiya, 11(2), 55 62. https://doi.org/10.14341/ket2015255-62 [in Russian].
Walley, T., Folino-Gallo, P., Schwabe, U., van Ganse, E. & EuroMedStat group (2004). Variations and increase in use of statins across Europe: data from administrative databases. BMJ (Clinical research ed.), 328(7436), 385–386. https://doi.org/10.1136/bmj.328.7436.385
Grundy, S. M., Cleeman, J. I., Bairey Merz, C. N., Brewer, H. B., Clark, L. T., Hunninghake, D. B., Pasternak, R. C., Smith, S. C., & Stone, N. J. (2004). Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Journal of the American College of Cardiology, 44(3), 720–732. https://doi.org/10.1016/j.jacc.2004.07.001
Studer, M., Briel, M., Leimenstoll, B., Glass, T. R., & Bucher, H. C. (2005). Effect of Different Antilipidemic Agents and Diets on Mortality. Archives of Internal Medicine, 165(7), 725 730. https://doi.org/10.1001/archinte.165.7.725
Davignon, J. (2004). Beneficial Cardiovascular Pleiotropic Effects of Statins. Circulation, 109(23 suppl. 1), III-39 III-43. https://doi.org/10.1161/01.cir.0000131517.20177.5a
Aronow, H. D., Topol, E. J., Roe, M. T., Houghtaling, P. L., Wolski, K. E., Lincoff, A. M., Harrington, R. A., Califf, R. M., Ohman, E. M., Kleiman, N. S., Keltai, M., Wilcox, R. G., Vahanian, A., Armstrong, P. W., & Lauer, M. S. (2001). Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: an observational study. The Lancet, 357(9262), 1063–1068. https://doi.org/10.1016/s0140-6736(00)04257-4
Tsiara, S., Elisaf, M., & Mikhailidis, D. P. (2003). Early vascular benefits of statin therapy. Current Medical Research and Opinion, 19(6), 540–556. https://doi.org/10.1185/030079903125002225
Pearce, S. H. S., Brabant, G., Duntas, L. H., Monzani, F., Peeters, R. P., Razvi, S., & Wemeau, J.-L. (2013). 2013 ETA Guideline: Management of Subclinical Hypothyroidism. European Thyroid Journal, 2(4), 215–228. https://doi.org/10.1159/000356507
Syvolap, V. V., Novikov, Ye. V., & Potapenko M. S. (2019). Vplyv subklinichnoho hipotyreozu na pokaznyky dobovoho monitoruvannia arterialnoho tysku u khvorykh na hipertonichnu khvorobu vysokoho dodatkovoho ryzyku [Influence of subclinical hypothyroidism on indicators of 24-hour arterial blood pressure monitoring in hypertensive patients with high additional risk]. Zaporozhye medical journal, 21(2), 170–176. https://doi.org/10.14739/2310-1210.2019.2.161329 [in Ukranian].
Strazzullo, P., Kerry, S. M., Barbato, A., Versiero, M., D’Elia, L., & Cappuccio, F. P. (2007). Do Statins Reduce Blood Pressure? A Meta-Analysis of Randomized, Controlled Trials. Hypertension, 49(4), 792–798. https://doi.org/10.1161/01.hyp.0000259737.43916.42
Borghi, C., Dormi, A., Veronesi, M., Sangiorgi, Z., Gaddi, A., & Brisighella Heart Study Working Party (2004). Association between different lipid-lowering treatment strategies and blood pressure control in the Brisighella Heart Study. American Heart Journal, 148(2), 285–292. https://doi.org/10.1016/j.ahj.2004.02.003
Ikeda, T., Sakurai, J., Nakayama, D., Takahashi, Y., Matsuo, K., Shibuya, Y., Gomi, T., Moriya, H., & Kobayashi, S. (2004). Pravastatin has an additional depressor effect in patients undergoing long-term treatment with antihypertensive drugs. American Journal of Hypertension, 17(6), 502–506. https://doi.org/10.1016/j.amjhyper.2004.02.002
Golomb, B. A., Ritchie, J. B., Criqui, M. H., Dimsdale, J. E. (2004). Statins Lower Blood Pressure: Results from the UCSD Statin Study. Circulation, Circulation
Strazzullo, P., Kerry, S. M., Barbato, A., Versiero, M., D’Elia, L., & Cappuccio, F. P. 2007(). Do Statins Reduce Blood Pressure? A Meta-Analysis of Randomized, Controlled Trials. Hypertension, 49(4), 792–798. https://doi.org/10.1161/01.hyp.0000259737.43916.42
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