Sluyter John D, Hughes Alun D, Lowe Andrew, Camargo Carlos A, Scragg Robert K R
School of Population Health University of Auckland Auckland New Zealand.
Institute of Cardiovascular Sciences University College London London United Kingdom.
Pharmacol Res Perspect. 2016 Nov 22;4(6):e00276. doi: 10.1002/prp2.276. eCollection 2016 Dec.
Randomized trials suggest that statin treatment may lower blood pressure and influence cardiovascular autonomic function (CVAF), but the impact of duration of usage, discontinuation, and adherence to this therapy is unknown. We examined these issues with regard to blood pressure (BP)-related variables in a large, population-based study. Participants were 4942 adults (58% male; aged 50-84 years): 2179 on statin treatment and 2763 untreated. Days of utilization, adherence (proportion of days covered ≥0.8), and discontinuation (non-use for ≥30 days immediately prior to BP measurement) of three statins (atorvastatin, pravastatin, and simvastatin) over a period of up to 2 years was monitored retrospectively from electronic databases. Systolic BP (SBP), diastolic BP (DBP), augmentation index, excess pressure, reservoir pressure, and CVAF (pulse rate and BP variability) parameters were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. Days of statin treatment had inverse relationships with pulse rate variability parameters in cardiac arrhythmic participants (20-25% lower than in statin non-users) and with most arterial function parameters in everyone. For example, compared to untreated participants, those treated for ≥659 days had 3.0 mmHg lower aortic SBP ( < 0.01). Discontinuation was associated with higher brachial DBP and aortic DBP (for both, = 2.0 mmHg, = 0.008). Compared to non-adherent statin users, adherent users had lower levels of brachial SBP, brachial DBP, aortic DBP, aortic SBP, and peak reservoir pressure ( = -1.4 to -2.6 mmHg). In conclusion, in a real-world setting, statin-therapy duration, non-discontinuation and adherence associate inversely with BP variables and, in cardiac arrhythmias, CVAF parameters.
随机试验表明，他汀类药物治疗可能会降低血压并影响心血管自主功能（CVAF），但使用时长、停药情况以及对该疗法的依从性所产生的影响尚不清楚。我们在一项大型的基于人群的研究中，针对与血压（BP）相关的变量对这些问题进行了研究。参与者为4942名成年人（58%为男性；年龄在50 - 84岁之间）：2179名接受他汀类药物治疗，2763名未接受治疗。通过电子数据库对三种他汀类药物（阿托伐他汀、普伐他汀和辛伐他汀）长达2年的使用天数、依从性（覆盖天数比例≥0.8）以及停药情况（在血压测量前立即停用≥30天）进行了回顾性监测。收缩压（SBP）、舒张压（DBP）、增强指数、过压、储器压力以及CVAF（心率和血压变异性）参数是根据从超收缩期肱动脉测量得出的主动脉压力波形计算得出的。他汀类药物治疗天数与心律失常参与者的心率变异性参数呈负相关（比未使用他汀类药物者低20 - 25%），且与所有人的大多数动脉功能参数呈负相关。例如，与未接受治疗的参与者相比，接受治疗≥659天的参与者主动脉SBP低3.0 mmHg（<0.01）。停药与较高的肱动脉DBP和主动脉DBP相关（两者均为 = 2.0 mmHg， = 0.008）。与不依从他汀类药物使用者相比，依从使用者的肱动脉SBP、肱动脉DBP、主动脉DBP、主动脉SBP和储器压力峰值水平较低（ = -1.4至 -2.6 mmHg）。总之，在现实环境中，他汀类药物治疗时长、不停药以及依从性与血压变量呈负相关，在心律失常患者中与CVAF参数呈负相关。
